The Opioid Epidemic | Millions of Americans Addicted To Opioids

Casey Black: Well, in this week's daily dose with Dr. Kasraeian, we are talking about something that has turned into an epidemic. More than two million Americans are dependent on or have abused prescription pain pills. In Florida there was a plan to curb the epidemic. In late September Governor Rick Scott, he announced that he will propose legislation that will place a three day limit on prescribed opioids. More than that it'll place strict conditions that must be met for a seven day supply. The governor says the issue must be handled with compassion.

Rick Scott: My heart goes out to anybody that's dealing with this. We're going to do everything we can to prevent it. And we're going to do everything we can to hold those accountable that continue it.

Casey Black: The proposal would also add reforms to fight unlicensed pain management clinics, require continuing education courses, and create new opportunities for federal grant funding. Okay, so how in the world has this become an epidemic? What is in an opioid medication that causes it to become so addictive and so destructive? We have Dr. Ali Kasraeian, once again, joining us to give us some great information on how this has gotten to this point. But first of all, what are opioids? What are they consisting of?

Dr. Ali Kasraei...: Opioids are the same active ingredient as in heroin. I mean, and back in the opium dens, back in the day that you hear about from that standpoint, it is a drug. It's a depressant and so the chronic use of them can have both physiologic dependencies that develop, but also psychological dependencies that develop from that standpoint. So the danger lies in that.

And a lot of these new regulations that you hear about people trying to limit prescriptions and limit dosing, are based on studies that show that chronic use seems to be linked with either longer duration prescriptions or higher dosages. And so by limiting each of those things the thought is you could potentially curb chronic use and by doing that you could potentially limit misuse, but also inappropriate use.

So if someone, people have sometimes that get into trouble are not necessarily bad people, is that you begin using that and your acute pain now turns into a chronic pain problem. Or you start using it for acute pain, you have a severe pain issue, and then you get these pain medications that sit around in the cabinet and you have a little bit of pain and instead of taking TYLENOL, you take this and then you turn a small problem into a big problem.

Casey Black: And it has such an addictive quality that it just snowballs. So, is that going to be the way of getting out of this crisis? Because, reading statistics from the National Institute on Drug Abuse, more than 90 Americans die every day from overdosing on opioids.

Dr. Ali Kasraei...: If you look at the statistics as they grow. So, 64,000 deaths in America last year were due to drug overdose.

Casey Black: Wow.

Dr. Ali Kasraei...: And two third of those are due to opioids. Now, I want the audience to be mindful that this isn't related to all prescription drugs. Now, this can be heroin. It can be synthetic drugs as well, that are opioid based. So this isn't all people going and getting drugs for medications for a surgery and all of a sudden they're addicts and they're dying and overdosing. So, we have to be a little bit mindful, but the statistics are staggering. This is a 20% increase from 2015. It's double that of 2005, and has quadrupled that, so four times that, in 2000. In 2000 the leading cause of unintentional death were falls. Now it's overdoses. So, we have to be very mindful of the statistics, but on the flip side we also have to take a balance where if we're too regulatory people that do have acute pain, postoperative pain-

Casey Black: They do need this, but there just needs to be some regulation.

Dr. Ali Kasraei...: Yeah.

Casey Black: So that's probably why you see a CVS coming in and saying, "Hey, we're only going to do this certain window with which you can get opioids before you have to come in." So it seems like checks and balances.

Dr. Ali Kasraei...: Have to be in place so that then if someone does have pain, they've had surgery, their pain is severe, we don't get into a situation where the regulation becomes so difficult for them to get the pain. And that balance is very difficult to navigate where we're going to get into a place where the patient-doctor relationship becomes strained, how you get the relationship between the government and the pharmacies to get in place. This is not an easy process because it's such a daunting problem. Again, you mentioned 90, that's actually increased according to the CDC, 142 people could potentially be dying a day from overdoses.

Casey Black: But as you point out, they work and they do work for people who need them for specific reasons.

Dr. Ali Kasraei...: Absolutely.

Casey Black: So for someone who's watching, who are concerned that they've been prescribed in opioid, what advice do you give them? I mean, it's hard to regulate yourself when you're talking about a psychological dependency to a drug.

Dr. Ali Kasraei...: So one thing to be very mindful, the regulations that they're putting here are for acute pain, for new pain users. So this isn't something that's dealing with chronic pain. And so chronic pain has a completely different set of guidelines. So if you have someone that's chronic long lasting pain, you want to be mindful that you're taking these medications under the guidance of a physician. And so you're not just taking medications that are in the cabinet for every time you have a chronic pain.

Casey Black: Right.

Dr. Ali Kasraei...: And so those are regulations. A lot of those regulations and the guidelines that are put out by the CDC, a lot of times begin with non-opioid medications and different non-medicinal uses incorporated with that. So that's one. This is for people that, or new to pain management and new to pain for a new pain issue, people postoperative pain, things of that nature. A lot of them are based on studies that people in that three to seven day window should be getting better from the pain that they're having in the acute setting. Again, the short term setting. If your pain is lasting longer than that, you should revisit with your physician to find that why you're having that pain.

Casey Black: Is there another underlying problem? Right.

Dr. Ali Kasraei...: Absolutely. Or your pain is just severe. And then your physician can work to try to make sure that your pain's controlled. And if you do need the medication, hopefully that the people that are doing this have infrastructure in plain, that it doesn't make it incredibly difficult for the next step to be in place, which sometimes those infrastructures that are in place are quite difficult. So the balance has to be in place that we don't have patients who are suffering, but also we don't create a perpetuation of this problem, which is incredibly severe right now. And as you see, people are dying.

Casey Black: And a gateway too, because 80% of people who use heroin for the first time had used or misused prescription opioids.

Dr. Ali Kasraei...: Absolutely.

Casey Black: So it's like one of those things that it becomes a slippery slope.

Dr. Ali Kasraei...: And the reason for that is you become dependent to it and it becomes easier and less expensive to get heroin than it is to get another prescription.

Casey Black: Bottom line, know what to think about going into having, if you need to take these opioid medications and make sure you're having the conversation with your doctor.

Dr. Ali Kasraei...: Absolutely.

Casey Black: Checks and balance.

Dr. Ali Kasraei...: And then, personal accountability. You also want to be mindful and honest with yourself. If you get in a situation where you feel like you're getting into trouble, have a short threshold for asking for help, this is not something that you should be ashamed of asking for help because it can save your life and talk to your doctor, talk to family members. And family members if you see someone that you suspect or worry about getting into trouble with medications like this intervene because it could save their life.

Casey Black: Yeah. And the bottom line, it's not your fault as you said.

Dr. Ali Kasraei...: Absolutely.

Casey Black: It's not your fault. All right. Good deal. Good to see you, Dr. Kasraeian.

Dr. Ali Kasraei...: Sure, always.

Casey Black: I appreciate you as always for coming in and you can find, by the way, Dr. Kasraeian at kasraeianurology.com or on his weekly radio show, The Conversation, which is on WOKV, every Saturday from five to six. So you can call in and ask him questions about this or anything else that might be on your mind-