PD Editorial: Fixing ‘biggest mistake' in modern medicine

David A. Kessler, a former director of the U.S. Food and Drug Administration, doesn’t mince words about assurances from pharmaceutical manufacturers that opioid painkillers wouldn’t be addictive.

“It has proved to be one of the biggest mistakes in modern medicine,” Kessler wrote this week in the New York Times.

Opioid use quadrupled between 1999 and 2013, and millions of Americans are now hooked on Percocet, Vicodin and other brand-name versions of oxycodone, codeine, hydrocodone and fentanyl. Some 20,000 die each year from opioid overdoses, possibly including the entertainer Prince, who was found dead in an elevator in his Minnesota home on April 21.

Yet doctors write enough prescriptions each year for every adult in the country to be taking these highly addictive drugs.

Why? They’re effective in treating acute pain and cancer pain. Opioids also are commonly used for end-of-life palliative care.

So the challenge is preventing abuse without causing sick and dying people to suffer.

Earlier this year, the Centers for Disease Control recommended some new guidelines for doctors who prescribe opioid painkillers. The CDC guidelines are voluntary, but they could make a difference if enough doctors adopt them.

There may be additional ways to reduce the alarming number of deaths caused by opioid abuse.

To that end, Assemblyman Jim Wood, a dentist before his election to the Legislature in 2014, is pushing for creation of a state task force to develop strategies and policies for curbing the use and misuse of opioid painkillers.

“It’s about getting all the stakeholders at the table and coming up with a plan,” the Healdsburg Democrat told Staff Writer Martin Espinoza. “Over-prescription is a component. Part of it is prescribing patterns, part of it is the amount, part of it is we have been pretty permissive about how we prescribe certain medications. It’s possible that something that isn’t a narcotic may serve just as well.”

Wood tried to take stronger action. As introduced, his bill would have required health plans to include at least one “abuse-deterrent” opioid on their drug formularies and prohibit insurers from requiring enrollees to first try a non-abuse-deterrent opioid. Some insurers were opposed.

The scaled-back proposal to establish a task force cleared the Assembly on a unanimous vote and is awaiting a committee assignment in the state Senate.

It could be several weeks before autopsy results determine whether Prince’s death resulted from an opioid overdose. But it already has moved discussions about over-prescribing, excessive doses and addiction into the public spotlight.

This week, two major health care players - Kaiser Permanente of Southern California and Blue Shield of California - announced efforts to get physicians to prescribe opioids in smaller amounts, which is among the CDC guidelines.

That’s a good first step. Others would include physician groups dropping their opposition to mandatory training for doctors who prescribe opioids and a requirement that doctors and pharmacies check a state database of existing prescriptions as a safeguard against abuse.

In the New York Times, Kessler compared opioids to tobacco. “Opioids are trickier because they have some value in certain conditions,” he added. “But we need to view them for what they are: addictive and potentially deadly drugs.” Lives depend on it.