Opinion: Policymakers don't get the opioid crisis

Mark Jesin
Jesin writes: "We all must think carefully about the societal risks of opioid prescriptions and take that into account in our prescribing practices."

When Tyler Trowbridge walked into my oral surgery office, he was taking his first steps out of a very dark place in his life. He was bone thin, pale and in significant pain. I would soon learn that Tyler was mere weeks into recovery after years of abusing opioids, seeking relief from profound dental issues.

Knowing his past, and his journey to recovery, there was absolutely no circumstance under which I would have prescribed him opioids. Yet, the procedures he needed were strenuous and could not be completed without medication.

Thankfully, I was able to treat him with a long-acting non-opioid painkiller which has no addictive properties – and take a small part in his journey toward health and well-being.

But what if I had not known that he had opioid use disorder? Or what if there were no non-opioid options at my disposal? Tyler has changed my thinking on these questions and prompted me to become active with state and federal policymakers, urging them to increase access to non-opioid treatments.

Thankfully, Michigan is ahead of our country in tackling some of these issues. Late last year, a law was passed directing Michigan’s Health Department to create a “non-opioid directive,” which would allow individuals to carry a permanent record indicating that they should not be administered an opioid. The form can be signed by an individual or guardian and will be available to any health care provider offering treatment.

I believe that this type of patient-centered, integrated care should be promoted at the federal level as well. Last year, The Centers for Medicare and Medicaid Services (CMS) recognized that Medicare payment policies were hampering access to non-opioids, and they made changes to the Ambulatory Surgery Center payment system. This year, they have another opportunity to make an even more powerful change – to broaden patient access to non-opioids by paying separately for them in the hospital outpatient setting.

In my view, this would be a far more powerful approach than what policymakers are recommending now for high-risk patients: to offer an opioid prescription in conjunction with naloxone, a drug to reverse overdoses. This policy seems counterintuitive to everything we know about opioids, their efficacy in treating pain, and the dangers they pose. It’s especially short-sighted as it completely ignores the availability of non-opioids, especially in the management of acute pain after medical procedures.

As an oral surgeon treating patients in acute pain every day, I believe all providers have a responsibility to the public’s health. Our choices, our medical advice, and our prescriptions for opioids do not happen in a vacuum.

They have rippling effects throughout our communities, both to the person receiving the opioid who might be susceptible to misuse, to the people in their lives with access to their medicine cabinet, to those in our communities that encounter opioids through diversion. In 2019, we all must think carefully about the societal risks of opioid prescriptions and take that into account in our prescribing practices.

I am grateful to Michigan’s lawmakers for thinking creatively and proactively to support our friends and neighbors in recovery. I will continue to call on our federal policymakers to follow their lead, not to simply accept the status quo and propose band-aid solutions, but to support the meaningful disruption of a pain management treatment regimen that is simply no longer acceptable.

Dr. Mark Jesin is an oral surgeon in Grand Rapids, Michigan.