Charlie, my patient, was a tall, brilliant young graduate student with an athletic build, sandy brown hair, a warm, friendly smile, and all the potential in the world. Charlie was lucky to have survived long enough to enter graduate school. His addiction to prescription painkillers almost killed him while he was still in college.
Charlie was no different from many young people across Central Alabama, and throughout our state and our nation. Charlie had first been prescribed opioid medications for the right reason. They are literally the most powerful and effective medications we doctors can give people with severe pain.
Yet long after Charlie's pain was controlled, Charlie would continue taking the opioid medicine, and often share it with his friends, having discovered the intensely pleasurable "high" these drugs can cause. We doctors call these drugs "opioids" for a reason – because they work on the same "opioid" receptors in the brain, causing essentially the same powerful effects, as the illegal opiate heroin, or its parent opiate drug, morphine.
Like these drugs, prescription opioids cause potent relief of pain, and a calming effect on anxiety. They also have devastating addiction potential like the opiates do. They cause the same horrific withdrawal syndrome when stopped abruptly; and – most frighteningly – they are lethal if taken in overdose, just like heroin or morphine.
Charlie's opioid misuse progressed in a way that was similar to other young people in Alabama and beyond. He went from taking the medications orally, to crushing and "snorting" the crushed pills up his nose, to eventually dissolving and injecting them into his veins. As his use escalated into full-blown addiction, Charlie no longer obtained the pills from a doctor. He became one of the 70% of Americans who, according to the National Survey on Drug Use and Health, obtain the opioids they abuse from a friend or a relative, or some source other than a doctor.
As an addiction psychiatrist, I found helping Charlie overcome his addiction to be difficult, and at times, scary – but incredibly rewarding, in the end. But prevention beats treatment any day. Imagine if Charlie had started with "abuse-deterrent" medication.
New "abuse-deterrent formulations" of prescription drugs have been developed. This means the same powerful pain relief can be provided by the same opioid medication, but the pills are specifically designed so that the powerful euphoric effect of these drugs is lost when they are crushed, chewed, injected, snorted or manipulated. The pills keep their pain-killing potency – which we want – but are stripped of their intense euphoric effect and their addictive potential, which we can do without.
Certainly, this development sounds exciting – so much so that FDA officials have signaled that as more and more abuse-deterrent formulations are approved, the agency may eventually call for all prescription pain medications to have abuse-deterrent properties. But obstacles exist. The drugs may be more expensive to produce than traditional opioids, which may induce health insurers to discourage physicians from prescribing them.
Ultimately, for Charlie's sake, and for the sake of thousands if not millions of other people in our great state, I believe it is essential that we doctors have the ability to prescribe opioids with abuse-deterrent formulations. I suspect these drugs will be less likely to be abused or obtained illegally; and their use can be limited to the powerful, appropriate pain-relieving purposes for which they were intended. That can only help us fight the dreadful epidemic of opioid addiction and opioid overdose deaths that is destroying the lives of so many people in Alabama. With parents and doctors working together, I am convinced we can make this happen.
