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A new phase in war against opioid crisis

5-mg pills of Oxycodone as seen on June

5-mg pills of Oxycodone as seen on June 17, 2019. Credit: AP/Keith Srakocic

Recently, a friend’s teenage daughter underwent wisdom teeth extraction. I had the same procedure in the late 1990s, at age 20.

Then, I was given a bottle of ibuprofen and, for the bleeding, told to apply teabags. My friend’s daughter was given something just a tad stronger: Vicodin.

A teen was given legal heroin to numb the pain of a tooth extraction. That the proceeding sentence isn’t completely absurd is, well, completely absurd.

Despite such foolishness, the fight against opioid abuse finally is gaining promising victories by wielding an effective weapon: lawsuits. As the epidemic grew, many called for state and local authorities to take drug companies to court for knowingly encouraging large-scale consumer use of highly addictive prescription painkillers such as OxyContin, Vicodin and Percoset.

Thousands of lawsuits have been filed and, in August, the $572 million decision won by Oklahoma against Johnson & Johnson became the first large-scale trial ruling concerning Big Pharma’s role in the opioid crisis. Most recently, the Sackler family — the owner of Purdue Pharma, which makes OxyContin — reached a tentative settlement for $10 billion to $12 billion.

Now, as the drug death crisis shows signs of ebbing but has by no means abated — 68,000 Americans died in 2018 compared with 72,000 in 2017, hardly cause for celebration — it’s time to consider what’s next. And New York State, with both legislative houses and the governorship in Democratic control, can be a key player.

For years, drug companies pushed opioids as a panacea for pain. The result was an avalanche of prescriptions: 191 million in 2017. And despite rules intended to discourage opioid painkillers as a first-step approach to easing chronic pain, primary care clinicians wrote 45% of all opioid prescriptions.

Many surgeons also have overprescribed. One study of nearly 20,000 surgeons, led by Johns Hopkins School of Public Health researchers, noted the common practice of prescribing dozens of opioid painkillers even for low-pain operations. Some prescribed more than 100 opioid pills for the week after a surgery, exceeding guidelines from several academic medical centers. No wonder some 6% of patients prescribed opioids post-surgery become dependent.

The diagnosis is simple: Many doctors have proven incapable of, or unwilling to, exercise responsible discretion in determining which conditions and medical procedures warrant painkillers linked to addiction, abuse and overdose.

The treatment is just as simple: Legislators must take much of this decision-making out of doctors’ hands. We’re familiar with mandatory sentencing guidelines; we need mandatory dispensing guidelines — laws that bring harsh punishment for overprescribing pill-form heroin. New York has approved some laws to fight the opioid crisis, but it can do more to set a precedent by passing common-sense opioid prescription laws.

The time has come for customized, ailment and procedure-related opioid painkiller dosing laws, complete with medical rationale requirements. Make doctors explain why they are prescribing opiates and why they decided on the pill count and refill allowance granted each patient. In a situation still way out of hand, the state must exert more control over what should be a tightly controlled substance.

Certainly, some need the relief that opioid painkillers bring. This is why the Centers for Disease Control and Prevention recently reiterated that opiates are reasonable for cancer, end-of-life care and palliative measures, including specific chronic pain conditions.

But it is irresponsible and dangerous to prescribe opioids for an ingrown toenail. Or for carpal tunnel syndrome. Or to a teenager after a tooth extraction.

We need strict statutes that place transparency and responsibility on prescribing doctors. New York can and should lead on this life-and-death issue.

Christopher Dale is a freelance writer who writes on society, politics and sobriety-based issues.

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