The medical director of Bradford Health Services traced how an effort in the medical community to increase patient comfort had deadly consequences for the nation in the second week of "The Journey Series," a free virtual series on addiction and recovery.
Dr. Brent Boyett traced the beginning of what became the opioid epidemic to the late 1980s and early 1990s. Opioids, once reserved for acute pain and end-of-life care, were prescribed more broadly for use at home after regulatory agencies established quality measures that were closely tied to reimbursement.
"Pain scores became a quality measure of what is good care. So hospitals and doctors who could provide lower pain scores were reimbursed and rewarded for this," Boyett said.
The number of opioid prescriptions in the United States increased from 76 million in 1991 to 219 million in 2011.
Opioid-related overdoses emerged as a disturbing new trend in the mid 2000s. Deaths rose from around 10,000 in 2002 to over 49,000 in 2017 with individuals age 45-55 being most likely to die of an opioid-related overdose.
By 2011, all age groups were more likely to die from a prescribed opiate than from illegal drugs, according to the Centers for Disease Control and Prevention.
In that same year, the United States made up 4 and a half percent of the global population but consumed over 80 percent of the world opioid supply.
In addition, U.S. doctors prescribed 99 percent of the world's supply of hydrocodone, an active ingredient in Lortab, Vicodin and Norco.
In 2013, the Appalachian region as a whole and Alabama in particular lead the nation in pain pill prescriptions per capita.
Boyett pointed out that such prescriptions mask pain but do not cure it.
"Medications like opioids and Benzodiazepines don't do anything to help our back. It just dopes our brain up so that we ignore our back. We continue to leave our hand in the fire, and then we wonder why our hand doesn't work the way it used to," Boyett said, referring to the analogy of how pain is necessary to the body because it would cause a person to remove their hand from a fire.
Boyett also explained that the brain will always balance pleasure or euphoria with pain and that prolonged use of pain prescriptions creates a rollercoaster effect in which the highs are not as high and the lows are more painful as the person becomes dopamine resistant.
"If I am tricking my brain into a perception of pleasure over and over again, then my brain will try to create a resistance to that in order to create a balance, which will ultimately wind up putting me into an area of chronic pain," Boyett said.
Thus, individuals who become dependent on opioids to function both take opioids because of pain and are in pain because of the opioids, according to Boyett.
Moving forward, Boyett said he expects the medical community to embrace the neuroscience of addiction. Addiction medicine became a recognized medical subspecialty in 2015.
In addition to reducing the chronic use of opioid prescriptions, Boyett said doctors should also seek to treat addiction before serious consequences occur by referring them early to an addiction medicine specialist.
"We need to become comfortable in a non-judgmental, non-stigmatized way of helping patients get the help they need through addiction professionals. We don't wait until a person is dying before we refer a patient to an oncologist, and neither should we wait until a person has had serious long-term consequences from substance use disorders," Boyett said.
"The Journey Series," a collaboration of the Recovery Ministries of the Episcopal Diocese of Alabama and Walker County Health Action Partnership as well as numerous other state and local partners, will be offered virtually each Thursday through Oct. 8 at 2:30 p.m. and 3:35 p.m.
To register or view past sessions, visit www.walkerrecoverymap.org/journey-series.