Macklemore, John Oliver join opioid epidemic awareness fight

As pop culture icons address the dangers of prescription opioid abuse, Dr. Michael Von Korff sees hope for raising the issue in public consciousness.

by Michael Von Korff, ScD, senior investigator at Group Health Research Institute and vice president of scientific affairs at Physicians for Responsible Opioid Prescribing

It was 2004 when I wrote my first editorial to bring awareness to skyrocketing use of prescription opioids as a long-term treatment for chronic pain — and the potential for problems such as abuse, addiction, and overdose. Now, more than a decade later, these issues have found their way into the pop culture spotlight.

“Open the bottle”

In his new song “Drug Dealer,” Seattle-native and Grammy-winning rapper Macklemore shares his personal battle with addiction to prescription opioids. His haunting lyrics tell of voices that scream “open the bottle,” while the music video shows the agony he experienced going through opioid withdrawal.

A gradual opioid taper under medical supervision does not need to be as traumatic as what Macklemore depicted in the video. But his story reflects a struggle that has become all too familiar nationwide: The CDC estimates that more than two million Americans have substance use disorders related to prescription opioids. More than 1,000 people are treated for prescription opioid misuse in emergency departments each day. And in 2014 alone, unintentional overdoses from prescription opioids caused more than 14,000 deaths in the U.S. — claiming more lives than heroin and cocaine overdoses combined.

Flying blind

How did we get here? To understand the trends in opioid prescribing that spurred this epidemic, we can look to another pop culture icon: comedian John Oliver.

In a recent episode of “Last Week Tonight with John Oliver,” the Emmy-winning talk-show host described the push from large U.S. pharmaceutical manufacturers in the late 90s that turned opioids into the go-to treatment for chronic pain. The result? A nearly four-fold increase in opioid sales from 1999 to 2014.

This dramatic increase occurred despite scant evidence to support the safety and effectiveness of opioids when used long term for chronic noncancer pain. The medical community was essentially flying blind — an alarming trend that I highlighted in that first editorial back in 2004.

Research and advocacy begin to move the needle …

Since then, I have worked with colleagues at Group Health and across the country to try to fill this evidence gap and better understand the safest, most effective ways to provide long-term treatment for patients with chronic pain. Our research and advocacy work has been instrumental in giving policymakers, physicians, patients, and families the evidence and resources needed to begin addressing the opioid epidemic. Here are just a few examples:

• We found that higher risk of fatal and nonfatal opioid overdose was linked to higher daily dose prescribed (Annals of Internal Medicine, 2010).
• We established Physicians for Responsible Opioid Prescribing (PROP), a non-profit organization whose mission is to reduce harms caused by opioids and to promote cautious and responsible prescribing practices.
• Our research helped shape a Group Health initiative that led to a dramatic drop in high-dose opioid prescriptions and was instrumental in the CDC’s effort to develop new opioid prescribing guidelines, released earlier this year.

Important research to support safer opioid prescribing continues at Group Health and elsewhere. One such example is the Medication Use, Safety, and Evidence (MUSE) study, led by my Group Health colleague Dr. Denise Boudreau. MUSE will look at the risk of misuse, abuse, and addiction associated with long-term use of long-acting opioids for chronic noncancer pain. This research is part of a series of safety studies on prescriptions opioids that the FDA has mandated and is requiring pharmaceutical companies to pay for, in response to a Citizen’s Petition filed with the FDA by PROP. That’s certainly progress, but not nearly enough.

… but public awareness can do even more

As a researcher, I realize that study findings can only do so much to raise awareness. It takes personal stories and popular media to really make an impact. And as critical as research has been — and will continue to be — in fighting the opioid epidemic, the reality is that Macklemore and John Oliver can amplify the issue far more than any study can. The video for “Drug Dealer” has more than 12 million views on YouTube, while John Oliver’s clip has more than five million.

And that’s why I’m encouraged to hear them raise their voices: It gives me hope that we can finally bring the dangers of long-term prescription opioid use into the public consciousness.

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