How we got here: Perfect storm led to deadly opioid epidemic

  • Dr. Ruth Potee, director of addiction services at Behavioral Health Network in Springfield, with a patient. STAFF PHOTO/CAROL LOLLIS

For the Gazette
Published: 10/23/2019 1:31:21 PM

The nationwide rate of overdose deaths caused by opioids has increased every year since 1999, bringing the nation’s opioid-related death toll for the years from 1999 to 2017 to 399,000, according to the Centers for Disease Control and Prevention.

Experts divide that opioid overdose death epidemic into three distinct phases fueled by different, though related, factors.

In the 1990s and early 2000, pharmaceutical companies began marketing opioids such as oxycodone (also known by brand names Percocet and Percodan, along with OxyContin, an extended-release tablet) and hydrocodone (brand name Vicodin) as the most effective way to treat pain. Marketing efforts also falsely claimed these prescription narcotics were not highly addictive drugs.

Meanwhile, responding to criticism that pain was often undertreated, the Joint Commission, the nonprofit accrediting body for medical institutions, around 2001 began referring to pain as “the fifth vital sign,” urging medical providers to be more active in asking patients about pain and treating it.

These factors led to what is now widely agreed was a period of massive over-prescribing of prescription narcotics. Some of the over-prescribing took place in highly suspect, illegal pill mills, leading both to a glut of prescription opioids available on the black market and to huge numbers of people becoming addicted to opioids.

Around 2007, there was a spike in overdose deaths related to heroin (a street drug that is also an opioid, illegal and highly addictive), driven by its low cost and availability. The third — and what is believed to be the most deadly — phase involves the introduction into the drug supply of the highly lethal synthetic opioid fentanyl, which is cheap, simple to make and easy to smuggle.

Dr. Ruth Potee watched all three phases unfold from her vantage point as a family practitioner in Franklin County. Potee worked for 20 years as a primary care doctor, during which time she saw an increasing number of patients suffering addiction, including a large number of people suffering from opioid use disorder.

Formerly a family practitioner at Valley Medical Group in Greenfield, Potee assumed the newly created position of director of addiction services in May at the Springfield-based Behavioral Health Network.

Potee says it was around 2010 when she realized the increasing number of patients struggling with opioid addiction she was seeing in her practice was a catastrophe — and a man-made one at that.

“It was so clear that the overprescribing of opiates had led to a public health crisis — I didn’t know how big it would end up being. I wanted it to go away,” Potee said. “I didn’t think in 2019, I’d still be doing this and that’s all I’d be doing. Scourges come and go. This one is sticking around because it keeps morphing into more dangerous drugs.”

With the appearance of fentanyl in street drugs, many people simply don’t know what they are taking; they don’t recognize its potency or lethality.

“The drug itself changes on a day-to-day basis,” Potee said. “It’s terrifying.”

Medical professionals are trying to reverse course by increasing education and training and making policy changes around prescribing practices.

In 2016, the organization Physicians for Responsible Opioid Prescribing sent a letter signed by more than 60 doctors and other medical professionals to the Joint Commission raising concerns about “the unintended consequence of encouraging aggressive opioid use in hospitalized patients and upon discharge.”

The letter made note of a study that found that physicians prescribed opioids, often in high doses, in more than half of 1.14 million nonsurgical hospital admissions.

“Patients suffering from pain require compassionate, evidence-based care,” the doctors wrote. “Medication is not the only way to manage pain and should not be over-emphasized. Setting unrealistic expectations for pain relief can lead to dissatisfaction with care even when best efforts have been made to resolve pain. Aggressive management of pain should not be equated with quality healthcare as it can result in unhelpful and unsafe treatment, the end point of which is often the inappropriate provision of opioids.”

Laurie Loisel, a former reporter and editor for the Daily Hampshire Gazette, is director of outreach and education for the office of Northwestern District Attorney David E. Sullivan. Loisel wrote these stories for the Gazette in her capacity as an employee of the district attorney’s office.




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