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Rotary Club of Los Altos: Physician offers perspective on opioids


Dr. Krane

As national headlines attest, the danger of opioid abuse is real, but a local physician put what many perceive as an epidemic into perspective in a presentation at the Rotary Club of Los Altos March 8.

According to Dr. Elliot Krane, pediatric anesthesiologist and Stanford University professor, the number of deaths resulting from many other public health menaces, including alcohol, smoking, obesity and heart disease, far outpace the number of deaths from opioid abuse.

Since the ancient Sumerians first cultivated the opium poppy 5,000 years ago, nothing has come close to its effectiveness for pain control, Krane said. Its side effects – constipation, depression, reduced testosterone production and addiction – make opiate use far from ideal, but it works best for controlling severe pain from surgery, broken bones and many other health problems. Approximately 100 million Americans suffer from chronic pain, and for many, opioids allow them to function daily.

Such medications include natural drugs like morphine as well as synthetic drugs such as Demerol, oxycodone and fentanyl. Krane estimated that 90 percent of his Rotary Club audience had likely been prescribed an opioid or administered one during the course of routine surgery.

Krane’s charts revealed that 2 million people in the U.S. suffer from opioid addiction. The death rate from opioids continues to rise, he said, with the majority of deaths resulting from the use of “street drugs” rather than prescription opioids. This year, experts have predicted 40,000 deaths from opioids.

Growing epidemic

Krane dispelled a few myths about the growing epidemic. Some point to increased abuse by adolescents, but he said that among children and adolescents, the frequency of illicit opioid use is no greater now than it was in the 1950s. He also debunked the idea that introduction to opioids at a young age leads to addiction, noting that no convincing connection has been made between medical use of opioids by adolescents and later opioid use disorder.

Addressing the widely held belief that doctors overprescribing opioids is driving the epidemic, Krane reported that fewer opioids are now being prescribed than in the previous eight years, yet opioid addiction and death rates continue to climb.

To explain the uptick, Krane introduced a study by the National Bureau of Economic Research revealing a statistical link between the unemployment rate and opioid overdose and death rates. The bureau’s county-by-county study across the U.S. shows that every 1 percent increase in unemployment is followed by a 7 percent rise in opioid overdoses and a 4 percent boost in opioid deaths.

A Brookings Institute study underscored the point, demonstrating that the rate of “deaths of despair” (which include suicide, alcoholism and drug overdose) has increased over the past 15 years, virtually exclusively among non-college-educated white men and women, presumably because economic hard times have hit this population the hardest.

Three primary factors lead to opioid addiction, Krane said: exposure to opioids, which alone does not commonly lead to addiction; genetics, to which 60-70 percent of the cause of addiction is attributed; and untreated psychiatric illness, for example, post-traumatic stress disorder, depression or anxiety.

The solution to the opioid epidemic, according to Krane, will be complicated. Partial solutions he suggested included the distribution of the opioid antidote naloxone, which reverses overdoses and could be supplied to first responders, methadone addiction centers and rehabilitation and recovery facilities.

Marlene Cowan is a member of the Rotary Club of Los Altos. For more information, visit losaltosrotary.org.

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