Sunday, July 22, 2018

Doctors and the Opioid Epidemic

I am against all forms of bodily pain, both foreign and domestic.  I wish the world were pain free.  When I am suffering from even a routine headache, I want immediate relief just like everyone else.  The medical approach to pain control has changed dramatically even during my own career.  When I started practicing a few decades ago, the strategy was pain reduction.  We gave narcotics for very few indications such as kidney stones, heart attacks and severe abdominal pain after a surgeon evaluated the patient.  (The reason for this was so the surgeon could obtain an accurate assessment of the patient’s belly before pain medicine masked the findings.) 

The new goal is pain elimination which I believe is one factor that has fueled the overconsumption of opioids, although there are other factors present.  I admit that I am opining on this as an individual who is blessed to be pain free.  I do not pretend or suggest that if I were afflicted with a painful condition, that I would not want whatever it might take to bring me relief.  In medicine and in life, the world looks very different when you are a victim.   Your view on health care reform, for example, might ‘evolve’ if you or a loved one is suddenly uninsured. 

But patients’ rising expectation of eliminating pain and the medical professions willingness to join in this mission has exacted a great societal cost.  I am not blaming anyone here.  Of course, patients want pain to go away.  Of course, physicians want to relieve suffering.  Isn’t a doctor’s mission to make his patient feel better?


Could this really result from a doctor's prescription?


The consequences of this approach have exploded.  Narcotics and opioids are addictive agents.  Any individual who takes these medicines over time risks addiction, which is a new disease.  In fact, the addiction may very well be a more severe illness than the original medical condition. When OxyContin (oxycodone) came on the scene in 1995 the drug company recommended it as first line treatment for chronic pain as well as for musculoskeletal pain, two conditions that today would not be initially treated with opioids.  Over a decade later, the pharmaceutical company accepted a guilty plea in federal court and admitted that it trivialized the drug’s addictive properties, along with other deceptive practices. 

Consider this sobering statistic.  The United States is about 5% of the world’s population yet consumes about 80% of the world’s oxycodone supply. 

When a doctor is prescribing opioids to a patient, which may be entirely appropriate, the physician and the patient must be mindful of how carefully this must be monitored and the addictive risks of prolonged use.   We must guard against creating a new disease – which may be fatal – which may result from unrestricted or inadequately monitored pain medication use. 

Ohio announced new rules recently that would limit opioid prescription for only 7 days for acute pain.  While I generally resist politicians interfering with medical practice, with thousands of overdose deaths in our state every year, I understand their need to intervene.  

Many heroin addicts today can trace their affliction back to a doctor’s prescription, which was given for the right reasons. 

The medical profession and the scientific community needs to triple down on research to develop new drugs and techniques that attack pain but leave patients protected from the ravages and misery of drug addiction. 



4 comments:

Indra said...

As The opiod "epidemic" is not in line with what the CDC list as causes of death ~ 60,000 from opioids with smoking being responsible for ~ 400,000 death a year. Were should resources go?
I found out many years you cannot be pain free without being a junkie. Narcotics take the edge of the pain and make life bareable. I can parcipitate in life when I am treated.Tolerence will lead to an increase of dose and then you are off to the races. Yale pain clinic showed me how to keep my tolerance under control so I did not have any desire to increase the dose. Same dose for years and it still works and I act and feel normal. Taking away my narcotics would leave me bedridden. Deserving pain patients are forced to go to the street. So from a Dr care to the streets, more junkies. Junkies are dangerous for the most part, why make more?

Paula Griswold said...

I also heard a presentation from an emergency room physician noting that she wished employers would give paid sick days, so workers wouldn't come in saying they couldn't take a few days off to recover from the back pain/whatever injury because they would lose their jobs.

I have no idea how significant a contributor this is to opioid prescriptions in the ER, urgent care, or primary care, but if it contributes at all it seems tragic and avoidable. Somehow, people should be able to take sick days without losing their jobs or failing to be able to feed their families.

Unknown said...

Many heroin addicts today can trace their affliction back to a doctor's prescription, which was given for the right reasons." How many of those can trace their affliction back to nicotine? i.e. addictive personality?

Unknown said...

Dr. Kirsch, can you please contact me? I'd like to republish this piece on the MedShadow Foundation (http://medshadow.org) website. My email is jonathan@medshadow.org. Many thanks.

Sincerely,

Jonathan Block
Content Manager
MedShadow Foundation

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