Doctors must lead us out of our opioid abuse epidemic
There are some video clips of the show, could not find a link to the entire 60 minute piece. Since there is one opiate substance abusers for every 19 chronic pain pt… this show had ONE chronic pain pt talking about how her quality of life was dependent on the opiates that she had been taking for a decade or more and then they had “19” people (substance abusers, parents, spouses, etc, etc) with their sob stories of how they were a functioning addict and/or lost someone to a opiate OD.. of course, all of those OD’s were unintentional/accidental deaths… not the first one committed a suicide.. even though we have ONE MILLION suicide attempts and 50,000 successful suicides every year.
(CNN)Veteran doctors don’t need a blood test to tell when someone is on the verge of a drug overdose. They can even narrow down the culprit by observation alone. Dilated pupils mean cocaine, amphetamines, maybe LSD. Constricted pupils mean an opiate.
Additionally, an opiate abuser is characteristically “nodding out” and often scratching their itchy skin. While their face is becoming pale and clammy, their fingernails and lips are starting to turn blue or even a sickly purplish-black. When the choking noises — or the deep snore gurgling sounds, known as the death rattle — begins, it’s time to act — and fast. That is a pretty clear sign the opiates have just turned off the person’s drive to breathe and they are in the throes of an overdose.
It is an awful sight, and yet someone in this country dies like this every 19 minutes. There is no other medication routinely used for a nonfatal condition that kills patients so frequently. The majority of those deaths result from prescription opioid medications, such as hydrocodone, OxyContin and Percocet.
It is so common that specialists even have a profile for the most typical victim: non-Hispanic Caucasian male, mid 30s. Initial diagnosis: back pain due to trauma, surgery or degenerative arthritis. And, most remarkably, average time from first prescription to time of overdose death: just 31 months.
This is a public health epidemic and one that is uniquely American. No other country in the world has the perverse amount of consumption as we do in the United States. And nowhere do we pay the price as dearly as with prescription opioid medications.
As of 2011, 75% of the world’s opioid prescription drugs are prescribed and swallowed up in a country that makes up less than 5% of the world’s population, leading to the most common cause of preventable death in America today. It is a horrifying and shameful statistic.
And, having traveled all over the world covering natural disaster, wars and famine, I am fully confident we Americans don’t have 75% of the world’s pain.
Who is at fault?
There is plenty of blame to go around. Drugs are cheaper than a multidisciplinary approach to treating pain, and cost savings are what insurance companies like to hear.
For decades, certain pharmaceutical companies misled the FDA about the risks of opioid dependence in an effort to sell more of the drugs, and three top executives from Purdue Pharma even pleaded guilty to those criminal charges.
Our federal government has created nearly insurmountable hurdles to studying other therapies such as medicinal marijuana, which has for years been used safely and effectively in other countries for chronic neuropathic pain, one of the most difficult types to treat.
Addicted? How to get help
If you’re addicted to prescription drugs, help is available. You can call the Substance Abuse Mental Health Services Administration 24/7 hotline at 1-800-662-HELP(4357) or visit their website.
Most of the blame, however, belongs on the shoulders of the American doctors themselves. I am a practicing neurosurgeon, and this is not an easy thing to acknowledge. The fact is, we have accepted the tall tales and Pollyannaish promises of what these medications could do for too long. As a community, we weren’t skeptical enough. We didn’t ask enough questions. We accepted flimsy scientific data as gospel and preached it to our patients in a chamber that echoed loudly for decades.
Even worse, too many doctors who didn’t actually believe the hyperbole surrounding opioids doled out long-term prescriptions regardless, in the same way doctors write antibiotic prescriptions for viral illnesses. In both cases, they don’t work. In both cases, they can cause colossal harm.
The King of Pain
It was a particular American doctor who, in many ways, started all of this. If you want to identify a specific moment this opioid epidemic sprouted wings, many would point to a paper written 30 years ago this month.
Based on a study of just 38 patients in 1986, Dr. Russell Portenoy challenged the conventional wisdom. Up until that time, opioids had been reserved for cancer patients and palliative care and only for short durations because of the concern about addiction. Dr. Portenoy, armed with his small study, believed prescription opioids could safely be used in all patients with chronic pain for years on end. He maintained that the drugs were easy to quit and that overdoses hardly ever occurred.
11 photos: Opioids: Addictive painkillers
Along with several others, Portenoy cited a single-paragraph letter to the editor from the New England Journal of Medicine stating that less than 1% of opioid users would become physically dependent or addicted.
As it turns out, almost none of this was true.
When we reached recently retired Dr. Hershel Jick, author of the oft-quoted “1% letter,” he was quick to point out that his statistic was misrepresented. It was intended to represent only patients prescribed opioids in the hospital who were carefully monitored. He told us he never anticipated the remarkable impact a one-paragraph letter would have in the decades to follow.
Why are opioids so addictive? 01:09
Even Portenoy, once mockingly referred to as the King of Pain, appears to have recanted and apologized for his part in walking the American people into an abyss of addiction.
There is no question that many people suffer unimaginable chronic pain, and we don’t want to solve the epidemic by impeding their ability to obtain pain relief. But the truth is, they deserve medications better suited for the job. They deserve medications that uncouple powerful analgesia from terrible addictive potential. They deserve medications that don’t cause hyperalgesia, a syndrome of increased pain necessitating escalating doses of opioids. Most of all, they deserve to have doctors who rely on scientific evidence that is solid, not fanciful.
Where we stand
We have a long way to go. Instead of safer pain therapeutics, patients are now being offered expensive new medications that only treat the consequences of the opioid epidemic. With 259 million opioid prescriptions being written yearly, it turns out side effects — such as constipation — are a big enough business to warrant its own Super Bowl commercial.
There are other grim signs. We now know that heroin has made a resurgence and 80% of new heroin users start off using pain pills, which contain the same type of base ingredients.
Most disturbing, however, is a recent study showing that 91% of people who survived an overdose were still able to get another opioid prescription, typically from the same prescribing doctor. Not only are we failing to learn and make progress, it seems we are turning a blind eye to the tragedies unfolding right in front of us.
A doctor call to action
As policymakers begin to catch on, rules and regulations will start to change. As part of a discussion I moderated with President Obama last month, we learned the Centers for Disease Control and Prevention is now recommending against doctors prescribing opioids for most chronic pain situations. When a prescription is written, it should be for the lowest effective dose and the shortest amount of time: usually just a few days.
Pills will also come with safeguards to make them difficult to abuse and discourage “doctor-shopping,” as well as a strong warnings about addiction — something we doctors should have been diligent about all along.
But most simply, we as doctors need to engage our patients and discuss treatment with them, whether its short term opioids or alternatives like physical and occupational therapy. We need to help set realistic expectations for our patients: Living entirely pain free is not always possible. As doctors, we need to have follow-up conversations with our patients to see how treatment is going. If we better understand our patients, we can provide better treatment and help develop pain strategies that are effective and safe.
It is not too late. In order for this American-made epidemic to finally end, however, it is the American doctors who must lead the way.
Filed under: General Problems
It was a semi truck load of crap. They didn’t want the chronic pain sufferers views on anything. The last lady who was an addict did make a good point about the states a needing to have a unified tracking system on prescription medications. She said that she was a heroin addict who started on prescription opiates and admitted to doctor shopping, not one of them asked her if she obtained her first drugs legally. This townhall only told the story it wanted to tell. There was no investigative reporting and there was no pain management specialist on the panel. It was just like the CDC and the planning of their guidelines. Bring only people who will make your point for you.
Anyone that takes pain medication in a compliant fashion knows that they will never live “entirely pain free”. I find that statement to be absurd. What they really meant there was that we all need to suck it up and learn to “live” with pain. What they also fail to mention is that there are a large number of the current chronic pain populace that will choose to take their own lives because they don’t really have one anyway without the benefit that opiates can provide. I have literally lost my appetite because of pain. I suppose they will tell me that I look good next time I go into my doctor’s office because I am in so much pain that I quit eating. Because I was overweight to begin with. As long as I look good, right? ‘Cause that’s what it’s all about.
I’ve got to say compared to all the other shows I have seen I’ve got to say this one was a lot better and at least we had ONE representative from The Chronic pain community out of 20 or so , and I guess one is better than none at all ? I do wish K Sanford The Chronic pain patient would have mentioned how our legitimate doctors are being terrorized in the environment today , but she was interrupted as she was starting to talk about the many patients being kicked off their treatment and of course they went straight to a guy from Circus Olay that was given opiates even though he asked not to be given any after a surgery , and the professional football player that said he was taking 1400 pills a month ? I definitely understand the need for a change in the way opiates are being prescribed in a lot of cases . Another positive part of this I thought was the police officer that said how they had changed their Outlook on drug users . So all in all it was better than shows have seen to date on nation media because they at least had one person representing us but it took me back to the last public meeting of the CDC we’re out of 30 some comments only three to four were from The Chronic pain community ? And just like this show they controlled who was speaking ….
And at least they didn’t drag out the film clips of shaking babies born addicted , so maybe ,
sort of , kind of , its a start ?????