KevinMD: I am a doctor, but I didn’t cause the opioid epidemic

[HuckleB]

http://www.kevinmd.com/blog/2016/05/doctor-didnt-cause-opioid-epidemic.html

"Let’s get this straight. I am a doctor, but I didn’t cause the opioid epidemic. That is not exactly what you hear in the media these days. After all, doctors are the ones with the prescription pads, and someone must be to blame.

The truth is that death from opioid abuse is on the rise. The Centers for Disease Control and Prevention (CDC) has reported some frightening statistics. Deaths from opiates have increased by 137 percent since 2000. In 2014 alone, more than 28,000 people died from opioid use, and more than half of them died from the use of prescription pills. This is a four-fold increase in opioid-related deaths over fifteen years.

We need an American detox.


It is not surprising that people are angry. They should be! These deaths are preventable and by all accounts unacceptable. The U.S. government is looking into ways to calm the opioid epidemic, but their approach may be a misfire. Right now, they have targeted doctors as the smoking gun. It would be more effective to make doctors their allies, instead of the scapegoats.

Instead, you see advertisements posted in Times Square and other venues featuring children in pain. The inflammatory slogans read: “Would you give your child heroin?” Doctors are seen as drug pushers instead of caregivers trying to relieve obvious pain. Parents are being judged for wanting to relieve their children’s pain. Where does the discussion of actual medical care come into play?

..."

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A worthy read, IMO.

[tonyt53]

1. Doctors aren't the cause of doctor-shopping either. Ask Rush Limbaugh about that.

When people travel to other locations to see other doctors, and then to other locations for another doctor, who is to blame? I could not agree more about working with doctors instead of blaming them. Hell, based upon the reasoning that we hear, why not got after the drug stores? CVS and Walgreen's keep filling those prescriptions.

[HuckleB]

2. I think we're going to need a system that tracks things across the nation.

That won't stop everything, but it's funny how we have to give driver's licenses and sign when buying pseudoephedrine, but not for narcotics.

[Downwinder]

3. You doctor-shop for relief.

[mopinko]

4. and doctors are getting gun shy.

my daughter lives w chronic pain, and has been tagged as a drug seeker. the truth is that she has taken all her meds exactly as prescribed, but they target her anyway.
recently had her gall bladder out. first the surgeon put her off, not believing her pain. finally decided to stop diddling around when she started showing signs of sepsis. she had one stone over 1" in diameter, and a golf ball size mass of stones altogether.
then he sent her home w THREE DAYS worth of pain meds. when my ex had his out he got 2 months worth of norco.

fortunately she has a fearless pain doc who took care of her.
hopefully the secondary pancreatitis will settle down soon.

[Crunchy Frog]

20. After the kidney stone I had last year

for which I was given virtually no pain management, I'm working on developing my own painkiller self sufficiency. I've got no intention of suffering like that again.

Sympathies to your daughter.

[HuckleB]

22. Yikes.

I was given a week.s worth for a hernia. I only used one pill. I probably should have used a couple more. Good luck to your daughter. Take care.

[msongs]

5. opioid use is NOT an epidemic. one would think a real doctor knows this.

an epidemic is something in which everyone has a chance to become infected through no fault of their own (unless you have some sort of natural immunity).

[HuckleB]

7. Yes, let's ignore the topic by getting focused on nitpicking.

[LanternWaste]

9. I pretend accuracy is nit-picking as well.

I pretend accuracy is nit-picking as well.

[HuckleB]

11. That particular word does not change the important parts of the story.

Accuracy matters when it matters, not when it does not change anything fundamentally.

[Major Nikon]

23. It's not really nitpicking

For one thing the CDC's use of statistics is extremely misleading and their recommendations are extremely misguided.

Right on their web page you will see the following:

The United States is in the midst of an opioid overdose epidemic.

Opioids (including prescription opioid pain relievers and heroin) killed more than 28,000 people in 2014, more than any year on record. At least half of all opioid overdose deaths involve a prescription opioid.

At best these figures are extremely misleading, and at worst they are simply outright lies. Believe it or not, although certainly not impossible, it's extremely difficult to overdose on opiods. Ask anyone what killed Philip Seymour Hoffman and they will tell you his cause of death was an overdose on opiods. This just isn't true. His actual cause of death was mixing other drugs with opiods, which is extremely dangerous. When you look at those 28,000 people, the vast majority of them will be similar to Philip Seymour Hoffman. Many of them will be mixing opiods with alcohol. What about River Pheonix, Jim Morrison, John Belushi, Chris Farley, and Heath Ledger? Everyone knows they died from opioid overdose right? Nope, all of them died from mixing other drugs with opioids. Many other famous deaths attributed solely to opioids almost certainly were from drug mixing, but things like alcohol are often not included on death certificates, because after all alcohol is legal and presumed safe (not).

So you look at what the CDC recommends to do about the "opioid overdose epidemic". Nowhere do you see an effort to warn people about mixing opioids with other drugs, yet doing so would undoubtedly save far more lives than anything else they list. That's when you realize this isn't really about saving lives at all. It's simply about denying drugs to people in chronic pain who need them by telling them tough shit, and driving addicts into illicit heroin use out of fear they might get a buzz from a legally prescribed product.

http://www.rehabs.com/pro-talk-articles/the-ultimate-harm-reduction-guide-to-drug-mixing/

[HuckleB]

25. Your point is valid, and quite different from the language police above.

[RobinA]

27. This Is, In Part,

why I will believe they are serious about the "epidemic" when they start endorsing controlled use instead of just cutting off the supply to everybody. The Jim Morrisons of this world will always be able to OD. However, Joe Average who started with pain, got cut off, and turned to street drugs, doctor shopping, and god knows what else in the mix could be helped with some oversight. So could the kids who started with Mom's medicine cabinet.

[Doctor_J]

6. Legalize pot. Problem solved.

[Crunchy Frog]

21. Pot does not effectively treat all types of pain, and not everybody can tolerate it.

End the fucking drug war, make addiction treatment freely available, treat underlying conditions in a timely fashion, and stop spiking opioid pain pills with toxic levels of acetaminophen.

IMHO.

[Major Nikon]

24. Still that action alone would create a tremendous dent in opioid deaths

Many types of pain can be alleviated by cannabis. Many people don't take opioids to alleviate physical pain anyway and making cannabis illegal forces them to seek that product through illicit sources that also tend to sell other drugs like illicit opioids. There's also no drug interaction with opioids and cannabis, so people can safely mix those unlike alcohol and certain other drugs which predictably kill thousands of people every year.

[Ichingcarpenter]

8. He doesn' t even talk about the role of the FDA and Pharmaceutical companies

And their corrupted Science and lies


You want to see a good documentary on this?

Try the Canadian Broadcasting Company CBC award winning documentary on this drug.

Time Bomb

[HuckleB]

10. The author is female.

No one is going to defend pharma, but that part of the equation was not what the piece covered. It's not a book intended to cover every angle.

[1monster]

12. Yup. They did the same thing with teachers. Made them the bad guys

when their mandated requirements caused education levels to fall rather than rise.

Perhaps they should let doctors be doctors and teachers be teachers and do their own jobs rather than try to micro manage everyone else.

[smirkymonkey]

13. I could be wrong, but it seems to me that where people get in trouble is when doctors

start restricting or cutting off painkillers for chronic or acute pain and patients start turning to cheaper street opioids for relief. I think that they need to be highly regulated, but cutting patients who are in extreme pain off without an alternative is not the way to go.

[HuckleB]

14. That's one supposition.

It has likely been part of the issue for some, but I don't it is the only underlying cause.

[REP]

15. Knock wood, I haven't had a problem so far with my prescription

I have pretty bad arthritis in my shoulders and spine as well as a herniated disc, and I currently have a kidney stone the size of a 2-carat diamond in my left kidney; I also have nerve damage. I have chronic kidney failure, so I can't take NSAIDs; I've had my lifetime maximum steroid injections and oral steroids aren't a great idea - it was steroids that brought on my diabetes. Opioids are what's left. I take enough to make the pain tolerable; I am never pain-free nor do I ask for a high enough dose or a stronger med to render me pain-free or below a "6" on the pain scale for fear of being labeled drug seeking ... even though the severity of my problems is readily seen on plain film. I can easily understand how some who are denied adequate or even moderately okay pain relief would turn to heroin; I would bet many do so not to get high but simply to be functional.

I support legalization of marijuana 100%. It, however, is not the answer to all pain relief; anecdotally I have found to my great dismay that it exacerbates my nerve pain. Opiates aren't great for it either but they do dull it a bit. The only thing that really works for me is ketamine, which I found out after having two surgical procedures (hand surgery and a biopsy) performed under it; for the next 36 hours I was as pain-free as I could ever remember being. Didn't turn me into a Special K raver though - too old.

[fasttense]

28. This constant restriction of pain relief on the off chance you might abuse it is too excessive

My 84 year old mother has too many illness to list. She is in constant pain. They restrict her pain medicines too. What are they thinking? That she is going to go to the street corner and sell her pain meds? Or do they really worry that an 84 year old woman might get hooked on some kind of pain killers during her last few years of life? If she does so what?

You sound like my husband who is on the transplant list for a kidney and does at home peritoneal dialysis. He also has a really bad back. Though he doesn't complain, I think he is always in pain.

I hope you can find a doctor that will help you.

[REP]

31. I don't blame my doctor

First, thank you for your kind thoughts. My thoughts are with you and your family; I hope your husband gets his transplant soon and it goes extremely well.

I am fortunate to have doctors who like me and care for me as a person. I'm sure if I asked for more or stronger meds I would get them, but besides risking being labeled myself, prescribing such meds puts doctors at risk for investigation. I've never been denied a refill and I "save" the requests for stronger stuff for really unbearable pain, such as post-surgery or the unknown future. If I made it sound like its my doctor's fault, that was bad writing and very unfair to my doctor!

I'm not worried about dependence or addiction; I'm more worried about tolerance. I take what many consider to be a "strong" opioid that has never made me "high,"'sleepy, disoriented or anything other than more mobile. Despite taking it for years, I'm pretty sure I'm neither addicted nor dependent; when I forget to take it, the only thing I really notice is "holy crap everything hurts so much today! Oh, that's why." I don't think I'm special in that way, either.

Again, my best to you and your family.

[Jesus Malverde]

16. Then they should renew the prescriptions free of charge, if they are not invested in this addiction.

They get paid well for 10 minute meeting to represcribe these highly addictive drugs.

[HuckleB]

17. How would that help?

[Jesus Malverde]

18. If a percentage of their practice, did not reimburse them.

They would be discouraged from getting them addicted in the first place. Being a drug dealer and having a captive addicted customer base is a great business. You have to attack the business model.

[HuckleB]

19. Yeah, I'm not buying that at all.

Most docs are ludicrously busy. The reason they need to see patients is not about that.

[fasttense]

26. Maybe we should look at WHY all these people are taking opioids

There is an underlying reason for mass ingestion of drugs.

[RobinA]

29. Opium

has a long and storied past. If it were a person it would be a tragic hero. Good for what ails us in so many ways, but as far as our wellbeing is concerned, one major flaw... Opium, if I were not a non-theist, would help me believe in intelligent design.

[Dustlawyer]

30. This doctor lives in a bubble or is in denial!

My brother's pain management Doctor is a "Pill Doctor." He had a back problem for years and got addicted to pain killers. Eventually we got him on disability and Medicaid/Medicare. He had surgery to repair his back and it went well. But my brother kept getting 90 10mg Narco pills every month. He is also an alcoholic who drinks all day. Since he never tells this to his doctors I sent his doctor a letter putting him on notice of my brother's surgery, who the surgeon was, that it had happened 7 months before, and how much my brother drank. At the time my 5'7" brother weighed 93 lbs and was malnourished.

He told my brother he wasn't going to let some lawyer tell him to practice medicine and kept prescribing the same prescription for another year until he closed his office last month due to changes in the opiod prescription guidelines. My brother will be dying in the next month or two from severe cirrhosis of the liver, certainly helped along by the narcotics in addition to the beer. My brother was an obvious addict, yet the doctor kept prescribing without pause. He would always prescribe two ther medications to make it look like he was treating a condition. I read all of his bottles while my brother was in the hospital fighting for his life a couple of months ago. All had big warnings not to take with alcohol.

I have chronic pain from small fiber sensory neuropathy. I am allergic to most medications they would normally use to treat my condition so I to have to take a narcotic. They now want to install another implant (I have a neural stimulator put in to help with pain), a pump to pump it directly into my spinal cord. They said it's because of the new guidelines. So I see both sides of this, but don't excuse the doctors, when someone like my brother comes in they know.

While in California for work and an extra day to kill I wandered down to check out Venice beach. I saw "Kush Doctor" signs everywhere. I stopped and spoke to a barker out front who was trying to get people to come inside. He explained a lot about medical pot, but I wasn't going in since I was flying out the next day. Some guy asked to bum a smoke and I gave him two. He was surprised I gave him two so he just handed me 1/2 a joint. The barker said "Now I guess you will find out how it works for you." That night at my hotel I was pain free for the first time in many years. I sat on the bed in my hotel room and cried.

Back in Texas I get piss tested randomly though I have never failed. It is illegal for me to use this substance which works better than any narcotic with much less side effects. I know that I couldn't use it anyway, at least during the day due to my profession, but it would be nice to get a break from the constant intense pain that never stops. It would be nice not to have to worry about withdrawals if my doctor goes on maternity leave again and I get a fill in doctor who won't prescribe my medication which happened to me last year. I take my meds just as prescribed, but my tolerance is so high now the pump seems the only way to go, as much as I don't want another piece of hardware and battery in my body.

We need a complete overhaul of this system and use medical pot for many like me instead of these dangerous and addictive pills!