This is my column in today’s Greenville News. 

drug overdose

The Centers for Disease Control reports that prescription pain medication abuse, and deaths, are at an all-time high in the United States. In the November issue of Vital Signs, a publication of the CDC, prescription pain medication deaths were reported to number 3,000 in 1999, but 15,000 in 2008.

            However, many in the day-to-day practice of medicine have been predicting this sort of cataclysm for years. We’ve all seen too many young people die from accidental overdoses related to abuse of prescription pain medications. But why is it happening?

            It begins with the very real, very miserable problem of chronic pain in those with legitimate illnesses and injuries. The overwhelming majority of physicians want to ease suffering, and often prescribe narcotics.

            Nevertheless, the deaths are partly the result of efforts by large organizations like the Joint Commission for Accreditation of Hospital Organizations (JCAHO), The Institute of Medicine, the AMA and advocacy groups (physician and patient-driven).

            Those well-meaning but influential groups said that physicians were doing a poor job treating pain. Practitioners started using more and more potent medications.  We were mandated to ask everyone about their pain scale.  It was dubbed ‘the fifth vital sign.’  ‘What is your pain today? On a scale of zero to ten?’ Sadly, it’s rather subjective. And the number of patients with a pain-scale score of ‘ten’ is always surprisingly high.

            The epidemic of narcotic abuse was worsened by financial possibilities.  Pharmaceutical companies are always happy to oblige the market with ever more potent drugs.  And the possibilities were immediately recognized and abused by a minority of physicians who opened ‘pill mills,’ where narcotics were obtained with startling, fatal ease. (Appalachia, my home, has suffered enormously from this sort of activity.)  The economic prospects did not go unnoticed by a subset of ‘patients,’ who realized just how much their prescriptions were worth on the street.

            State medical boards muddied the water by punishing doctors for prescribing too many narcotics. Physicians were left confused between a national campaign and their local regulatory bodies.

            Another grave problem, seldom mentioned, is the customer service model of medicine. Physicians often receive negative patient satisfaction scores from patients who feel they didn’t receive the pain medicine they desired or that was their new-found ‘right.’Hospitals, eager to please ‘customers,’ reprimand those physicians; who learn all too quickly that they should give the patient what he or she asks for to keep the administration happy.

            Not to be excused, our country has an enormous population of individuals whose lifestyles are based upon entitlement living, who come from fractured families, grew up with alcoholism and consume many other drugs of abuse. And not all of them are poor. Prescription narcotics may just be the ‘lowest hanging fruit’ of all in the endless attempt by humans to anesthetize their lives.

            As we struggle with the economics of health, I suspect we have no real grasp of the amount of money spent on prescription narcotic abuse. Not only in treatment of overdose, or rehab, but in the enormous costs we incur as physicians sift through confabulated complaints and outright lies, searching for pathology but finding no objective evidence of anything; except a history of drug abuse and likely drug diversion.

            Physicians obviously share in the blame.  Sometimes we’re lazy and give in too easily. Sometimes, we’re afraid to challenge authorities or cause arguments.  And the medical education establishment has educated away the idea that humans are fallible and may not be truthful, so that in our new-found relativism everyone speaks the truth.  Thus, every pain needs a pill…why would anyone lie?

            What can we do?  The CDC recommends monitoring programs, alternative treatments for pain, improved education of practitioners and access to rehab. But the reality on the ground is that pain specialists and rehab are costly, and not widely available.  Furthermore, the best drug seekers know the drill.  They’ll endure Motrin a time or two, but all too quickly their allergies, or ulcers develop. 

            Prescription narcotic abuse is killing Americans, defaming and harming those truly in need of pain medication, and crushing the health-care economy. There are no easy solutions. But there’s plenty of blame to go around. 

            That is, if anyone of influence is willing to listen to regular physicians and nurses, slogging through mountains of pain-scales and prescription requests, day after day, night after night. 

And sometimes, too many times, giving tragic news to the families of the dead, whose pill bottles lie empty at their bedsides.

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