The Opioid Crisis

Today, our legislators are debating the issue of health care. Among the more difficult problems is how to pay for the treatment of the massive number of people who are suffering from opioid abuse.

By now we all know that the opioid epidemic was visited on the nation by pharmaceutical manufacturers, physicians and the federal government. It is an astonishing story, but, what is being done to shut this down? Apparently, not very much. Is anyone going to be held accountable for what appears to be drug trafficking? Apparently, not.

Cathryn Jakobson Ramin has written a new book, called Crooked, that examines the problem. Within her discussion of her own experience with back pain, Ramin explains how we got to this point.

In her words:

In the first five years that OxyContin was on the market, Purdue Frederick, the pharmaceutical company that had launched the drug in 1996, conducted over forty national pain management and speaker training conferences. Physicians who were willing to spread the word could expect to make up to $3,000 for telling their colleagues, often at lavish dinner meetings or continuing education medical seminars, why Oxy worked so well for them. The strategy could not have been more successful; in record time, ordinary musculoskeletal pain, long understood to be a normal part of life, was recast as an enemy to be battled and subdued.

For decades, physicians had recognized that opioids were highly addictive drugs, and that to prescribe them to any patients other than those who suffered from terminal cancer was illegal. But with Oxy, the tide had turned: suddenly, physicians who allowed patients to “suffer needlessly” from back pain were labeled as lacking in compassion. For general practitioners, who found themselves with “failed” back surgery patients entrusted to their care, OxyContin offered an answer to their prayers.

And then, the federal government protected everyone:

Under pressure not only from the pharmaceutical business, but also from physicians who wanted to be sure they had the federal stamp of approval for this rampant prescribing, the Joint Commission declared pain to be “the fifth vital sign,” adding it to measurements of pulse, blood pressure, core temperature, and respiration. This would turn out to be a grave error. The standard vital signs were readily quantified—either they were normal, or they were not—but only the patient could identify his pain level. Nevertheless, the Joint Commission directed all accredited US hospitals and health care facilities to instruct personnel to monitor pain and to provide compassionate care. In the Joint Commission’s monograph, published in 2001, the organization noted that “in general, patients in pain do not become addicted to opioids.”

And so did Bill Clinton:

Even the DEA climbed on board, signing an agreement with 21 medical professional societies that allowed doctors to prescribe the drugs without fear of prosecution. If physicians had lingering doubts, and some did, these were dispelled in president Bill Clinton’s last weeks in office, when he signed legislation declaring the upcoming decade, 2000 to 2010, to be the Decade of Pain Control and Research.

New York Magazine has reported on a recent study that showed that opioids are not just being prescribed for chronic pain. They are being given to patients having psychiatric conditions. How many prescriptions for opioids are written for anxiety and depression? The research says that the number is 50%:

The study’s researchers (led by Brian Sites, a professor of anesthesiology and orthopedics at Dartmouth’s Geisel School of Medicine) also found that adults with anxiety and/or depression were more than three times as likely to use prescription opioids as those without: 18.7 percent versus 5 percent, respectively. While some people with anxiety and depression undoubtedly suffer chronic pain, these disorders may make it difficult for patients to accurately rate their own suffering — whether because the pain is made more acute by the mental illness which accompanies it, or because the patient is less able to cope with that pain.

In an interview with the Washington Post, Sites said that while someone without anxiety or depression might report their pain level “as a two out of ten, someone with mental-health disorders — depression, anxiety — may report as a ten out of ten.” This disparity between the overprescription of opioids and the undertreatment of mental illness makes for a dangerous correlation — and with a gutted Medicaid budget, it’s likely to get worse.

Have a nice day!