I’ve been an emergency physician for more than 20 years, and I see the effects of opiate addiction on a daily basis.
I was there in the early 2000s when Purdue Pharma’s aggressive and misleading marketing of OxyContin coincided with both the Joint Commission’s stressing the safety of opiates in treating pain and the mandate in 2001 that hospitals use a subjective pain scale as a fifth vital sign and be more aggressive in pain management.
There were indirect threats of censure for hospitals which didn’t comply, a fact that the Joint Commission denies today. I still remember an article published in the Arizona Daily Star around that time discussing the pain patient’s right to complain to the State Boards if they feel their doctor is inadequately controlling pain.
As a result of these events and mandates, doctors, who are now the scapegoats, were forced to prescribe opiates in increasing amounts, in essence became legal pushers in the current epidemic.
Two other factors have also led us to the current situation. First, we have become a society of instant gratification and opiates provide just that. We have a population that just wants another pill to fix them, despite the fact that all medications have some amount of risk involved.
Patients show up with back pain and expect to walk out with a prescription for pain pills despite the fact that what they really need are back strengthening exercises, physical therapy, and to lose the 40-plus extra pounds they have been carrying for the past decade, but that is too hard. It is so much easier to just pop another pill.
The final factor is the rise in use of patient satisfaction scores in all aspects of medicine, despite the fact that patient satisfaction does not always equate to quality medical care.
There are studies demonstrating this, such as a study showing the most satisfied patients with bronchitis are those receiving antibiotics despite the fact that more than 99 percent of bronchitis is viral and is self-limited, and doesn’t respond to antibiotics.
Another study showed that the most satisfied patients presenting to the emergency department with abdominal pain are the ones who received a CT scan with the inherent risk of radiation exposure, whether it was indicated or not.
I am lucky to practice at a hospital where the administration has been strongly supportive of our efforts to curb opiate prescribing but for many emergency physicians that is not the case.
While we all recognize that there is no totally effective treatment for chronic pain in all patients, the use of opiates for chronic pain will frequently start a downhill spiral in many patients as they get deeper and deeper into dependency.
The U.S. has 5 percent of the world’s population yet consumes nearly 70 percent of all opiates produced worldwide which, in and of itself, is a very telling statistic.
Patients don’t die from their pain, but we have an epidemic of people dying from overdoses of the treatment for their pain.
