Blog | Thursday, August 16, 2018

Doctors and the opioid epidemic


I am against all forms of bodily pain, both foreign and domestic. I wish the world were pain free. When I am suffering from even a routine headache, I want immediate relief just like everyone else. The medical approach to pain control has changed dramatically even during my own career. When I started practicing a few decades ago, the strategy was pain reduction. We gave narcotics for very few indications such as kidney stones, heart attacks, and severe abdominal pain after a surgeon evaluated the patient. (The reason for this was so the surgeon could obtain an accurate assessment of the patient's belly before pain medicine masked the findings.)

The new goal is pain elimination, which I believe is one factor that has fueled the overconsumption of opioids, although there are other factors present. I admit that I am opining on this as an individual who is blessed to be pain free. I do not pretend or suggest that if I were afflicted with a painful condition, that I would not want whatever it might take to bring me relief. In medicine and in life, the world looks very different when you are a victim. Your view on health care reform, for example, might ‘evolve’ if you or a loved one is suddenly uninsured.

But patients' rising expectation of eliminating pain and the medical professions willingness to join in this mission has exacted a great societal cost. I am not blaming anyone here. Of course, patients want pain to go away. Of course, physicians want to relieve suffering. Isn't a doctor's mission to make his patient feel better?

The consequences of this approach have exploded. Narcotics and opioids are addictive agents. Any individual who takes these medicines over time risks addiction, which is a new disease. In fact, the addiction may very well be a more severe illness than the original medical condition. When OxyContin (oxycodone) came on the scene in 1995 the drug company recommended it as first line treatment for chronic pain as well as for musculoskeletal pain, two conditions that today would not be initially treated with opioids. Over a decade later, the pharmaceutical company accepted a guilty plea in federal court and admitted that it trivialized the drug's addictive properties, along with other deceptive practices.

Consider this sobering statistic. The United States is about 5% of the world's population yet consumes about 80% of the world's oxycodone supply.

When a doctor is prescribing opioids to a patient, which may be entirely appropriate, the physician and the patient must be mindful of how carefully this must be monitored and the addictive risks of prolonged use. We must guard against creating a new disease that may be fatal and that may result from unrestricted or inadequately monitored pain medication use.

Ohio announced new rules recently that would limit opioid prescription for only seven days for acute pain. While I generally resist politicians interfering with medical practice, with thousands of overdose deaths in our state every year, I understand their need to intervene.

Many heroin addicts today can trace their affliction back to a doctor's prescription, which was given for the right reasons.

The medical profession and the scientific community needs to triple down on research to develop new drugs and techniques that attack pain but leave patients protected from the ravages and misery of drug addiction.

This post by Michael Kirsch, MD, FACP, appeared at MD Whistleblower. Dr. Kirsch is a full time practicing physician and writer who addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.