The Opioid Epidemic, physician generated, yes, it is almost
entirely our fault
I can say that as a physician. In my professional career I have
seen the use and abuse of opiates go from almost nothing to epidemic
proportions. When I started my residency in 1987 in Washington DC, it was not
common for patients to be on oral opiates. We did use Intravenous morphine quite
a bit, but only in limited and necessary cases.
Now, almost 30 years later, I can say first hand that about half
the patients that I admit to my ICU in any given day are on some kind of opiate
medication prescribed by a physician, but also on gabapentin, neurontin,
psychiatric medications, and more. Sometimes I cannot believe the amount of
prescriptions these patients are on, and it is not unusual to see a patient on
at least 10 medications, and I have counted many cases of patients being on more
than 20!!!! I always wonder how a patient can keep up with that kind of regimen,
not to mention the poisonous effects of all this chemicals taken together.
One of the first things I do with the opiates is to try to taper
them, not only because they interfere with patients respiratory and digestive
function, but also because I believe that 90% of these patients do not need
it.
The patients often complain, and some times they insult me, and
they become very angry in some cases, especially the young patients that do not
have much wrong with them except their polysubstance abuse and addictions. But I
also have had patients that thank me for taking the effort, and make them
realize that they can live without this medications, and usually with better
quality.
Why are physicians doing this? why are they prescribing so many
opiates? are patients having more pain than what they were having years ago?
There is probably no single answer, but I have found that people
have now a very low tolerance for any kind of pain, and we have been led to
believe that we should not suffer any kind of pain, anytime, anywhere. And it is
true that one of our missions as physicians is to alleviate pain and suffering
as much as we can, I do not believe that it should be done at the expense of
harming patients in other ways. It is impossible to live our lives entirely
pain-free, pain is a part of life as much as disease is.
I had one clue to the problem about a year ago when I had to be
hospitalized for about 5 days with a kidney stone that would not go away and
caused me great pain. I was initially given opiates for a couple of days, I was
only given a few pills, because I found that IV toradol (a non-narcotic
analgesic) gave me better control of the pain. But the effects of the few
percocets or oxycodones I took were so severe in terms of constipation that I
ended up with all sorts of laxatives to try to alleviate it (and I do not want
to go into the details of what finally worked......). So while I was going thru
this ordeal, I noticed that the nurse on every shift was writing something on
the board in my room. There was a scale that measured my level of pain, and she
taught me that they were evaluated on how well and how quickly I became pain
free and stayed that way. So one of the measures of quality is pain control,
which is good, but I think it is being carried on to extremes. So there are
probably some bureaucrats in the health care system that are pushing this notion
of pain free lives to stupid levels.
Physicians are probably writing all these prescriptions under
pressure by patients, or maybe induced by pharma, but even if that were the
case, it is ultimately the physicians responsibility to prescribe appropiately,
nobody else’s. And maybe physicians do not realize the harm
they are causing, otherwise it borders on the criminal if they are aware and
still do it.
Finally, as a reflection of the gravity, but also ridiculousness of
the situation, you have probably seen an ad on TV, I think it run on the
superbowl, but it is also running regularly, that promotes the use of other
medications to treat the chronic constipation caused by opiates. Really????
Instead of addressing the problem we are going to add one more drug to treat the
side effects of another drug? and then what? we are going to add one more to
treat the side effects of the drug we use to treat the constipation caused by
the use of opiates?
C’mon physicians, let’s wake up and face the reality of a problem
we are mostly responsible for.....we owe to our patients and to
society.
