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November 8, 2015

"How Doctors Helped Drive the Addiction Crisis"

The title of this post is the headline of this extended New York Times op-ed authored by Richard Friedman, which reinforces my long-standing view that drug use/abuse and related social ills are most properly considered and addressed as public health concerns rather than criminal justice issues.  Here are excerpts:

There has been an alarming and steady increase in the mortality rate of middle-­aged white Americans since 1999, according to a study published last week.  This increase — half a percent annually — contrasts starkly with decreasing death rates in all other age and ethnic groups and with middle­-aged people in other developed countries.

So what is killing middle­-aged white Americans?  Much of the excess death is attributable to suicide and drug and alcohol poisonings.  Opioid painkillers like OxyContin prescribed by physicians contribute significantly to these drug overdoses.

Thus, it seems that an opioid overdose epidemic is at the heart of this rise in white middle­-age mortality.... Driving this opioid epidemic, in large part, is a disturbing change in the attitude within the medical profession about the use of these drugs to treat pain....

[S]tarting in the 1990s, there has been a vast expansion in the long­term use of opioid painkillers to treat chronic nonmalignant medical conditions, like low­back pain, sciatica and various musculoskeletal problems.  To no small degree, this change in clinical practice was encouraged through aggressive marketing by drug companies that made new and powerful opioids, like OxyContin, an extended­release form of oxycodone that was approved for use in 1995....

The consequences of this epidemic have been staggering.  Opioids are reported in 39 percent of all emergency room visits for nonmedical drug use.  They are highly addictive and can produce significant depressive and anxiety states. And the annual direct health care costs of opioid users has been estimated to be more than eight times that of nonusers.

But most surprising — and disturbing — of all is that there is actually very weak evidence that opioids are safe or effective for the long­term treatment of nonmalignant pain. So how did they become so popular for these uses?  A large review article conducted between 1983 and 2012 found that only 25 of these were randomized controlled trials and only one study lasted three months or longer.  The review concluded that there was little good evidence to support the safety or efficacy of long­term opioid therapy for nonmalignant pain....

What is really needed is a sea change within the medical profession itself.  We should be educating and training our medical students and residents about the risks and limited benefits of opioids in treating pain.... It is physicians who, in large part, unleashed the current opioid epidemic with their promiscuous use of these drugs; we have a large responsibility to end it.

This commentary fittingly highlights that, in modern times, doctors and Big Pharma are the most significant (and potentially dangerous) drug dealers for most Americans.  It also informs my own disinclination to defer completely to doctors and Big Pharma when they express concern about the potential harms of marijuana reform or to trust politicians when they suggest doctors and Big Pharma should guide us through modern marijuana reform debates.  When it comes to pain management and the developments of safe drugs to treat chronic pain, doctors and Big Pharma have a track record in recent decades that should prompt much more suspicion than confidence.

Some prior related posts:

November 8, 2015 at 03:22 PM | Permalink

Comments

NY Times? Dismissed.

Posted by: Supremacy Claus | Nov 8, 2015 10:12:52 PM

Defense attorney here. My hometown of Lancaster, Ohio is struggling with the fallout of this epidemic. Doctors are overprescribing opioids. I personally know of at least one instance where someone went to the local ER with the flu and was, mystifyingly, prescribed Vicodin. Patients with legitimate pain problems develop dependencies, then their supply runs out. They initially turn to the black market, but the $50-60/pill price tag quickly becomes too rich for their blood. They then begin using heroin, which is sadly much cheaper. Right now, in Lancaster, one can buy heroin for less than the cost of marijuana! A local judge has begun his own campaign to fight back by prohibiting opioid consumption as a condition of pre-trial release, regardless of the nature of the charges against a defendant. He also ran the local drug court until leaving for a position in the common pleas court. Many local defense attorneys find this to be an overreaction, but I interned for this judge and observed it to be the desperate attempt of a man with few other options to curb the deterioration of his town and help ensure the health of the community.

Posted by: Krystin Martin | Nov 10, 2015 1:33:22 PM

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