Passing the Blame of the Opioid Epidemic Solely on Physicians is Making the Crisis Worse
The current blame placed on physicians as the ‘cause of the opioid epidemic’ is completely wrong. This crisis did not originate with medical professionals and focusing on this sole cause has turned a bad problem into a nightmare.
I work full-time, in the outpatient setting, treating people with addictions. In the last few years the results of the urine drug tests for my opioid addicted patients have increasingly pointed toward one dire conclusion. The opioid crisis is going from bad to terrible. Intense medical restrictions on physicians and prescribers are making this epidemic worse.
I routinely send urine to labs that can tell me not just IF someone has taken opioids but exactly which kind. In other words, I can see when a patient is only using heroin or if they’ve been using some fentanyl. When I used to review the results for an intake, they would mostly show heroin (demonstrated by a numerical result to tell me how high the level is in the body). Now, the results have changed. People are using nearly 100% fentanyl, with almost no heroin present.
All of this is while we have been working feverishly to crack down on doctors for prescribing opioids. Granted, there were indeed ‘pill mills’ and some reckless prescribers of painkillers, opioids, and the like. No one is disputing this. However, are we solving the problem the right way?
We are now driving patients with pain to self-treat themselves in the most financially feasible way possible. How did this happen? Basic economics. Because of the opioid epidemic, the DEA and other government and medical organizations cracked down on medical professionals who were prescribing painkillers like Percocet, Vicodin, Oxycodone, etc. Consequently, fewer of these medications have been prescribed to patients. As a result, the number of painkillers in the community decreased. Decreased supply led to an increased demand for opioid pills, driving the cost up, often $50-100 for a single tablet. Compare this to the current cost for a baggie of ‘heroin’ (which is usually fentanyl or worse): often $5 or less).
Controlling patient’s pain is so restricted that I now have patients who come to see me at my ADDICTION MEDICINE practice because their PCPs are afraid to prescribe them any opioids. Mind you, though I’m a family physician, I am not currently focusing on primary care per-se. Now I treat people for their addictions with medication assisted treatment. However, patients are coming to see me merely to get help and to know where to turn to get their pain adequately managed.
For example, about a month ago, I had a patient come to see me. As I’m doing the intake, the patient interrupts me and starts bawling. He was just diagnosed with stage four (meaning it’s spread all throughout his body) of a rare form of cancer and was expected to live less than 6 months. His oncologist offered some treatments which ‘might help give him a little extra time’, perhaps extending his life a few months longer. These treatments, though, would require him to do long sessions of chemotherapy and radiation therapy. He had multiple joint problems and the positions he had to be put into caused him such pain that they had to abort several treatment sessions. I reached out to his primary care provider in order to learn more. The provider told me he was afraid to prescribe opioids (who can blame them in the current medical-legal environment), for ‘fear of losing’ their license. The patient’s oncologist was similarly concerned about “starting him on opioids”.
We have swung too far. “Pill Mills” shouldn’t exist. Agreed. But withholding pain treatment for someone about to die because “doctors prescribing opioids got us into this epidemic” is baloney. We need to turn our focus on improving our management of behavioral health problems, listening to our patients about their pain issues, and helping to resolve them. Unfortunately, we have turned a big problem into a massive, fatal problem. Let’s act and treat patient’s underlying issues which are driving their addictions before it’s too late for more of our loved ones.