Who’s to Blame?

Fifty-two people die every day from prescription opioids1.

So, who do we blame for all of this death? Doctors? Big pharma? Unscrupulous pill mills? Or the users themselves?

Convincing arguments can be made for all of the above. But does assigning blame get us anywhere closer to finding a solution to our opioid epidemic?

Consider this: Millions of people suffer from chronic physical pain; just how many millions depend on which source you choose. According to the National Institute of Health (NIH), 11.2 percent of American adults suffer from some sort of severe or chronic pain, the equivalent of 25.3 million people2. The Institute of Medicine of the National Academies estimates the number to be closer to 100 million3. This would mean that chronic pain would affect more Americans than diabetes, heart disease, and cancer combined. The Institute of Medicine (IOM) estimates that the number is closer to 116 million4. Twenty percent of American adults (42 million people) claim that pain or physical discomfort disrupts their sleep a few nights a week or more5.

Whatever the actual numbers, chronic pain costs the country in medical bills, lost productivity, and missed work. According to the IOM this amounts to $560 to $635 billion each year.

No Gain in Pain

And then things get even more complicated: Sales of prescriptions opioids in the U.S. nearly quadrupled from 1999 to 20146. Yet, despite this surge in prescriptions, there was no overall change in the amount of pain Americans reported4,6.

By 2012, more than 250 million prescriptions were written for opioid drugs, a number larger than all of the adults in the U.S. According to the Centers for Disease Control, drug overdose was the leading cause of injury death.

So, Who’s to Blame?

  • Doctors? One out-of-three Americans believe that doctors are7 the culprits. While it’s undeniable that doctors are the ones writing the prescriptions, doctors say they are responding to patients’ complaints about pain. In prescribing painkillers doctors are fulfilling their fundamental role in healing and reducing human suffering. Yet, by 2010 in the United States, a country with about 5 percent of the world’s population, Americans were consuming a staggering 99 percent of the world’s hydrocodone (the narcotic in Vicodin), 80 percent of the oxycodone (in Percocet and OxyContin), and 65 percent of the hydromorphone (in Dilaudid).

It has been argued that the increase in opioid prescriptions came about as a result of greater social acceptability of using medications for different purposes.

This came about largely as a result of:

  • Big Pharma? There is no question that the pharmaceutical companies aggressively marketed opioids beginning in 2004. They promoted opioids to doctors through targeted ads in highly regarded publications, through continuing-education courses for medical professionals, and also by funding Pain focused non-profits. Coincidentally, these non-profits published guidelines that advocated for doctors to expand their use of opioids for pain relief.

Policy was drafted by the Federation of State Medical Boards that called on the states’ boards to punish doctors for inadequately treating pain. You may not be surprised to learn that several people with ties to narcotics makers were involved in creating the policy9.

One company, Purdue Pharma, and three of its top executives pleaded guilty to misleading doctors, regulators, and patients about the risks of addiction for the top selling opioid OxyContin. (To date, OxyContin has earned $31 billion for the company.) In 2007 the company paid out $635 million in fines. This legal bump did little to slow sales of the narcotic down: In 2014 alone, 5.4 million prescriptions were written.

  • Misinformation? It wasn’t long ago that doctors mostly prescribed opioids for short-term pain, such as post-operative pain related to cancer or to end of life.

How did this change?

Blame two small accounts published in medical journals8 for the change in perceptions. One was a hundred word letter published in 1980 which reported that less than one percent of patients at a major medical center who received narcotics while hospitalized became addicted. The other was a study published in 1986 that concluded that, for non-cancer pain, opioid narcotics had shown a low likelihood of addiction. The actual words were “little risk of producing maladaptive behaviors that define opioid abuse.”

As we know now, this was simply not true: Opioids are highly addictive.

  • Hospitals? Then there were hospital patient satisfaction surveys: If a hospital was looking to receive high ratings in their patient surveys, pain was an important factor. With questions such as “During this hospital stay, how often did the hospital staff do everything they could to help you with your pain?” and “How well was your pain controlled?” it’s easy to see how this could encourage doctors to prescribe more painkillers. With ratings often tied to federal funding, including under provisions in Obamacare, these surveys could be vital to a hospital’s bottom line10.

A 2012 study in the Archives of Internal Medicine put it this way: The most satisfied patients were the ones most likely to spend more on prescription drugs. They were also more likely to have higher mortality rates. In another study, almost half of doctors admitted to the yielding to patient pressure by prescribing inappropriate medications.

  • Pill mills? Called Pain Management Clinics, many of these facilities are little more than fronts for drug dealers in white coats. And they’re profitable. In Florida – a state that prescribes 10 times more oxycodone pills than all other states combined – recently indicted six clinic owners and operators for conspiring to illegally dispense 660,000 doses of oxycodone, netting $22 million in profits. Unlike legitimate pain management clinics, pill mills will write prescriptions with little or no medical examination, often using falsified urine tests, and accept cash-only payments.

When Florida began passing laws to clamp down pill mills in 2010, within five years deaths from oxycodone dropped 69 percent. With pills no longer readily available, and prices being forced up on the street, many addicts moved onto heroin which is 1/8 the price. As a result heroin deaths in Florida more than doubled in 201412.

As it turns out, this moving from prescription drugs to heroin isn’t an unusual story: Four in five heroin users started out misusing prescription painkillers. Over the last 10 years, heroin use has spiked by 63 percent.

  • The users themselves? According to a recent poll11 respondents thought drug users were more responsible for the epidemic of opioid abuse than either doctors or pharmaceutical companies. Many surveys of public opinion show that a majority of people see drug addicts as dangerous, unpredictable, and, most of all, having only themselves to blame for their situation. Bottom line: The stigma of addiction persists.

Addiction is a disease – or a group of behaviors, if you’re not comfortable with that model – that acts like a mental illness. Opioids change the brain in ways that make drug-taking compulsive. Drug addiction is an illness of the will and of the self. It acts in ways that illnesses like cancer or diabetes don’t. It’s been said that with addiction it is harder to distinguish between the illness and the person. For instance, what other diseases include loss of judgment, self-involvement, poor impulse control, and irresponsibility? And this: Denial.

Some will realize the great damage their inflicting on their own lives and the lives of loved ones while others won’t see it. It’s easy to assume that those in denial are morally corrupted, lack discipline, have a deficiency of character, or are otherwise blameworthy – but that is the nature of addiction.

It’s not understood why some will take action to make themselves better and others won’t. It could be neurochemical, psychological, or environmental. It could be all of them, a combination thereof or something else. But like cancer or diabetes, not everyone is affected in the same way. This we do know: If addiction is not treated or dealt with, the conditions and the life of the addict will only get worse.

Saying Nope to Dope

Fortunately, not everyone is taking opioids for pain: According to NIH analysis, 17.7 percent of those chronic pain patients sought out treatments using natural products, 10.9 percent turned to deep breathing, and 10.1 percent practiced yoga, tai chi, or qi gong. There’s also massage, meditation, behavioral therapy, mindfulness-based stress reduction, multidisciplinary pain teams and others as possible alternative treatment strategies.

What Can Be Done?

The good news is efforts are being made, both by society and institutions, to address the epidemic. According to the Director of the National Institute on Drug Abuse (NIDA) Nora Volkow, a program of action is being taken on at the federal level13. These actions include traditional approaches such as expanding prevention education and more aggressive law enforcement aimed at doctor shopping and pill mills, to more innovative programs such as expanding distribution of opioid antidote naloxone, drug monitoring programs (PDMPs), abuse-deterrent formulations of opioids, and sending substance abusers to drug courts rather than criminal courts. A crucial component to this new approach also includes initiatives to reduce opioid overprescribing.

In states where these programs have been in use, the results have been encouraging. By reducing availability of the narcotic through these various means, deaths have been reduced.

If you or a loved one have an addiction to alcohol, contact BLVD Treatment Centers. At BLVD Treatment Centers we custom tailor our recovery programs within the safe and nurturing confines of our rehab treatment centers. Located throughout California, in Los Angeles, Orange County, San Diego and in Portland, OR, our mission is to assess the severity of your addiction to help you achieve true recovery within 30 days. Call us now at 1-866.582.9844.

Sources

  1. According to a study by the Center for Disease Control, in 2014 19,000 deaths were caused by prescription opioids – this equals 52 deaths a day.
  2. National Institutes of Health. NIH Analysis Shows Americans Are in Pain. Retrieved May 26, 2016
  3. Institute of Medicine Report from the Committee on Advancing Pain Research, Care, and Education: Relieving Pain in America, A Blueprint for Transforming Prevention, Care, Education and Research. The National Academies Press, 2011.
  4. Centers for Disease Control and Prevention. Vital Signs: Overdoses of Prescription Opioid Pain Relievers. Retrieved May 26, 2016
  5. Chang H, Daubresse M, Kruszewski S, et al. Prevalence and treatment of pain in emergency departments in the United States. Retrieved May 27, 2016
  6. National Sleep Foundation . Sleep in America poll. Retrieved May 27, 2016
  7. Daubresse M, Chang H, Yu Y, Viswanathan S, et al. Ambulatory diagnosis and treatment of nonmalignant pain in the United States, 2000 – 2010. Retrieved May 27, 2016
  8. 1 in 3 Americans Blame Doctors for Opioid Epidemic. Retrieved May 27, 2016
  9. Report Chronic, Undertreated Pain Affects 116 Million Americans. Retrieved May 27, 2016
  10. The Wall St Journal. A Pain-Drug Champion Has Second Thoughts. Retrieved May 27, 2016
  11. How Obamacare is Fueling America’s Opioid Epidemic. Retrieved May 27, 2016
  12. Florida Department of Law Enforcement. Drugs Identified in Deceased Persons by Florida Medical Examiners. Retrieved May 27, 2016
  13. National Institute on Drug Abuse. What is the Federal Government Doing to Combat the Opioid Abuse Epidemic? Retrieved May 27, 2016

Is the Burden on those Who Prescribe Opioids?