The Opioid Epidemic: It’s time to place blame where it belongs

Original Article from KevinMD.com

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The media is full of stories about the current opioid crisis. But unlike many national crises, such as the Flint lead-contaminated water crisis, the focus is on solutions and not blame. A few weeks ago, the Centers for Disease Control and Prevention issued guidelines for prescribing opioids in chronic pain, Congress approved funding for prevention and treatment, and the US HHS released a “National Pain Strategy.”

So to fulfill my duty as an American, allow me to place blame for our current opioid crisis. Allow me to start with physicians. We overprescribe opioids, just as we overprescribe antibiotics. But it is generally well meaning; we don’t want our patients to experience pain. Healthy Living magazine recently published a heart-wrenching story of a woman whose life was nearly destroyed by two weeks of oxycodone prescribed by a well-meaning physician for arthritis. These physicians can best be described as innocent bystanders. But “pill mill” doctors who set up shop, accept cash as the only payment and are willing to prescribe to anyone for any ailment, real or feigned, are criminals and need to be stopped. They cast a long shadow on the work of every other physician trying to help patients.

After the minor role of physicians come the real co-conspirators. First is Purdue Pharmaceuticals, the manufacturer of Oxycontin. Despite a lack of increased efficacy in treating pain compared to older medications, Purdue mounted an aggressive marketing campaign that included a warning from the FDA in 2003 over misleading advertisements. Physicians, including myself, believed Purdue and started using Oxycontin, thinking we were helping patients.

At around the same time as Oxycontin’s approval, the American Pain Society, introduced the “pain as the 5th vital sign” campaign, followed soon thereafter by the VA  adopting that campaign as part of their national pain management strategy. This declaration was not accompanied by the release of any device which could objectively measure pain, as was done with all previous vital signs, making it the first and only subjective vital sign.

The Joint Commission joins the list in 2001, issuing standards requiring the use of a pain scale and stressing the safety of opioids. According to the Wall Street Journal, they even published a guide sponsored by Purdue Pharma. This guide reportedly stated, “Some clinicians have inaccurate and exaggerated concerns about addiction, tolerance and risk of death. This attitude prevails despite the fact there is no evidence that addiction is a significant issue when persons are given opioids for pain control.” The Joint Commission framed pain as a patient’s rights issue, inferring that inadequate control of pain would lead to sanctions.

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