According to Steven Tyler, singer of Aerosmith, doctors are to blame and equivalent to drug dealers when it comes to overcoming struggles with dependence. While Mr. Tyler does make some claims that make his statement a bit dubious (he readily admits that he did not stick to the recommended daily dosage), it does offer up interesting conversation – who is to blame for the recent increase in prescription painkiller abuse and the associated fatal overdoses?
A Problem on the Rise
It is obvious that prescription pain medication has grown beyond a simple problem. In fact, we can now officially label it as a crisis. Over the last two decades, the number of fatal unintentional drug overdoses in the United States has increased by more than 500 percent. The majority of these fatal overdoses are attributed to prescription painkillers. According to the statistics, the number of deaths because of prescription pain medication is now higher than the number of deaths related to cocaine and heroin abuse combined.
Perhaps even more problematic is the fact that we cannot trace most of these pills back to the ‘pill mills’ or to Mexico, but rather to doctors who prescribe them to patients struggling with pain. Well-trained doctors and conscientious physicians are (partly) to blame for the increased number of deaths attributed to these pain relievers.
How We Ended Up Where We are Now
The backstory is relatively straightforward, the medical community recognized as early as the 1980s and 1990s that patients who struggled with pain often did not receive the type of treatment they needed. The scientific term for the undertreatment of pain is oligoanalgesia – and this issue (rightly) concerned many people who were involved in day-to-day patient treatments. Studies suggested that if doctors did identify pain properly, they often did not treat it properly or even ask about it again. Perhaps even worse was the fact that affluent white patients traditionally received better pain treatment than patients who were minorities or a lower socio-economic class.
Understandably, medical professionals made a major effort in order to redress this oversight. Doctors were told to consider patients’ pain severity, to treat it almost as though it was a “fifth vital sign” that was previously overlooked, on the same page as body temperature and blood pressure. The next step was that both medical trainees and medical students were informed that when prescribed for legitimate pain, there was no possible way that a patient would ever become dependent on their medication. Finally, opioid pain medications such as hydrocodone (the active ingredient in Lortabs and Vicodin) and oxycodone (the active ingredient in Percocet) were framed as far safer alternative to NSAIDs (non-steroidal anti-inflammatory drugs) such as Vioxx, naproxen, and ibuprofen. These could trigger cardiac conditions and peptic ulcer.
Interestingly enough, the drug companies that were actively producing these opioid medications were the same forces behind the push toward opioids. Even though there were some patient-advocacy groups that clamored for this type of medication, studies found that these groups were often related to the drug company in some way or another.
A Shift that Went Too Far
Unfortunately, because of mainstream acceptance of opioid pain medication and a continued push from the pharmaceutical companies, the shift went entirely too far. The number of opioid narcotics that American physicians prescribed between 1999 to 2010 tripled in number. Unfortunately, children were not immune to this problem either, since the 1990s the number of opioid medications for children has doubled. While this seems excessive by itself, if we consider that across the nation, physicians in 2011 prescribed enough hydrocodone to keep the entire population sedated 24/7 for well over a month, that should put the shift in perspective.
An Increase in Diagnosis
Even though doctors now feel more comfortable than ever when it comes to prescribing these opioid painkillers, they are also more likely than ever before to diagnose patients with chronic-pain syndromes. If we exclude children, the Institute of Medicine estimates that almost one out of every two Americans suffers from chronic pain. Are we suddenly incapable of dealing with physical discomfort, is there something that causes everyone to experience pain, or is there something else going on?
It is difficult to determine exactly what may account for those massive numbers, whether it is attributable to the treatment side or diagnosis side. One thing we do know for sure, chronic pain traditionally starts as acute pain, whether it be because of surgery or injury. In order to combat the acute pain, many patients receive opioid pain relievers, but still experience pain.
Hyperalgesia: One Possible Reason
The reason behind this could be hypersensitivity to new pain caused by those very opioid prescriptions – also known as hyperalgesia. Between hyperalgesia and the body developing a tolerance, many patients often feel that they need more and more of the same narcotic in order to go about their day without pain. If we consider that the higher doses may disturb breathing patterns as the patients sleep and the combination of alcohol or sleeping medications, in addition to the higher doses possibly becoming fatal, we may have a reason that we are seeing an increase in fatal painkiller overdoses.
Adhere to the Medical Guidelines
According to medical guidelines, physicians must not opt for opioid medication for the majority of patients who struggle with chronic pain. However, it is also vitally important that physicians throughout the country no longer give out opioids for acute pain. Especially because acute pain may eventually develop into chronic pain.
Some people suggest that a solution is impossible, but this is untrue. A high dose of acetaminophen (like Tylenol) or ibuprofen (like Motrin or Advil) is proven to work as well as these prescription opioids, even for serious pain conditions such as gallstone attacks. In the event that these opioids are “necessary” for patients, it is important that they come with a massive warning that clearly states that even in short-term use, these drugs are highly addictive. It is important that doctors get away from the pressure from pharmaceutical companies and patient-satisfaction surveys and discuss patient pain honestly without pressure. Even though it may take a little longer per doctor visit, it is the only way that we are going to see a shift that will end up saving lives.