Exiting the Highway to Hell, Which Healthcare Thoughtfully Paved with Good Intentions

The United States is in the midst of an epidemic; an epidemic you may not even recognize when it stares at you from across your dining room table, sits next to you at the office, or shops with you. You may not even recognize it when it sells its body in a flophouse, lays dying alone in an alley,  or dies upstairs in your own home.

The cost of the opioid abuse epidemic in dollars is staggering, but the cost in human terms is more than we can imagine, and certainly more than we can tolerate. On an average day:

Around 100 Americans die due to an opioid-related overdose.

Almost 4000 began abusing prescription opioids.

Slightly fewer than 600 begin using heroin.

Recently I had the opportunity to attend a meeting hosted by the Drug Enforcement Agency.  I am not sure which part of me was more curious about the presentation - the doctor or lawyer. The Agency was updating medical practitioners about the worsening trend towards opioid abuse in the United States.  I knew the problem was significant, but the presentation made clear the scope of this epidemic is staggering.  [The HHS has produced a handout about the epidemic. Check it out here.]

This epidemic is rooted in good intentions, and, sadly, these good intentions served to pave a superhighway to Hell for many.

At the meeting, we discussed a time in the 1990s when physicians were criticized for not prescribing enough narcotics. Physicians were criticized – and sometimes subjected to medical licensing board actions – for not prescribing narcotics to anyone who had the least bit of pain. Withholding pain medication was seen as cruel. Physicians and hospitals were pressured by society and credentialing organizations to prescribe more so that we could finally experience the better living through chemistry we as a society had long sought.

We had been part of a culture rooted in stoicism and accepting that some pain was inevitable in life. Suddenly we were encouraged to complain about every ache and pain – because finally there was a treatment for all our pains.  Narcotic prescriptions – and sales – shot through the roof. 

Aches and pains previously treated with Tylenol or some non-steroidal analgesic (or just ignored) were suddenly treated with potent narcotics. Physicians concerned about the addictive potential of these drugs were discounted as out of touch, uncaring, and somehow, of a lower standard than those with a lower threshold for prescribing potent painkillers.

Estimated Yearly Cost of the Opioid Epidemic

55 BILLION DOLLARS in health & social costs related to prescription opioid abuse

20 BILLION DOLLARS in emergency & inpatient care for opioid poisonings.

What we failed to understand was the addictive potential of these medications. We have learned – the hard way – that we cannot predict who will become addicted, or at what point they will be unable to resist the drive to consume more drug.  The mental effects of these drugs become an obsession for these individuals.  They organize their lives around obtaining their next dose of drug. Most make poor choices, unraveling their lives, and all too often, ending them.  

The DEA and the FBI have jointly produced an educational video which is shocking and disturbing, yet I consider it a vital educational tool for all of us. The censored version can be found here, and an uncensored version can be found here.  [Note: Both versions are very intense. Parents may want to preview these alone first.] One consistent theme I hear from so many DEA and FBI agents is their belief that prison is not the answer for this epidemic. They really believe prevention and treatment is the answer, but they must use the tools our laws make available to them.  

Far too many Americans do not realize the impact of prescription medications on this epidemic. It is not a disease of the poor or the mentally weak. It can strike where we least expect it. For many of us, the time bomb is already ticking in our medicine cabinet. That is where too many of us, and particularly our youth, start using and abusing opioids. . 

This is not a doctor problem. It is not a hospital problem. It is national problem. As a nation we must act to solve this problem.

Now is time for us to act, and tools like this presentation from law enforcement are but one part. As a nation, we must move away from our belief that we can eliminate all pain from life.  We must also make readily available rescue medication, such as naloxone, to treat overdoses. Addiction treatment is also a vital component of our response. 

Think about it the next time you have some little injury that your father or mother would have just ignored.  Is your pain really so bad that you need some pill to numb your mind and possibly start you on a deadly spiral? Or should you just suck it up, get back into the game, and get on with life?

I counsel my medical clients to be very careful when prescribing narcotics. It is far easier to defend refusing a patient narcotics than it is to treat an addiction or defend a death. 



Contact the Spiers Group to discuss this or other health care matters.