What we’re seeing now is an unintended consequence of a change in prescribing. Which doesn’t mean that the medical professions weren’t warned about the possibility, however — they were.

iStock_000010816304XSmallToday’s New York Times tackles the question of curbing prescription drug abuse. If you’re interested, here’s the link.

In a growing number of communities around the country (including mine), prescription drug abuse is now a bigger problem than illicit drugs. That certainly wasn’t the plan when physicians began lobbying for access to more potent painkillers for use with their patients. What we’re seeing now is an unintended consequence of a change in prescribing. Which doesn’t mean that the medical professions weren’t warned about the possibility, however — they were.

At the time, the argument was that patients who suffered from serious and persistent pain were undertreated due to unreasonable fears of abuse and addiction. We can argue about how ‘unreasonable’ those fears actually were, but there’s no question some patients did need stronger drugs for relief. As the result of some effective lobbying, newer and more potent painkillers such as Oxycontin were introduced into clinical practice.

It wasn’t long before we began to see problems. First, ‘mini-epidemics’ of Oxy abuse, among youth in the suburbs and rural areas. Back then they were associated with theft from pharmacies, or with outlaw pharmacists selling out the back door. That’s all changed. Current data suggests that many abusers and addicts get their drugs directly from a licensed physician, and they don’t even need to doctor-shop. We’ve actually made it easier to get in trouble with prescription drugs. As a result, more people are doing just that.

Addiction treatment programs weren’t immune. Accrediting bodies began to require that they assess patients for pain and treat as indicated — a challenge because so many addicts have already demonstrated their willingness to misuse drugs, prescription or otherwise. Much of the pain reported was chronic; it had been around for quite a while and lacked a clearly identifiable physical cause. Clinicians were forced to rely on patient report. Any addiction clinician quickly sees the problem with that.

There remains a large contingent of healthcare professionals who insist we are causing needless discomfort to millions of Americans through undertreatment of their pain. That could be true. But now there’s also a growing opposition based on those escalating overdose numbers. There will have to be some reconciliation between the two sides. I have no doubt it will be partly based on politics. I’m just hoping that in the end, it will actually make some sort of sense.

Prescription Drug Abuse Epidemic, Part 2


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