Who is Really to Blame for the Prescription Opioid Crisis

The opioid addiction and abuse crisis in America is still in full swing.  Few argue that this is a huge problem.  Drug overdose is the most common cause of accidental death in the U.S. and opioid overdose causes over half of these deaths.  Prescription opioid overdose deaths caused nearly twice as many deaths as heroin caused in 2014 (18,893 overdose deaths related to prescription pain relievers, and 10,574 overdose deaths related to heroin *)   I just read an interesting article by Ronald Hirsch M.D. that looks at who should bear the blame for this disaster.  A few of the major players leading to this epidemic are summarized here. To see the whole article read:

The Opioid Epidemic: It’s Time to Place Blame Where It Belongs

  • Purdue Pharmaceuticals: Producer of Oxycontiln(R) convinced physicians, hospitals and consumers that their sustained release oxycodone product was both safe and more effective at pain relief than older and cheaper opioids.  There is minimal if any data to support this claim, and yet their drug became a huge best-seller.  It also became known as Hillbilly heroin among other monikers.
  • Pain became the 5th Vital Sign:  At the calling of the American Pain Society and others controlling pain became a cardinal component of acceptable patient care.
  • JCAH Added Pain Control at a Metric:  In order to become certified to receive government payments from Medicare and Medicaid hospitals needed to meet JCAH published pain control guidelines.  This led to a more-is-better ethos in inpatient pain control prescribing.
  • Press Ganey and Patient Satisfaction:  Press Ganey began about 1985 to survey patients about their experience and this quickly led to equating satisfaction with quality.  There is substantial data that suggests that these are inversely related, but regardless the money of pay for performance, or pay for quality followed.  This was yet one more incentive to institutions to err on the side of too much rather than too little opioid use.

Physicians are a part of the problem, but Dr. Hirsch suggest that at least most physicians (excluding the few pill-pushing criminal physicians selling Rx for cash) were well meaning participants.

Also see prior DrPullen.com articles:

Opioid Abuse Remains in the News and In the Office

How to Spot a Drug Seeking Patient

Can’t Find a Doctor to Prescribe Pain Meds?

Overoutrage: The Right Way to Determine Healthcare Policy?

I came across a very interesting article today in The Health Care Blog by Saurabh Jah, MD titled Overoutrage and the Assymetric Skepticism of Healthcare Journalists. This addresses a concept I’d not heard of until now. Here is a quote from the above linked article: “Overoutrage is excessive moral outrage. Outrage is excessive anger. Anger is… Continue Reading

Blood Pressure: How Low is Low Enough

A new clinical trial published in the New England Journal of Medicine called the SPRINT Trial ( Systolic Blood Pressure Intervention Trial ) which compares standard treatment of hypertension to a goal of a systolic BP < 140 compared to more aggressive treatment to a goal of systolic BP <120 was published on Nov. 9,… Continue Reading

Editorial on PSA Screening for Prostate Cancer

If you’ve been following this blog for a while you may have noted a number of posts on the dilemma of overdiagnosis and PSA screening for prostate cancer.  We used to thing that all cancers has a common characteristic that once established they inexorably progressed, eventually becoming symptomatic and often lethal.  We now know that… Continue Reading

WHO: Red Meat, especially Processed Meat Causes Cancer

Although I believe the findings in the WHO report the conclusion of the WHO that eating processed meat, and even eating meat at all, causes cancer this information adds very little to my reasons not to eat meat. Some of you may recall from a prior post that I chose to eat a plant based diet… Continue Reading

It takes more than Ankylosing Spondylitis to Keep Guti Down

One of the very few good things about my beloved Seattle Mariners this year, besides Nelson Cruz crushing the ball, has been the call up of Franklin Gutierrez. Guti has been one of my favorite M’s over the years, and to see him struggle with his health concerns since 2011 has been really sad and… Continue Reading

The Mammograms or Not in Women 40-49 Controversy

As usual Dr. Kenny Lin, a former USPSTF member and prolific writer of “common sense” articles writes on how emotions rule rather than evidence and data when it comes to how people feel about breast cancer Check out his article: Countering the too neat narrative on screening mammography. Here are a couple of snippets for… Continue Reading

Personal Experience on a High Plant Based-Low Fat Diet

This post is unlike any I’ve put up over the years of DrPullen.com  It is largely anecdote and not based on enough hard data that I will convince my physician friends.  Intrigued?  Read on. My son Brett has been on a journey with his diet and health over the last few years.  He has become… Continue Reading

USPSTF “Strong” Recommendations for Preventative Services.

This article is the second in a series on the USPSTF recommendations to health care providers and U.S. residents on recommendations for preventative care services.  The previous article listed 16 “D” recommendations, i.e. things you should not do in an attempt to prevent health problems.  In that article I selected the most relevant “D”: recommendations,… Continue Reading