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:
- 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: