Overprescribing Doctors Chase a Lost Generation of Pain

 

 

 

“Doctors are prescribing like crazy.” 

-Dr. C. Richard Chapman, the director of the Pain Research Center at the University of Utah.

High-strength opioid painkillers represent the most widely prescribed class of medications in the United States. And over the last decade, the number of prescriptions for the strongest opioids has increased nearly fourfold, with only limited evidence of their long-term effectiveness or risks, federal data shows.
       

Consider that medical professionals have been on high alert for many years about the health risks associated with powerful prescription painkillers like OxyContin, and now the alarm is extending from street abuse to an arena in which the drugs had been considered legitimate and safe: doctors’ offices where they are prescribed — and some say grossly overprescribed. Studies link narcotic painkillers to a variety of dangers, like sleep apnea, sharply reduced hormone production and, in the elderly, increased falls and hip fractures. The most extreme cases include fatal overdoses.

 

Many medical professionals fear these opioids are being overprescribed for the following:

 

* Back Injuries

 

* Arthritis

* All Types of Non-Malignant Chronic Pain

* Mood Disorders and Severe Stress

 

Data confirms that hundreds of thousands of patients nationwide are on potentially dangerous dosages. And while no one questions that the medicines help countless patients and that most doctors prescribe them responsibly, there is a growing resistance to their creeping overuse.

 

Experts say that doctors often simply keep patients on the drugs for years and that patients can develop a powerful psychological dependence on them that mirrors addiction.

 

(Barry Meier, "Tightening the Lid on Pain Prescriptions,"

The New York Times, April 8 2012)

 

Meier reports:

 

"The federal Centers for Disease Control and Prevention has urged doctors to use opioids more judiciously, pointing to the easy availability of the drugs on the street and a mounting toll of overdose deaths; in 2008, the most recent year with available data, 14,800 people died in episodes involving prescription painkillers.

       

"The Departments of Defense and Veterans Affairs are trying new programs to reduce use among active-duty troops and veterans. Various states are experimenting with restrictions, including Ohio, which is considering following the Washington model.

       

“We are trying to prepare our state for what we hope is the inevitable curbing of the use of opiates in chronic pain,” said Orman Hall, the director of Ohio’s Department of Alcohol and Drug Addiction Services."

 

Pain expert Dr. Jane C. Ballantyne, in charge of pain treatment for more than a decade at Massachusetts General Hospital in Boston before taking a post in 2008 at the University of Pennsylvania, in Philadelphia, said she once agreed with Dr. Portenoy, but she now finds herself in the role of former believer turned crusading reformer.

      

“We started on this whole thing because we were on a mission to help people in pain,” she said of the medical profession’s embrace of opioids. “But the long-term outcomes for many of these patients are appalling, and it is ending up destroying their lives.”

      

Want a telling sign that opioids are destroying patients' lives? 

 

In 2006, Dr. Gary Franklin, a state official in Seattle, Washington, found something in thousands of workers’ compensation claims. He called together 15 medical experts to discuss some troubling data found in the records. Here are the findings:      

 

"Thirty-two injured workers who were prescribed opioids for pain had died of overdoses involving the drugs. In addition, in just a few years, the strength of the average daily dose of the most powerful opioids prescribed to patients treated through the workers’ compensation program had shot up by more than 50 percent. The number of patients taking the drugs in large quantities had grown to 10,000."

       

Of course, doctors often increase opioid dosages because patients can adjust, or develop tolerance, to the drugs and need greater amounts to get the same effect. Pain specialists had argued that it was safe to increase dosages so long as doctors made sure that patients were improving. 

 

Yet, Franklin concluded:

"It is possible that additional prescription opioid related deaths could be prevented by more intensive efforts to educate health care providers about opioids. Two years after implementation of the 2007 WA AMDG opioid dosing guideline, only 45% of WA primary care physicians responding to a survey reported being familiar with the guideline [Morse et al., 2011]. This indicates the need for more intensive educational efforts, perhaps including special emphasis on targeting opioid prescribing education to high-frequency prescribers."

 

(Gary M. Franklin M.D., "Bending the Prescription Opioid Dosing and Mortality Curves: Impact of the Washingto State Dosing Guideline," American Journal of Industrial Medicine)

 So, the Washington data suggested that doctors were not monitoring patients; they were simply prescribing more and more opioids. 

 

Dr. Claire Trescott, the official at Group Health in Seattle, believes such practices are common because treating pain patients, who are often also depressed or anxious, is time-consuming and difficult.

      

“Doctors end up chasing pain” instead of focusing on treating the underlying condition, Dr. Claire said.

 

Before the widespread use of opioids, the University of Washington’s medical school was known for an approach to chronic pain that emphasized nondrug treatments like physical therapy and counseling. Some specialists like Dr. Ballantyne, who moved here a year ago, are now determined to revive that tradition.

      

“If doctors understood how hard it is to get patients off of these drugs, they would not prescribe them to begin with,” Dr. Ballantyne said.

 

Dr. Ballantyne once embraced the wide use of opioids to treat chronic pain. But, about a decade ago, she became a skeptic when she noticed that hospitalized patients taking high dosages screamed when they were examined — as if the drugs had increased their sensitivity to pain.

 

She decided to research long-term data about the drugs and published a medical journal article in 2003 with her findings. It concluded that high doses might not be safe or effective.

 

(Jane C. Ballantyne, M.D., and Jianren Mao, M.D., Ph.D. "Opioid Therapy for Chronic Pain."

N Engl J Med 2003; 349:1943-1953. November 13 2003)

 

Now, Ballantyne has little patience for those who believe that the opioid problem can be solved simply by screening out those patients who might abuse the drugs.

       

“I think that after 20 years of a failed experiment that there are not many people supporting this except for the die-hards and the pharmaceutical industry,” Ballantyne said.

 

The Food and Drug Administration indicated in 2008 that it might require that doctors receive several hours of mandatory training in the use of opioids as a condition of prescribing them. But in 2010, the agency backed away from that stance in the face of opposition from some medical and patient advocacy groups. In addition, although the Obama administration announced plans last year to introduce legislation containing such a mandate, it has yet to do so. No mandatory training is presently required.

      

Few programs are in place to deal with patients now on high opioid dosages who are not benefiting from them.

 

If the patients were taken off the medications, many would experience severe withdrawal or have to take addiction treatment drugs for years.

 

Much to the horror of pain sufferers, even avid believers in the new direction, like Dr. Ballantyne, suggest that it might be necessary to keep those patients on the opioids and to focus instead on preventing new pain patients from getting caught in the cycle. Considering the danger of long-term treatment with opioids, this will surely mean deaths is close to many. How does this translate to Ballantyne?

       

“I think we are dealing with a lost generation of patients,” she said.


Sign this online petition to request that the FDA require doctors to have mandatory pain management training before prescribing opioids: http://www.change.org/petitions/f-d-a-commissioner-margaret-a-hamburg-require-doctors-to-have-mandatory-training-to-prescribe-painkillers

 

Big Pharma's Frankenstein Monster Unchained

"It is a farce to call any being virtuous

whose virtues do not result from

the exercise of its own reason."

-Mary Shelley

"Treating pain with opiates became the norm in the late 1990s,"

Orman Hall, director of the Ohio Department of Alcohol and Drug Addiction Services said.

Hall explained, "This not only increased the dangers of addiction,

but also of opiate-induced hyperalgesia,

or an increased sensitivity to pain."

"That switch in the 1990s was sparked

by a surge in direct-to-consumer prescription advertising.

Pharmaceutical companies’ ad spending

more than quadrupled from 1995 to 2000,

when about $22.5 million was spent," he said.

"This marketing effort led

to patients seeking certain drugs from their doctors."

(Pat Holmes and Deanna Pan, "Death Toll Drops In Drug War,"

The Columbus Dispatch, April 4 2012)

                                                                                                                            
If you really care about entering the fight against prescription drug abuse, you should study Mr. Hall's words very carefully. The language is very specific, but, on first reading, the meaning is likely to breeze past your ears like another insignificant sound bite. Why? Our nation has been willingly desensitized to pharmaceutical-induced destruction. Big Pharma, mass media, and, yes, gullible and greedy medical professionals have successfully numbed the senses of Americans by over treating their pain.

I know this sounds like the rantings of a lunatic bent on jousting with deeply ingrained, cherished institutions. And, I realize that any efforts I make toward revealing the underbelly of the beast are likely to be in vain; however, please consider some addition statistics from the Centers for Disease Control and Prevention:

* The quantity of prescription painkillers sold to pharmacies, hospitals, and doctors’ offices was four times larger in 2010 than in 1999.

* Enough prescription painkillers were prescribed in 2010 to medicate every American adult around-the-clock for a month. Although most of these pills were prescribed for a medical purpose, many ended up in the hands of people who misused or abused them.

Hall, himself, tells of a staff member taking his son for treatment of a sore throat. The patient received a prescription for medicine to treat his throat and one for an opiate painkiller. Stories like these are commonplace in every community in the United States.

Ohio State Senator Dave Burke, a pharmacist who sponsored last year’s pill-mill bill, said,

“We started down this path where patients joined up with the (pharmaceutical company).

That matured significantly in the 2000-to-2010 window,

where people developed arts of deception realizing physicians

would do as you asked them to do

because they’re just trying to help people."

He added, “And until you know you’ve been deceived,

you don’t know you’re being deceived. ...

The physician and the pharmacists no longer acted in collaboration.”

Richard Whitehouse, executive director of the Ohio State Medical Board, stated, “Despite whatever background or experience, folks may still not appreciate the addictive properties of these medications. Governor of Ohio John Kasich said the next step for Ohio should include redefining the treatment of pain. “Long term, we’re going to need the medical schools to begin to instruct physicians about the way to use these highly addictive drugs,” Kasich said.

Burke agrees. “If we’re going to treat this as a disease, then we need to treat it as a disease,” he said. “We’ve got to legitimize the art of pain treatment and management."

The biggest, seemingly insurmountable problem, is to put reins on distribution. Of course, this means taking on Big Pharma and simultaneously re-sensitizing the American public about pain itself. This, folks, is something few seem willing to tackle. Why? Just consider the unpopularity of any effort that has, at its core, the goal of redefining and controlling pain management.

America in the 21st century seems to echo Shelley's Frankenstein monster in its simple understanding of such a cerebral issue: "Pain... Bad! Pill... Good!" While medical schools have instructed doctors to treat patients with extreme compassion and never under treat pain, the doctors have responded by putting far too much faith in the good intentions of both pharmaceutical companies and their self-diagnosing, commercial-fed patients. Now, people go to doctors and convince the professionals to script them popular opiates.


The source of the problem is not the Frankenstein monster -- in this case, an addicted legion of its maker. The monster is an opiate-dependent public.

Dr. Frankenstein -- in this case, Big Pharma, is the maker and the source of the national epidemic. Read the history for yourself. What are the duties of the creator towards its "creature"?

In Mary Shelley's novel, when Victor Frankenstein understands that his monster causes the destruction of everyone dear to him, he realizes he must destroy it. The creation of Frankenstein's monster is presented as an unsurpassed feat of scientific discovery, yet one which brings sorrow, terror, and devastation to mankind. Frankenstein, like Big Pharma, is simply a bad parent. He bestows life upon his "child," yet refuses in any way to care for it.


We can forever debate that "the pill" is just "an inanimate object" until the dependent, himself or herself, takes the willing action to consumes it. This blame game will not help solve the problems of rx drug abuse. And, this mindset will not save the lives of millions of innocent future addicts. It's time to put the blame exactly where it belongs.

I've said this many times before: Look into your mirror to begin the steps toward needed change. You see the one thing you control that can effect change in a very ill nation -- your face. As you place "your face" in person, in words, in some active movement for reform, you begin to eliminate the cause of the epidemic. This problem requires the efforts of millions of "faces."

Yes, I believe you and I caused this terrible scourge to happen. We did it by complacently sitting for decades in our pain free environments until the entire medication-dependent culture became so immense and entrenched that it grew out of control. Even after we knew the scope of the problem, we chose to trust those in charge of our meds with blind faith and, instead, blame the junkies and the drug cartels and the street dealers and the devil and whoever else we could scapegoat for the cause.

It is up to you and me as individuals to tackle what we have let prey upon us all. I honestly believe that greed and the need for powerful influence have driven Big Pharma to use us and to abuse us. Unless we come together, en masse, as a caring, committed public, we will continue to be in the comatose state of passive acceptance. New and more powerful medications sit posed to reap the huge profits of the market.

We should assemble and march on Washington to convince those in charge of the nation's regulatory bodies to legislate adequate controls and restraints. How many more prescription drug deaths and dependencies and addictions? How much longer must we be under the hold of those whose only concern is profit and/or power?  Are you still looking into your mirror? I wonder if anyone is smiling?