Do doctors play a role in prescription painkiller addiction?
After a major surgery, doctors will often send patients home with a prescription for a painkiller. In the same vein, the United States battles an opioid overdose epidemic.
The Centers for Disease Control and Prevention reports half of all fatal opioid overdoses involve a prescription. For every opioid overdose death, experts estimate nearly 130 people abuse or have a dependency on these drugs.
"I've had grandmothers beaten up by their grandchildren. I've had neighbors come in with a knife and rob my patients of their prescriptions," said Dr. Palmer MacKie, M.D.
MacKie is the director of the Integrative Pain Program at Eskenazi Health in Indianapolis. He proclaimed to be a reformed opioid proponent until he realized the prescriptions he wrote wrought more pain than predicted.
"We would have little old ladies, sweet, little old ladies come in who were being coerced, forced, by their relatives to come in, report pain, report the pain increases, so they could get prescriptions that they could give to their younger relatives to either support their addiction or to sell it on the street," MacKie recalled. "These were my patients, and that's why I say, 'Mea culpa.'"
MacKie says he and his colleagues played a role in propagating opioid abuse and misuse.
"It is arguably the single largest iatrogenic epidemic -- the biggest medical-initiated problem that ever has appeared in the United States," he stated.
South Bend physician Dr. Robert Riley, M.D., weighed in.
"I think some physicians honestly haven't used all their skills in making appropriate judgments in who should and who shouldn't get which pain medications sometimes," he said. "I think we've learned though, over the years, is these are not particularly good medications in most cases for long term use become the downside becomes too significant."
The downsides of using prescription opioids include poorer health. A 2011 study published in The Clinical Journal of Pain found that the pain lingered longer with stronger prescription painkillers. Plus, patients reported worse quality of life scores in mental and physical health. That's compared to folks who forewent opioids to treat their ongoing aches.
Add to that, painkillers stymie the nation's economy. Misuse apparently cost Americans an estimated $53 billion in 2006 mostly due to lost productivity.
In some cases, doctors say opioids are appropriate to comfort palliative care patients and treat short-term pain.
"If you have jaw surgery or head surgery, there's no reason to allow that individual to just wallow in pain and misery," said Dr. MacKie.
"This is the worst public health problem, most consequential public health problem I've seen in 15 years," said Dr. Deborah McMahan, the Allen County health commissioner.
While McMahan maintains her colleagues are not the only culprits, she says physicians felt external pressure to placate patients over the years.
"You’re being pushed to control everybody’s pain," she said.
The epidemic dates back to the 1990s. Medical experts said doctors had too many patients complaining about excessive chronic pain. Drug companies swooped in. Meanwhile, MacKie said hospitals had high hopes pinned on the Hospital Consumer Assessment of Healthcare Providers and System (HCAHPS) questionnaire The Centers for Medicare and Medicaid Services (CMS) requires all U.S. hospitals to administer this patient satisfaction survey.
Results from the 2011 National Survey on Drug Use and Health (NSDUH) showed Indiana had one of the highest rates of non-medical painkiller use, ahead of California and Texas.
"[The opioid epidemic] may start with the pen and prescription pad, but everybody's got a role in this," said Dr. Deborah McMahan. "And until we see that, until people see their role and start doing what they can to change it, even the federal government, I don't think we're likely to be successful."
- Doctor shopping, numerous forthcoming appointments
- Atypical behavior (e.g. worsening work performance, not taking part in activities once enjoyed in the past, such as sitting down for dinner)