***Update: August 23, 2013: It has been brought to my attention that a list has been compiled of doctors who are suspected of recklessly prescribing opiate painkillers. Lee Weber from AddictionBlog.org pointed out an article from the LA Times that discusses how Purdue Pharma – the maker of Oxycontin – identified approximately 1,800 doctors that the drug maker listed as “suspicious.” This confirms what we already know: that there are some rogue doctors out there tainting the system. But what it also tells us is that Big Pharma is aware of the problem. However, according to the LA Times article, Purdue Pharma reported just 8% of these “suspect doctors” to the authorities. The rest were allowed to continue writing prescriptions.***1.) This is Not a New Problem
What is prescription drug abuse? It’s really opioid abuse, when you get right down to it. Keep that in mind when you consider that every headline about this issue usually features the much-hyped term “epidemic” when referring to prescription drug abuse rates in the United States. But by its very definition, the word ‘epidemic’ is associated with a specific period of time; meaning, for something to be an epidemic it must have been widespread and fairly sudden.
The fact of the matter is that the prescription drug problem is largely associated with addiction to opioids, which can hardly be considered an epidemic. Why? Man has been addicted to opiates in one form or another for at least several thousand years. (1) It is an ancient part of what makes us human; dating back through the Egyptians, the Sumerians, and into the Neolithic era.
Consider also that in America’s recent past opium-based medicines and products were the norm and were found in nearly every household in the country. This included opiate products for children. Addiction was a significant problem during this era, and there’s still a resident generation that remembers these times and can recount them clearly.
The history of human addiction to opiates is long and storied and includes a couple of major wars between powerful nations over the drug. So are we then to believe that it is only in the last 30 years that our highly advanced medical professionals have suddenly spawned something new; some vast and rash infection of addiction that can only be termed an “epidemic?”
The answer is no, and we need look no further than our own history to see that little has changed. This is not a problem caused by doctors, physicians and psychiatrists; it is an intrinsic affliction of man and it infects all levels of society.2.) Just do the Math
All it takes is a little bit of basic math to figure out that doctors are not to blame for American’s prescription pill addiction. For instance, the 2009 National Survey on Drug Use and Health found that 70% of people who abuse prescription drugs acquire the medications from friends or family members. Another 5% obtain their prescription drugs from illicit street dealers and clandestine online pharmacies. (2)
This means that of the total number of people who abuse prescription drugs in the United States, 75% of them do not acquire their pills from doctors at all. So for those who claim doctors are to blame for this supposed (but not) epidemic, the best figure that can be quoted is that doctors might be about 25% responsible.
However, as the rest of the arguments here will prove, that’s not accurate either.3.) Drug Addicts are Professionals, too
Now let me tell you a little something about myself. I am a recovering drug addict. I spent years drinking and snorting my life away until I lost everything and almost died. After getting clean I began helping other addicts find their own paths to recovery. Eventually I became a CAS and a Board Certified Interventionist. More than 10 years ago I founded a drug rehab center that is thriving today, and I’ve seen literally thousands of addicts and alcoholics come through our doors in search of a better way to live.
The point is that when it comes to addiction, I’ve seen it all, and chances are that I’ve probably done it all as well. And even after all these years and all the people I’ve seen get clean, relapse and get clean again, there’s no doubt in my mind that an active addict is the most impressively convincing salesperson you will ever meet. Not all of them and not all the time, but here’s my point: if an addict has set their focus on obtaining a prescription, they’re going to get it despite even the best attempts of doctors at preventing this.
Addicts will lie, steal, connive, forge evidence, fake symptoms, forge medical records, fake credentials, conduct intensive research, concoct elaborate plans and have the cojones to follow through with them. An active addict is often as good at their job of drug seeking as a surgeon is at repairing the human body, and it is the doctors that doubt this who are likely duped most often.
So before you go pointing the finger at doctors, physicians and psychiatrists, let me just assure you that addicts will go to incredible lengths to get their fix, including appearing well-presented, likeable and extraordinarily convincing.
So with U.S. doctors up against two groups of people:
1.) Those with legitimate pain problems
2.) Those with addictions that expertly mimic pain problems
How is this distinction made accurately and effectively every time, and furthermore how can we blame the doctors when a criminal commits a crime that in reality the doctor is a victim of?
The blame game in this regard is backwards.4.) Prohibition Never Stopped Anything
Tighter restrictions on prescription pads have already occurred and continue to be adopted, but the fact of the matter is that restrictions and prohibition in regard to drugs of any sort has never worked. This is especially true considering that only 25% of the people who abuse prescription drugs actually get them from doctors. (2) In other words, 3/4 of the people who abuse prescription drugs get them illegally from sources outside of the medical setting, which is of course a felony in every state and at the federal level.
In even simpler terms, 75% of people who abuse prescription drugs do so despite complete nationwide prohibition.
Even with some tight measures already in place, the “epidemic” figures cited by those who blame doctors for the U.S. prescription drug problem indicate that about 15,000 people overdose and die each year on prescription painkillers (opioids). (3) But based on the 2009 NHDUH survey we can logically conclude that only 3,750 of those deaths can be attributed to people who obtained prescriptions from a doctor and not a drug dealer, friend or family member.
Compared to the number of deaths from other causes, such as the 26,000 “unintentional fall” deaths each year (4), these numbers don’t seem to indicate an “epidemic” status warranting the harassment, berating and classification of doctors as somehow directly responsible for the problem.
Because prohibition won’t stop the demand for opiates, placing restrictions on doctors and subjecting them to severe punishments such as those suggested by Nevada Senate Bill 75 (which will hold medical professionals accountable when people become addicted to prescription drugs) is only going to make things worse. Doctors will no longer practice medicine based on the legitimate needs of patients; instead, they’ll practice based on fear, and the level of care in this country will likely plummet as a result.5.) Doctors Have Already Taken Extraordinary Measures
The majority of US physicians are aware of and deeply concerned by the prescription pill addiction problem, and responses have been varied across the country, ranging from improved patient surveys and questionnaires to complex medical reporting and prescription drug databases.
However, the fact of the matter is that American doctors have long been responsive to the needs of patients in regard to pain management. As Dr. Zachary Meisel and Dr. Jeanmarie Perrone point out in a 2012 article for Time, the medical community was barraged with pressure from a number of different groups and organizations – including patient advocacy groups – in the 1980’s and 1990’s to significantly “step up” pain management programs. The general idea at the time was the opposite of today’s dilemma, with people of the era believing that medical professionals were not doing nearly enough to treat legitimate pain. (5)
Doctors responded to the pressure and by the following decade the number of opioids prescribed in the U.S. tripled. (6) But since the early-mid 2000’s doctors have been pressured to reverse these practices and tightly restrict the number of painkiller and other prescriptions they issue. In fact, entire databases and recording systems have sprung up in recent years, nearly always with the support and assistance of medical professionals including pharmacists, technicians, doctors, dentists, psychiatrists and others.
For instance, consider the 125 physicians who petitioned Capitol Hill to require them – the physicians and their peers – to have access to and attend specialized training to prevent if possible, treat when necessary and report where applicable any instances of prescription painkiller abuse and addiction. (7) Or consider the slew of San Diego doctors who just last week registered for California’s prescription drug monitoring program (8), and the countless others who are registering for similar programs across the country.
The truth of the matter is that physicians in this country have been and continue to be extremely flexible and responsive to the needs of the people, despite the fact that this same group is being attacked and blamed for a problem that is in reality the result of an extremely high demand for drugs by U.S. citizens.6.) The Proof is in the Innocent
If you need any further evidence that doctors are not to blame for the U.S. drug addiction “epidemic,” just look to the growing numbers of patients with legitimate medical conditions who are largely unable to obtain the treatment and medication they need thanks to significantly tighter controls on the part of doctors. With more and more doctors operating out of fear of liability and potential consequences, people who really need assistance with pain management are being given fewer or no options whatsoever.
In an article for KevinMD, an anonymous Emergency Department doctor known as “Dr. Whitecoat” writes about the many legitimate pain patients and the difficulties they experience when attempting to find treatment that works. The author perhaps sums up the direction this blame game is going in when he (or she) said:
“Doctors can’t get sued if they don’t prescribe the pain medications.” (9)
And this is likely the direction that we’ll continue to go in, until people realize that despite forcing the hand of our physicians, little to nothing will change in the severity of the opiate addiction problem in the U.S. I can tell you this as a former addict and as a current treatment specialist: doctors are not to blame for the prescription painkiller addiction problem. Demand for drugs, demand for the next easy high and demand for a constant state of placation and medication is to blame, and that demand is older than even our most ancient of medical institutions.
Focusing the blame on doctors will only delay the inevitable focus on our own human nature, but this is typical of our impulsive society; and impulsivity is the hallmark of true addiction.
(1) Brownstein, Michael J. A brief history of opiates, opioid peptides, and opioid receptors Laboratory of Cell Biology, National Institute of Mental Health, Bethesda, MD Proc. Natl. Acad. Sci. USA Vol. 90, pp. 5391-5393, June 1993 Accessed 04/27/2013
(2) Substance Abuse and Mental Health Services Administration Results from the 2011 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-44, HHS Publication No. (SMA) 12-4713. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012. Accessed 04/28/2013
(3) CDC Vital Signs Prescription Painkiller overdoses in the U.S. Centers for Disease Control and Prevention http://www.cdc.gov/vitalsigns/PainkillerOverdoses/index.html
(4) Accidents or Unintentional Injuries Centers for Disease Control and Prevention
(5) Meisel, Zachary F., MD and Perrone, Jeanmarie, MD Are Doctors to Blame for Prescription-Drug Abuse? Time Ideas 11/26/2012 http://ideas.time.com/2012/11/26/viewpoint-prescription-drug-abuse-is-fueled-by-doctors/
(6) Morbidity and Mortality Weekly Report Vital Signs: Overdoses of Prescription Opioid Pain Relievers — United States, 1999–2008 November 4, 2011 / 60(43);1487-1492 U.S. Centers for Disease Control and Prevention http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6043a4.htm?s_cid=mm6043a4_w#fig2
(7) Kane, Jason Doctors Tell Congress How to Rein in Prescription Drug Abuse PBS News Hour June 30, 2011 http://www.pbs.org/newshour/rundown/2011/06/doctors-tell-congress-how-to-rein-in-prescription-drug-abuse.html
(8) Murphy, Susan San Diego Physicians Tackling Prescription Drug Abuse KPBS News April 12, 2013 http://www.kpbs.org/news/2013/apr/12/progess-san-diego-physicians-tackling-prescription/
(9) Whitecoat, MD The cost of blaming doctors for prescription drug abuse KevinMD.com JANUARY 31, 2013 http://www.kevinmd.com/blog/2013/01/cost-blaming-doctors-prescription-drug-abuse.html