As I write this (in November 2017), the opioid epidemic is dominating the news reports.
The recent numbers are staggering – 90 Americans die every day from drug overdoses. That even dwarfs the (shamefully high) number – 35 or so – who die each day from gun violence. And it comes close to the equally shamefully high number of deaths from car crashes – about 100 per day.
Over the course of my career I’ve been a first hand witness to the entire arc of the opioid crisis.
It wasn’t always like this.
When I was first in practice, in the early 1980’s, AIDS was the biggest health news – abuse of prescription drugs was far down the list of important public health issues.
But that was soon going to change. It began with an innocuous sounding letter to the editor of the prestigious New England Journal of Medicine in 1980:
To the Editor:
Recently, we examined our current files to determine the incidence of narcotic addiction in 39,946 hospitalized medical patients who were monitored consecutively. Although there were 11,882 patients who received at least one narcotic preparation, there were only four cases of reasonably well documented addiction in patients who had no history of addiction. The addiction was considered major in only one instance. The drugs implicated were meperidine in two patients, Percodan in one, and hydromorphone in one. We conclude that despite widespread use of narcotic drugs in hospitals, the development of addiction is rare in medical patients with no history of addiction.
Hershel Jick, M.D.
Boston Collaborative Drug Surveillance Program Boston University Medical Center, Waltham, MA 02154
The authors didn’t describe their methodology; other researchers never followed up to corroborate their results. By today’s standards, the letter might not even qualify as having any scientific value at all.
But apparently the overly rosy view of prescription narcotics was the message many doctors were ready to hear. Opioids provided a simple solution to treating patients’ pain.
The publication of this letter was the beginning of a long downhill slide, resulting in the chaos our health system is dealing with now.
In the early 1990’s, I was a member of the New York Academy of Traumatic Brain Injury. This was a multidisciplinary group that held monthly educational meetings to foster cross-disciplinary thinking in the field of head trauma.
The featured speaker at one of the monthly gatherings was Dr. Russell Portenoy, head of the American Pain Society. His presentation was on how to block acute pain from becoming chronic pain with the aggressive use of pharmaceuticals.
Here’s a summary of Dr. Portenoy’s main points:
- It’s important to interrupt pain before it becomes chronic. Once pain settles into the brain, it creates reverberating, self-perpetuating circuits. Then pain is hard to get rid of.
- Opioids are actually safer drugs than one of the main alternatives, non-steroidal anti-inflammatories (NSAID’s.) NSAID’s are implicated in 15,000 to 20,000 deaths a year, primarily due to uncontrolled bleeding from a torn up stomach lining.
- You can safely prescribe opioids with little risk of addiction.
I was impressed by Dr. Portenoy’s presentation. I certainly found myself in agreement with his first two points. My own practice was focused on treating acute pain so that it wouldn’t develop into chronic pain. And I was well aware of the dangers of pain killer drugs.
What was excessively optimistic was Dr. Portenoy’s third major point. In fact, the opioids then being prescribed, and even newer versions (like Oxycontin), which in theory should have been harder to abuse, were too easily transformed into weapons of human destruction.
And, unknown to any of the meeting attendees, Dr. Portenoy’s lecture schedule was being financially supported by Purdue Pharmaceuticals, the company that developed and made billions of dollars from Oxycontin.
What’s more shocking is that Dr. Portenoy was only one small player in the massive investment pharmaceutical companies were making to push unsafe products on the American public.
Now the pendulum has begun to swing away from the indiscriminate use of opioids. Unfortunately, our medical system is so drug-oriented that many practitioners don’t have the imagination to understand the full potential of non-pharmaceutical pain approaches.
Pain is a complex phenomenon, with sensory, neurological, hormonal, psychological, and social components. Earlier in 2017 I had the opportunity to address a meeting at Robert Wood Johnson Medical Center on the topic of “Complementary Therapies in Pain Management.” I tried to illuminate the value of the hands-on treatment I offer pain patients within this multi-factorial model.
Although our knowledge base about pain and the potential of non-drug treatment keeps growing, it may be many years before we can reverse some of the ingrained habits developed under the hypnotic spell of large pharmaceutical companies.