Madness, Death, and the Real Solution to Over-Prescribing Prescription Narcotics

Last month, the LA Times chronicled the stunning rise of deaths attributed to prescription drug overdose, particularly narcotics meant to manage pain. The push to control or manage all pain regardless of the legitimacy of the pain has made overdose from prescription drugs a bigger killer than heroin and cocaine combined, the story reported. 

Incidentally, a few days after the LA Times article was published, a blogger for the New York Times suggested one solution to drug overdoses, including those from heroin, might be to make naloxone (Narcan), a drug that can prevent opioids from reaching receptors in the brain, available over-the-counter.

That solution sidesteps the real problem: physicians are unintentially killing patients, a madness that has to stop. What is needed is a common sense approach to managing pain, not more plentiful, more available drugs.

Let me be clear. I am not advocating denying pain medicine to those in need of acute pain management. The issue is an unwillingness to address chronic painful conditions in a reasoned and rational approach. Patients with chronic conditions need management through personal physicians who will work with them long-term. Physicians need to explore and discuss what to expect with their patients when it comes to pain. A treatment plan needs to be in place. People need to understand that pain is a part of life and a pill will not remove it. And doctors, hospitals, and the health profession at large need to address the patients who bounce from ER to ER looking for narcotic pain prescriptions.

If the data shows that physicians are responsible for the rise in prescription drug related deaths than we as a physician community must address it. The data is clear, we have seen the enemy and he is us. According to a September article from the Chicago Tribune:

Drug fatalities more than doubled among teens and young adults between 2000 and 2008, years for which more detailed data are available. Deaths more than tripled among people aged 50 to 69, the Times analysis found. In terms of sheer numbers, the death toll is highest among people in their 40s… Overdose deaths involving prescription painkillers, including OxyContin and Vicodin, and anti-anxiety drugs such as Valium and Xanax more than tripled between 2000 and 2008.

And, this:

The rise in deaths corresponds with doctors prescribing more painkillers and anti-anxiety medications. The number of prescriptions for the strongest pain pills filled at California pharmacies, for instance, increased more than 43% since 2007 — and the doses grew by even more, nearly 50%, according to a review of prescribing data collected by the state.

The only reason we are seeing a rise in statistics such as prescription drug death is the significant increase in prescriptions physicians are writing.

Two particular causes of this phenomenon need to be understood:The push nationally to address and track pain as a condition for hospitalized patients has led to mountains of regulations and processes that encourage providers to medicate to get a better score from patients. Similarly, patient satisfaction is also a component and hospitals will soon be compensated on how happy their patients are with their care. These are all laudable goals, but taken to the extreme they have unintended, even deadly, consequences.

Over-prescribing narcotics also makes more narcotic pills available in the community. It is the opposite of the ‘herd’ effect we see with vaccines. (The more people are vaccinated, the less likely for a disease to be available in a community because the total burden of disease is less through less carriers of the disease.) The more prescriptions we prescribe, the more availability there is in the community. Whether that be to an individual patient or to Johnny or Sally searching their parents’ medicine cabinet to take a pill to a party or sell to one of their friends at school.

Unless we take a reasoned approach to the prescription narcotic problem physicians and society will have only one place to look for blame, the mirror.