Map of life expectancy at birth from Global Education Project.

Wednesday, December 14, 2011

Hillbilly heroin

I've kinda changed my mind -- kinda -- about opioid prescribing. I used to lean toward emphasizing that doctors are often too reluctant to prescribe opioid analgesics, that they can be a tremendous boon to people in chronic pain, and that a) short term use for pain relief seldom leads to addiction and b) if people who need them basically forever technically become addicted, who cares? Biologically, maintenance on a steady level of opioids can have some side effects, such as constipation, but people can function perfectly well and in fact better than they would in chronic pain.

But, as CDC reports here, we have a large and growing problem with prescription opioid abuse and the ultimate manifestation, that we can't look away from, is death by overdose. It turns out that by 2008, death from prescription drug overdose rivaled death from motor vehicle crashes, the leading cause of unintentional injury death (36,450 vs. 39,973). Since motor vehicle deaths are declining (due to socialist fascist nanny state regulations such as air bags, antilock brakes, etc.), and prescription opioid ODs are increasing, those lines will probably cross soon if they haven't already. (By the way, it's non-Hispanic whites who are at by far the highest risk. African Americans and Hispanics have much lower rates of death from misuse of opioid pain relievers. They're much more likely to end up in jail for drug offenses, but they commit them less often. This is another national scandal.)

However, I've only kinda changed my mind. As the linked report also states, it has been found that 3% of physicians account for 64% of opioid prescriptions, and there's plenty of evidence that most of this epidemic is linked to "Pill Mills" -- unscrupulous operations that hand out scrips without appropriate medical indication, evaluation, or follow up. Astonishingly, the governor of Florida, the state with the highest concentration of these operations, long resisted efforts to crack down. It's still likely that many physicians are withholding relief from some people who ought to get it. But we need to stop these criminals.


roger said...

"3% of physicians account for 64% of opioid prescriptions"

well they sure are busy. on the one hand, i see the public health dimension of ods, the effect on families and communities, on the other hand, stupid people kill themselves. is it wrong to hope they do so before reproducing?

so some stupid (users),greedy (docs) people abuse a useful medication, which may now be even further restricted for use by people who would benefit from it medically.

i certainly appreciated the morphine drip i had after abdominal surgery. i recall how awful i felt if i didn't push the button soon enough.

Cervantes said...

Yeah me too -- but I was also anxious to get off it as soon as I could, it made me stupid, itchy, and sleepy. That's what usually happens when people use it for pain relief -- they don't enjoy it, they just need it, and stop ASAP.

Daniel said...

Yep, I needed it too for my brain bleed. I was given Vicodin at discharge but didn't use it. I'm sure it wasn't as potent as the IV drip.

What I didn't know, until now, is that the constant itchiness I had could have been related to the opioid drip. The doc was cautioning me about shingles. Cervantes, you are a wealth of information.

Roger, kill themselves before reproducing? Are you getting jaded in your senior years?

roger said...

i don't recall itching. stupid and sleepy yes. and constipated.

Cervantes said...

Itching is a common side effect of opioids. Not everyone has it.

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