The United States is in the grips of an opioid addiction epidemic, and so far society has not seen any real, viable way to break this cycle. Right now the solution is the use of pain management doctors and pain management clinics that specialize in prescribing and monitoring the use of these types of medications. It’s one of those solutions that looks good on paper, but in practice it leaves a lot to be desired. This solution starts to fail the patient almost as soon as the words pain management are uttered by the original prescribing doctor. See, doctors that are NOT pain management specialists will get looked at hard by governing bodies if they feel the doctor is over-prescribing, or prescribing narcotic medications for too long. Therefore, these doctors are eager to refer patients that may require long term pain management over to clinics that specialize in this. Unfortunately for some patients, many doctors are over-eager, and feel that the minute the referral is made, their part is done. The cease prescribing these medications, sometimes abruptly, and leave patients that may have already developed an addiction with no clear way handle the gap between the last prescription and the first appointment with a pain management clinic. It appears, at least anecdotally, that these doctors feel no sense of responsibility for the addiction to medications that they prescribed to start with. Herein lies the a large part of the problem.
Deaths from drug poisoning, 2002-2014 per 100,000 people, by U.S. county.
In some areas, it can take as long as 6 months to get the first appointment with the pain management clinic or doctor. In that 6 months, the patient no longer receives the medications from the original prescribing doctor and is faced with going through withdrawals from the drug and the loss of pain control being provided as well. This double whammy to the patient can lead to behaviors they wouldn’t ordinarily have, such as doctor shopping, ER hopping, and finally street level drug dealers to bridge that gap. For those that choose to attempt withdrawing without medical help, the effects can be devastating, and even deadly. There is no clear win in this situation, and no clear way to address the problems faced by the patients that find themselves there. Unfortunately there is so much scrutiny being placed on physicians that the patient suffers in order to protect the doctor. While there are some willing to face that scrutiny, a calculated gamble for them at best, most are not. Sadly, the patient then becomes known as a drug seeker, or a problem patient. The local emergency rooms start flagging them, and it becomes a case of the boy crying wolf, because first and foremost, the patient will be seen as having a drug problem, and will be treated accordingly. Once the patient has traveled far enough down that road, and reaches the point of street level drug use, all bets are off. They never know for sure what they are getting, and can wind up addicted to other drugs as well. Then instead of facing the addiction to opiates, doctors are faced with addiction to unknown substances which complicates treatments for any malady. Again, no winners come from that scenario.
If a patient is fortunate enough to have a prompt appointment with a pain management specialist, with little to no lapse, then most times they are facing a lifetime of doctor sanctioned dependency on narcotics. While not all pain management clinics are guilty of this, the fact is that many merely regulate what the patient is already taking, and do not look for other solutions. These doctors and clinics are so overbooked that, in reality, that may be all they have time to do. Very few clinics see a point that their patients will be weaned off of the drugs unless the patient forces the issue themselves. The companies that manufacture these drugs see no problem with this approach, and why should they? This is a guaranteed revenue stream for them. In an age where the public has risen up and cried foul at the tobacco industry, demanding that they offer ways to aid people in the cessation of tobacco use, no such cry has been raised and maintained at the pharmaceutical industry. Narcotic use has been mainstreamed into our society as a whole, and our society has yet to see the inherent dangers from this mainstreaming. Until they do, pharmaceutical companies and pain clinics will continue to thrive, to the detriment of many patients. While not every single patient needs to be weaned off of narcotic medications, and for some, it will never be a viable option at all, for many patients it should be considered a top priority in their care. Sadly for now, it is not.
Doctors also need to be open to dialogue with their patients about this issue. Too many times, you hear that the patient feels like their doctor does not listen to them. It becomes a case of ‘What I said vs. what they heard.’ By and large, patients never claim to know more than their doctors about their diagnosis or treatment. What they do know more about is their bodies and their responses to treatments. Being told that a pain medication didn’t work isn’t necessarily a patient angling for a stronger drug, or a higher dose. It just means that it didn’t work. Alternative therapies are one of the most underutilized treatment options today, and yet many patients would be willing to try anything if it stopped the pain. It isn’t a lack of compassion on the part of the physicians. Mostly it is a lack of imagination in the inability to think outside the box they’ve trained in their entire career. Since there is little chance to change how the government interferes in health care matters, perhaps it is time to change how doctors are trained to deal with these matters. While the argument that nobody is born addicted can not be supported, the statement that nobody was born being a doctor can. Becoming a physician is a learned ability, and if a doctor feels there is nothing left to learn, perhaps they should no longer be entrusted to care for the lives of others.
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