Dover

When you have, NPR, The Guardian, New York Times, Vanity Fair and every other leftwing publications, in the US, blaming Purdue Pharma for Opioid deaths, it’s always a good idea to seek a second opinion (pun intended).

Purdue most certainly over-marketed that drug, but let’s not forget that there is a firewall between Pharma and the patient. They’re called doctors!

So to fulfill my duty as an American and a physician who practiced internal medicine for over 20 years and was faced with many patients with real pain and many drug-seeking patients, allow me to place blame for our current opioid crisis and provide a roadmap for further investigation.

First, in all fairness, I will start with physicians. We overprescribe opioids, just as we overprescribe antibiotics. But it is generally well meaning; we don’t want our patients to experience pain. But then we prescribe 30 or 60 pills when 5 or 20 would have been adequate. We do that because we are used to prescribing in multiples of 30; 30 days for a month supply of a once a day medication, 90 days for a mail-order prescription. Prescribing 6 or 10 pills will undoubtedly result in a phone call from a pharmacist asking for a round number of pills, taking up time better spent entering meaningless information into our electronic health record systems. It is the leftover pills that sit forgotten in the medicine cabinet which often lead to trouble, stolen by a relative or visitor and abused. But sometimes it is that prescription that was provided for true pain that leads rapidly to tolerance and addiction. Healthy Living magazine recently published a heart wrenching story of a woman whose life was nearly destroyed by two weeks of oxycodone prescribed by a well-meaning physician for arthritis.

The role of these physicians can best be described as innocent bystander. We were truly trying to help the patient. But there are also what are known as “pill mill” doctors who set up shop, accept cash as the only payment and are willing to prescribe to anyone for any ailment, real or feigned. One physician in my area was so bold as to meet his “patients” in a local coffee shop to exchange prescriptions for cash. Needless to say he is no longer licensed to practice medicine. Doctors such as these are criminals and need to be stopped. They cast a long shadow on the work of every other physician trying to help patients.

And then lookee here: From where the pressure to deal with management also came from.

At around the same time as Oxycontin’s approval, the American Pain Society, our third guilty party, introduced the “pain as the 5th vital sign” campaign, followed soon thereafter by the Veterans Health Administration adopting that campaign as part of their national pain management strategy. This declaration was not accompanied by the release of any device which could objectively measure pain, as was done with all previous vital signs, blood pressure, pulse, respiratory rate and temperature, making it the first and only subjective vital sign.

The Joint Commission also bought into this, earning a place on the list. In 2001 they issued standards requiring the use of a pain scale and stressing the safety of opioids. According to an article in the Wall Street Journal, The Joint Commission went so far as to publish a guide sponsored by Purdue Pharma on pain management. This guide reportedly stated, “Some clinicians have inaccurate and exaggerated concerns about addiction, tolerance and risk of death. This attitude prevails despite the fact there is no evidence that addiction is a significant issue when persons are given opioids for pain control.”

Pharma is there to sell meds. The firewall between the patient and pharma is the doctor and that’s where the real hidden blame lies.