Opioid Epidemic Knows No Boundaries

By now, we have heard about the rise in deaths related to opioid abuse. What many people fail to realize is that addiction usually starts with the street drug heroin. When injected, heroin induces a high that can last for a long time. It also is why many people choose to shoot up with it. When the supply runs out, they turn to opioids.

Oxycodone, OxyContin, Fentanyl, and other powerful pain medicines have surged into homes. Normally used after surgery to ease pain, these same drugs have found their way into the hands of corrupt doctors. These so-called pill mills churn out pain killers in large quantities. All it takes is a person faking a major injury to start the cycle of addiction. Once hooked, quitting is almost impossible.

Why is quitting almost impossible after a person is addicted? The reason is that opioids are more powerful than the average pain killer. This leads to needing more of the same drug to produce a high.

According to the New England Journal of Medicine and Doctor Anna Lembke, prescription opioid abuse is an epidemic. In 2010 alone, there were a reported 2.4 million opioid abusers in the U.S. alone. The number of new abusers had increased a staggering 225% between 1992 and 2000.

Over half of the abused opioids come from a doctor's prescription. In many instances, these same doctors are fully aware of the fact their patients are addicted, yet these drugs are still prescribed. In fact, many patients who are abusing these medications are not using them for the intended use or are diverting them to others who in turn get hooked.

Recent changes in the philosophy of pain treatment, cultural trends in attitudes toward suffering, and financial disincentives for treating addiction have only made the problem worse.

Over the last century, and especially as morphine derived drugs increased, a paradigm shift occurred. Today, pain management and treatment are every doctor’s responsibility. In today's society, treating pain is seen as the only option in modern medicine. There are other ways to treat pain without resorting to opioids right away. Tylenol and Non-Steroidal Anti-Inflammatory Drugs, or NSAIDs can be just as beneficial and have a lower rate of addiction.

When a physician colleague that Dr. Lembke knew was asked how they deal with the problem of opioid addiction in patients who abuse them, the answer was that sometimes the right thing has to be done and not give the opioids out. The physician also knew that this action could lead to a bad rating on Yelp. This leaves someone to wonder about the other times that opioids are intentionally given to abusers.

A cultural change has also contributed to physicians' dilemma that all suffering is avoidable. Some segments of our society believe that any kind of pain is a pathological indicator and amendable to treatment.

Some segments of society also believe untreated pain can cause a psychic scar leading to Post Traumatic Stress Disorder. Doctors who deny patients who report feeling pain may be seen as withholding relief and inflicting further harm through psychological trauma.

No one understands this better than addicted patients, who use their awareness of cultural narratives of victimization and illness to get their fix. One patient said that they knew they were addicted, but it was the doctor's fault for prescribing the opioids in the first place. “I will sue the doctor if I am left in pain,” the patient said.

The mainstays of treatment for addiction are both education and effective counseling, which take time.

Time spent with each patient is modern medicine's least valued commodity from a financial perspective. This is especially true in emergency departments, where physicians are usually evaluated on the number of patients seen rather than the amount of time spent with the patient.

According to the American Medical Association (AMA) and Dr. Patrice Harris, the epidemic of opioid addiction has continued to take victims. Those responsible for health care and policy are looking at ways to stop these needless deaths. As medical professionals, these people have a professional and ethical responsibility to end this epidemic.

The Centers for Disease Control and Prevention (CDC) recently issued a guideline on prescribing opioids. The AMA shares the CDC's goal of reducing opioid abuse and applauds the agency for making this a high priority. Specifically, the AMA is concerned about the CDC's recommendations for specific dosage and duration limits.

If the CDC proposals reduce deaths caused by abusing opioids, they will prove to be valuable. If not, the AMA will need to mitigate them. While the AMA shares the CDC's goal of saving lives and reversing the epidemic, the AMA will work with the CDC and other agencies to take steps in this direction.

In the meantime, countless patients come to emergency departments and doctors' offices every day reporting pain and receiving opioids despite known or suspected addiction to these powerful drugs. Health care providers have become hostages of the patients. The ultimate victims though are the patients themselves, who are not getting the treatment for addiction they both need and deserve.

On May 5, 2022, more than one dozen medical professionals across eight federal districts were charged with fueling the opioid epidemic.

The Appalachian Regional Prescription Opioid Strike Force carried out the raids. According to Assistant Attorney General Kenneth Polite, who was part of Wednesday's criminal announcement in Cincinnati, Ohio, over 75,000 Americans died last year due to opioid overdoses.

The defendants span seven states and account for roughly $7 million in opioid-related fraud loss according to the Justice Department.

One pharmacist in Florida allegedly sold 219,567 pills of oxycodone and 112,840 pills of hydromorphone on the black market between 2019 and 2021. In another case, an Alabama physician and a codefendant are accused of signing off on fraudulent prescriptions and medical bills for patients across three different medical clinics. And in Tennessee, a family medicine doctor allegedly ordered doses of opioids like hydrocodone and oxycodone for patients who did not need them.

In another case, a Kentucky dentist was charged with allegedly prescribing opioid pills without a legitimate medical purpose in August 2020. That month, the dentist provided three opioid prescriptions to a 24-year-old dental patient over a span of five days, prosecutors claimed. The patient later died from a morphine overdose allegedly tied to one of the dentist's prescriptions, according to the Justice Department.

“From January 2016 to September 2020, a review of just the dentist prescribing showed that they issued approximately 3,577 prescriptions for Oxycodone, totaling approximately 62,943 pills that were dispensed to patients," prosecutors also alleged in a recent court filing, prescriptions that they say likely fell "outside the accepted practice of dentistry." The dentist’s defense attorney, Robert McBride, did not comment on his client's pending case, which is set to go to trial later this month, according to court records.

The Appalachian Regional Prescription Opioid Strike Force has so far charged 111 defendants over three years. In all, those defendants are accused of prescribing 115 million controlled substance pills. One person dies from a drug overdose every 5 minutes throughout the United States, the Drug Enforcement Agency said Wednesday.

"These medical professionals…are operating no differently than any drug dealer," U.S. Attorney for the Southern District of Ohio Kenneth L. Parker said Wednesday. "They are simply donning white coats while they are prescribing dangerous levels of opioids."