Opioid Epidemic

Every one’s excited about the “epidemic.” Recently I posed the question, “who cares?” As it turns out not very many people.

Let’s look first at the epidemic. Using CDC data we can see the rise in deaths from opiates:

opiate deaths

Wow, it seems that no one thought this was a problem until WHITE PEOPLE started dying. People of color either no how to use recreational drugs or simply don’t. The epidemic is a problem because it’s affecting the white middle class. Gosh, no we gotta do something. The death from opiates is widely expected to top 55,000 for 2016. That’s the equivalent of SIX people every hour, every day. What did the Federal government do? The CDC issued “guidelines” for prescribing. Many states have issued similar guidance- but it’s mostly voluntary. Prosecutions are rare and the penalties vary widely. State medical boards routinely fail to take meaningful actions.

The bottom line- doctors continue to be treated “special.”  They’re subjected to some additional scrutiny and “guidance” now that their actions have begun killing white people but they’re largely immune to discipline.

 

Who cares about opiates?

There’s an opioid epidemic. Oops. Maybe that should be a question. There’s an opioid epidemic?

Even if there is, who cares?

Doctors care. Not because of patients but because addiction pays. I can say with complete certainty that without payment no physician would be offering addiction treatment. The newest rage is Suboxone for “medication assisted treatment (“MAT”).” Suboxone, like methadone before it, is not a cure for addiction- no matter what The American Society for Addiction Medicine may say. These addicts are not recovering they are exchanging one addictive narcotic drug for another one. A different drug for which they need a prescription which can only be obtained by a licensed provider (physician, physician-assistant, or nurse practitioner).  The idea behind MAT is substituting one addiction for another. To put it in perspective it’s like treating an alcoholic with limited supplies of prescription beer. It’s like treating crack addicts with methamphetamine.

Doctors also care because they make money from each and every visit at which they write prescriptions. The price for a “suboxone visit” may be as high $500 and some providers only take cash. The rise of “pill mills” has occurred, not because doctors altruistically want to ease the suffering of people but because it pays. In short, cutting back prescribing cuts into business. Medical boards are hesitant to intervene because they are frequently run by doctors- the same doctors who make money prescribing. For example, Mississippi, with great fanfare announced the “Governor’s task force” on opioids in December 2016. Eight months later the task force has 41 recommendations. The few recommendation that have been released so far are similar to what other jurisdictions already have in place. It’s worth noting that the Governor specifically indicated that “here have been 95 overdoses to date this year in Mississipp.”

“Pain doctors” frequently run cash-only businesses with waiting rooms and parking lots filled to capacity with “unsavory” individuals. Pill mills are enough of a problem that there are instructions for how to recognize them. It’s not hard. See here, here, here, and here.  Some of my favorites:

334baa96-d56c-47eb-b128-40c018db4f64-large16x9_Capturepillmills-splash

 

Recent occurrences may cause doctors to re-think whether the income from opiate prescriptions is really worth it. South Bend, IN now has “groups working together to fight the local opioid epidemic.” It remains to be seen what “working together” will actually mean. It is, after all, only the providers (mostly doctors) who can stop the flow of unnecessary prescriptions.

More on the “opioid epidemic” later.