I try not to link to articles on sites that use paywalls, but I’ll make an exception for these two very recent Washington Post pieces. They’re both by physicians who work on the front lines of the opioid epidemic. Their backgrounds, however, are very different.
The first is from the medical director of a respected program for treatment of chronic pain. He believes that due to our wrong-headed desire to eliminate pain completely, we inadvertently laid the groundwork for what is now the nation’s worst-ever drug crisis. Without, unfortunately, making any progress at all in the management of chronic pain.
That’s a “lose-lose” outcome if ever I heard one. His thoughts:
I’ve often found myself wishing for accessible, affordable, effective alternatives to our historic dependence on opiates for pain. Handing out pills, however, is so darn easy and cheap that it’ll be a real struggle to replace — especially in the era of the 11 minute office visit. We did experiment with simply restricting availability, but that seems to send the addicted into the streets — vulnerable to crime, violence, arrest, and IV drug use. The latter leads to a host of serious medical problems, not least of which is AIDS.
That’s right — AIDS is a growing threat, courtesy of the drug epidemic.
At the author’s clinic, patients are taught self-management techniques which require time and dedication, something many patients resist. Even when behavioral approaches have been refined, we still face the usual barriers to getting practitioners to use them. I’m afraid our poor tired American healthcare system is better at excluding consumers than engaging them.
The second of the two articles looks at the problem from an entirely different direction: the potential for Big Business to exploit chronic pain for profit. Its author is a former pharma sales rep who did very well peddling painkillers before deciding to enter the field of medicine — where he encountered the victims of opioid addiction when they showed up in the Emergency Room.
He offers insight into how drug sales reps rationalize their role in persuading U.S. physicians to prescribe more and more opioids for more and different problems. Their focus is on pushing product, not patient care. They pursue glossy sales statistics and generous bonuses for record numbers of new users. I can’t help thinking of those bank employees who secretly opened thousands of new accounts in the names of unsuspecting customers, in order to qualify for some skeevy corporate incentives.
As one former drug rep explained, ethics never once came up in any corporate communication. It was all about the cash. “And once the sale’s made, it’s somebody else’s problem,” he shrugged.
Ironically, I met him in rehab, engaged in a desperate attempt to hang onto his job after having been busted for sampling his own product.
I guess you could call that karma.