The Narcotic Death Epidemic

Is it driven by addiction or by the chronic pain epidemic?

I am a general surgeon but many of my patients have chronic pain caused by hernia mesh. Narcotic pain medication is an essential tool in the treatment of chronic and acute pain. Are these medications being abused? Probably, but I believe that the legitimate need for these medications has been under appreciated. My concern is for patients with a legitimate need and for patients with persistent chronic pain. From my perspective the Government and the Media has it wrong and will end up hurting innocent patients.

In 2015 there were 33,000 narcotic related deaths in the US. Half of these involved prescription medications.Pain, dispair and suffering Each year there are 200 million prescriptions for narcotic pain medication in the US. Sounds like a terrible epidemic with an obvious cause according to our Government. The media is running with this story like it is real news and settled facts.

Loss of human life is tragic no matter the cause. But to accurately assess the problem and not change public policy prematurely with serious unintended consequences we have to keep in mind patients with chronic pain and patients having surgery in mind. There are 100 million patients in the US with chronic pain. There are 100 million patients in the US undergoing surgery every year. When you look at these raw numbers that is only one prescription per patient per year with a legitimate need.

Narcotic deaths are most commonly attributed to accidental overdoses. I suspect this is wrong. It is very likely that narcotic related suicides are under reported. The answer to this question is very important. If we ration pain pills in an attempt to control illicit use we may be making things much worse for a lot of patients with chronic pain. Already big pharmacies like CVS have announced that they are taking proactive steps and will not fill any narcotic pain medication for more than a week supply. Most patients in chronic pain have already experienced isolation, confusion and despair because of lack of their doctors', family's and employer's understanding their pain. Pain patients have been stigmatized as narcotic pain medications have. This worsens isolation, depression and suffering and ultimate leads to despair.

The state of Colorado sought to control illegal sale of narcotic pain medication by stopping the practice of doctor shopping. Patients doctor shop to get a new source of pain medication when their previous doctor starts to ration them. The result was that the number of prescription narcotic related deaths went way down but the number of heroin related deaths went way up.

Should a patient with chronic pain who seeks relief from their pain in oblivion who achieves it with narcotic pain medication be considered an accidental over dose. I don't think so. For one thing I think we as a society are responsible for these deaths. To call them accidental overdoses is to dismiss them as not our fault. We should be doing a much better job at treating patients with chronic pain. We should have much more compassion for patients with chronic pain.