The Centers for Disease Control and Prevention recently reported that physicians' prescribing practices have finally caught up with us in a big way. In 2009, the annual number of deaths (37,485) caused by improper/overprescribing and poor to non-existent monitoring of the use of tranquilizers, painkillers and stimulant drugs by American physicians now exceeds both the number of deaths from motor vehicle accidents (36,284) and firearms (31,228). Deaths from street drugs during 2009 were vastly less than those caused by prescription drugs. Medical doctors are leaving regular drug dealers in the dust.
Every 14 minutes one American is killed by prescribed painkillers and psychiatric drugs. The number of "anxious" people or prescription tranquilizers taken by "anxious" people for "anxiety" has jumped 286 percent between 2000 and 2009, and should reach 341 percent by the end of 2011. Really. The prescription of stimulant drugs, amphetamines and methyl-phenidate -- Adderall and Ritalin -- has skyrocketed. The U.S. now consumes 86 percent of these drugs worldwide. The prescribing of painkillers, the leading killer, has also risen dramatically, 328 percent, during this same time period. Vicodin kills the most pain and people, and is the single most prescribed medicine on the face of the earth.
The vast majority of these 37,485 deaths were not caused by intentional suicide. Causes of death range from overprescribing, over-usage, not following the prescriptions directions, drug mixing, mixing drugs with other substances such as alcohol, accidentally doubling doses, replacing doses thought to have been missed, etc. Because of overprescribing, the streets are awash with prescription drugs, which bring lots of money. We doctors have inadvertently created a vast black market for all of these prescription drugs. A prescription of 20 Vicodin pills, for example, perhaps purchased through insurance with a very minor cash outlay, is worth about $1,000-$2,000 on the street -- a nifty profit. Pain relievers (Vicodin, etc.), tranquilizers (Xanax, Klonopin, Ativan, Valium), stimulants (Adderall and Ritalin) are all easily obtainable on the street, although at very high prices. Interestingly, the cost of these prescription drugs on the street are considerably higher than the cost of heroin and cocaine.
Information is not available on which disciplines of physicians prescribe which of these drugs. Some inferences can be drawn. Painkillers, for example, according to the CDC, are the most dangerous of all these drugs. They are usually not prescribed by psychiatrists but by other physicians. Psychiatrists usually prescribe tranquilizers and amphetamines, as well as other drugs not identified by the CDC as killers (anti-psychotics, mood stabilizers, antidepressants, etc.) Other physicians also write prescriptions for tranquilizers, antidepressants, amphetamines and painkillers. Which disciplines in medicine prescribe the most of the drugs that cause the most unnecessary deaths isn't clear. Realistically put, however, all us physicians are in this together.
The only specialty group of which I am a member, psychiatrists, is the only one about which I have direct knowledge. We are major contributors to the prescribing of many of the drugs the CDC has identified as killers: tranquilizers and stimulants. We are the 5-15 minute drug-check prescription writers.
We have other drawbacks. We nearly always lack the type of knowledge other physicians have. A cardiologist, for example, can identify a "heart attack" by history, physical exam, blood, electrical and X-ray tests and take appropriate, scientifically-proven treatment measures and measure the results of these tests. We surmise based on patients self-evaluation and our discussion with them, diagnose, and then write prescriptions. Having been "diagnosed," discussions with the psychiatrist, minimal at first, become shorter and shorter. The patient comes in for a med check and only a few minutes later emerges with his new prescription, maybe with an increase, decrease or maybe a drug change or addition. Not good at all.
What to do? Least we all run all psychiatrists, including me, and other physicians out of town, let us remember that the vast majority of physicians, psychiatrists included, are ethical and moral beings and generally do a world of good for the vast majority of us. The very large majority became physicians to help people, hardly to hurt them, let alone kill them.
There's a lot we can do. As physicians, we can be better educated, more aware of the very serious prescription drug problem that we propel, intentionally or not. We can have higher thresholds for prescribing, be much more cautious, write generally for less, talk more and educate our patients. We need more education on the illicit use of legal drugs. The DEA needs to be stronger and more aggressive. More backbone to say no wouldn't hurt.
The pharmaceutical industry certainly doesn't help, although one would be in dreamland to expect them to try to sell less drugs and make less money. They do their best to make more drugs, promote them, sell them, encourage their use, find new uses for drugs and make profits. Societies' woes fatten their wallets.
Let's not leave us out. Us civilians. We also drive the problem. We are a pill-crazed society. We want pills. We have to want less. The war on drugs didn't work. Efforts at education about drugs usually fall deafly on the ears of the deaf and are welcomed by the ears of the already believers -- preaching to the choir. Will we respond better to the horrendous information about prescription medication misuse than we did and do to information about illicit street drugs?
"We have met the enemy, and it is us." -- Pogo
Follow Ronald Ricker on Twitter: www.twitter.com/RonaldRickerMD
Anxiety Health
Antianxiety-drugs.com
This blog itself is close to over. It will slip down the left margin of the page, reach the bottom, and drop into the oblivion of blogs.
The blog itself was at best a starting point. Where everyone went, the thoughts that were created and advanced, the beauty of their crafting, all take my breath away. I know how long it takes me to think and write. Many of you are surely faster, yet the content of your writings are both inspirational, thoughtful, beautifully written and hope filled.
The quality and content of your comments have contributed mightily to my already present awareness of the magnitude of the problems we face in our medical care system. If there were, in my profession, dialogues with the quality and perception you offer, we would all be far the better for it. The obvious duty of doctors to talk to patients, know their patients, talk and co-ordinate their work with each other, be aware of prescribing problems, while a huge problem for professionals, is no problem at all for you.
I know I will, but I hate to lose you. The ongoing, driving, now satisfied Sisyphus, pushing the ball over the crest effort is what is needed to move our failing system. Make no mistake, our medical care system is failing and the seeds of further destruction are firmly rooted.
Thank you
RER
When you say over prescribing is responsible, you should make it clear this is not a matter of people who didn't need the drug taking it and dying. The problem is doctors prescribing meds to people who get them so they can make money by selling them.
For example, someone who was in an accident and had to have surgery on his shattered femur might be a valid candidate for Vicodin. But maybe that person decided he'd rather stick to naproxen sodium and marijuana instead of taking addictive pain killers, and his pot dealer offered him an ounce of weed in exchange for the pills. He then has a reason to get the refills, and tell his doctor he's still in pain when he goes in for a followup
When you get a prescription narcotic, sedative or stimulant from your physician, psychiatrist or dentist, they will clearly state, and write down on a piece of paper that you're not supposed to mix it with alcohol or certain other drugs. The pharmacist will reiterate this information and it will be written on the box, bottle and accompanying literature. I'm not sure how it's sold on the streets, but I'm guessing that it's not in the original packaging.
The article you link to at the Week, the article they link to at the LA Times and the CDC data this is based on all say that drug overdoses are now more common causes of death than car accidents and that prescription drug abuse is driving the increase. This number includes illicit drug use (it's all drug use) and it covers accidental and intentional overdoses.
If you read your comments you can see people are interpreting your article to say that big pharma is killing 37k a year- evil pharma. Maybe I've had better doctors (or most likely, just very little schedule III and no schedule II prescriptions). But I have always been warned and the packaging is clearly marked.
Don't forget instances where people are harmed by prescription drugs that are not appropriate for everyone and where tests exist that would sort out this subpopulation. I almost had my heart shut down by metoprolol succinate because I am a CYP2D6 non-metabolizer, as is close to 10% of the population. Fortunately, I am a scientist by training and did my own research on my situation and uncovered the problem myself. Anyone given such a powerful medication should either be pre-screened for CYP2D6 function or at the very least tested at the first sign of trouble.
That being said, we definitely DO need some form of controls on prescribing, especially in cases of "polypharmacy." A friend of mine was recently prescribed THREE serotogenic medications, with no warning about the possibility of serotonin syndrome. The third medication was added when the SSRI caused severe side effects and she needed to start tapering off of it, so when she started having symptoms of serotonin syndrome she thought it was withdrawal. She stepped back up as she'd been told to if the withdrawal symptoms got too bad. It nearly killed her because the doctor hadn't bothered tell her to watch for symptoms of serotonin syndrome. The explanation? "We didn't tell you because you needed to be on the third medication and we were afraid you wouldn't take it if we told you what could happen." Not only is this an ethical violation, it's a violation of her right to informed consent, and it's malpractice. Risking a patient's life because they might not take a medication if you actually told them what could happen is unacceptable, and happens much too often.
Yes, especially when it comes to nutrition and its effects on mental health (and most everything these profit-reaping pills are prescribed for...including blood pressure):
FEED YOUR HEAD:
http://www.youtube.com/watch?v=CNXfdjjy_Uk
http://store.documentarychannel.com/Feed-Your-Head-p/1065.htm
Or, the potential benefits of certain psychedelics in therapy:
http://healthland.time.com/2011/06/16/magic-mushrooms-can-improve-psychological-health-long-term/
http://www.youtube.com/watch?v=LKm_mnbN9JY&list=FLdtzbRTSD6TZYFecpWpcD2g&index=8
Food Matters:
http://topdocumentaryfilms.com/food-matters
Yet, that's what the Feds are coming down on. No lucrative marijuana lobby out there?
1) There will never be a marijuana lobby. Why spend millions to lobby for a drug that anyone can grow in their backyards.
2) Why spend tens of millions running FDA tests for a product that you can't make your money back on.
3) For profit prisons should be outlawed. Too much incentive for conviction of innocent people or refusal of parole. Just as the privatization of other public functions should be avoided. Yes, I know that's contrary to the Republican agenda.
I agree with the true Tea Partier among us on these points. Ron Paul. (Not much else I agree with him on.) The so called Tea Partiers are just the right wing fringe of the Rep Party.