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Susana Duncan, M.D.

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The New Drugging of America

Posted: 06/23/2012 5:11 pm

The CDC reports that the relatively recent epidemic of opium-addiction is now America's fastest growing drug problem. The source of most of these opiates is not the foreign cartels, traffickers and drug dealers depicted in Hollywood movies; it is pharmacies fulfilling prescriptions written by often well-meaning doctors for Vicodin, Oxycontin, Oxycodone, and other opoid pain relievers. According to the CDC, enough of these opiate-based drugs were prescribed last year to medicate every American adult with a dose of five mg of hydrocodone (Vicodin and others), taken every four hours, for a month, and have led to over 40,000 drug overdose deaths. Today there are more overdose deaths involving opoid analgesics than heroin and cocaine combined, and the public consumption of them costs health insurers approximately $72.5 billion annually. The urgent problem is the addiction of a vast number of patients whose pain but not their underlying causes are managed. While the consequences of this prescription-driven epidemic may be largely invisible to the general public, it is all too clear to doctors like myself who specialize in sports medicine, physiatry and the treatment of a range of painful conditions.

Just recently a 71-year-old patient saw me for a painful swollen knee. One year previously she had undergone total knee replacement and after the post surgical discomfort had subsided, the knee pain began. She explained that her surgeon prescribed she continue her physical therapy, but the pain worsened. She went back to her surgeon, who then prescribed Oxycontin, an opiate pain reliever. When the initial dose did little to relieve the pain, she was told to increase her dose, and continued to do so over the next two months. By the time she sought my help, not only was still in pain, but she had become addicted to the medication. The problem, which not unusual in such cases, is that the opoid had partially masked the underlying problem. I had requested a knee MRI, which found chronic synovial inflammation of her knee, which is treatable with steroid injections. By judicially providing this treatment, the inflammation was relieved and pain was gone. But not the addiction. For that, she needed a 30 day in-patient rehabilitation center to safely detoxify her and help her reform her drug habit.

I wish I could say that this case is atypical but unfortunately, it is not. Such addiction is becoming common. Part of the problem is doctors. Some busy surgeons find it more efficient to write a prescription that might work for the pain, than to spend time attempting to find its cause. Another part of the problem is patients. Many sufferers demand immediate pain relief, and, instead of fully following their doctor's advice, increase the dosage by seeking prescriptions from multiple doctors. Part of the problem is the government's failure to better police prescriptions. But whatever the causes of this epidemic, the results are tragic for the patients, especially since with rigorous evaluation many of the cause of the pain can be solved -- and without recourse to opiate drugs.

 
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10:33 AM on 06/27/2012
Because of this country's hysteria I can't get any pain medication at all. What a joke the medical "profession" is. You are just an arm of the DEA. Because some hillbillies decide that getting dizzy is fun the rest of us will suffer in pain until we die.
02:18 AM on 06/27/2012
"Another part of the problem is patients. Many sufferers demand immediate pain relief, " Really? that is a problem?
olddognewtrick
Half full or half empty...It's the same
07:38 PM on 06/25/2012
accompanied by an unusual rise in problem constipation...
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Ron Hinchley
The wise man considers what he wants
10:10 AM on 06/25/2012
You can only argue why doctors cannot be relied on to administer the drugs. These drugs are effective and moving the criteria for their administration into the political arena can only mean stepping back from the doctor patient relationship. You are deciding whether you are treating the patient or treating the public.
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bubwalt
another day in my life
05:15 PM on 06/24/2012
This is not exactly a new problem. In 1965, The Rolling Stones wrote a song called "Mothers Little Helper." It describes a dependant housewife running to the medicine shelf for relief.
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smurfshoe
el conquistador
03:46 AM on 06/26/2012
Better living through chemistry.
jhNY
Mercy.
02:31 PM on 06/24/2012
On the other hand, many in chronic pain refuse pain medication, for fear of becoming addicted-- including in my experience,an 85 year old and an 86 year old, both off whom suffered accordingly and needlessly. And there are complaints among terminal patients that their doctors withhold medication or keep the amounts prescribed lower than would address their problem. Are the doctors not aware that you can kick your habit in heaven?
09:04 AM on 06/24/2012
I have come to refer to many individuals as "innocently addicted": they start out with a legitimate ailment, only to end up addicted. Also, we HAVE become a nation of instant gratification - I want to feel better now!

My wife and I have done some homework and found an excellent resource (I understand that this will most likely be moderated out; however, people need access to information/ recovery - please consider) If you are struggling with addiction; we have come across a team that is amazing! They provide video and phone communications to their "clients". I will tell you that they are not real inexpensive; however, if you have run out of options - they might be able to help. Also, very limited number of active "clients" : so they can focus on individual cases. If you need help and discretion is a must... respond and I can get you in touch.
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DinNM
I'm 57 and I do as I damn well please!
12:47 AM on 06/24/2012
Dr. Duncan, thank you for this post. You make some very valid points. I am one of those people who takes Hydrocodone, for my SEVERE lower back pain (osteoarthritis and spondylosis). I'm 57 and I've had this problem a long time. But before I was prescribed the pills I went through other therapies such as physical therapy and lumbar injections. I was also prescribed TENS, which helped a little but not enough. ONLY THEN was I allowed by my PCP to have Hydrocodone (4x per day as needed). But I found that it made me so tired and sleepy that I couldn't take it during the day and still function, so I only take it at bedtime. This also helps the script last longer. Being aware of the addictive danger of this drug I often take half doses. I think that it's as much my own responsibility to take my medications BOTH as prescribed AND as my own judgement tells me I can tolerate, ESPECIALLY when it comes to opiates!! Frankly, I'd rather smoke pot, but even though I live in a state (NM) where medical marijuana is legal, I have to find a doctor outside my health plan (BCBS) who will prescribe it. THEN I would have to pay for everything out-of-pocket and currently that's just not feasible.
12:05 AM on 06/24/2012
The Right Wingers who believe everything is best always in America are going to come after me for this........AGAIN.
We have to look to other models for our healthcare than the one perpetrated by the AMA for decades.
The doctors' "union" which due to licensing laws prohibit fair medical competition.
Which allowed the advertising of cigarette testimonials from white coated doctors in magazine ads.
Which tried to drive Chiropractics out of existence in the 1950s.
In Europe, as one example, and in the Far East and elsewhere, herbal remedies, including homeopathy, and alternative medicine - still vigorously opposed by the American Medical Establishment - is a trusted traditon.
80% of all pain killers are consumed in the U.S.
We are a pill culture.
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hess1745
Liberty, Peace, and Prosperity! 420-24/7-365
11:58 PM on 06/23/2012
Harm reduction and pain relief in the form of medical marijuana.
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cafebeege
11:45 PM on 06/23/2012
Dr. Duncan.......With the aging population and the deterioration of their bodies, most are unfortunately not going to be like my grandfather who was on the squash court after the age of 90. Unfortunately most will be like my grandmother who suffered from terrible arthritis, osteoporosis, (asthma as well, though that isn't a pain producer per se) etc., etc. Her poor little body was fragile and went from aches to PAIN over the years, dying at the age of 86. Would it be better for these old people to just sit in agony, OR be able to get up and walk around, get dressed and function the best they can in their later years ? The BOOMERS are aging and their bodies are deteriorating. THAT is a big reason for the increase in prescribing these meds, and they effect cognition LESS than anti-depressants allowing clearer thinking. I say monitor more carefully so overdose not as likely, but I'd rather they have more comfort and be able to function as well as they can and be able to enjoy their last years in less pain.

My step-mother was amazing, taking college courses in her 80's with terrible arthritis BECAUSE she was able to take these meds. Got her BS in nursing for her own satisfaction not having finished before. Each case is individual. If it increases the quality of life for these elders, and the individual is monitored, not in danger of overdose, I say let them not suffer.
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realitytrumpsbull
Two 'alves of coconut!
11:15 PM on 06/23/2012
Sometimes, life blows. It blows LESS, when you're happily floating in a chemical haze. Unfortunately, that haze is also enough to keep you diffuse, unfocused, and unwilling/able to really do anything about it. So, have some more Hypnozinol, turn on channel Z, and have a (not so) great day(but, you really don't care, either way, because everything's so fluffy...happy...).
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cimmereo
manu ad ferram
10:42 PM on 06/23/2012
Many doctors I have seen got into the profession for questionable motives, but patient care is not one of them. These are the ones that are more likely to give you quick prescription before they hurry off to their next billable patient.

Futhermore, the pharmaceutical industry has gone to great lengths to court doctors, starting the day they enter med school. Its strategy has paid off.
10:36 PM on 06/23/2012
This article is incredibly insightful. However it raises a few questions for me. How will this opium addiction be affected by universal heathcare? And vice versa, how will costs of universal health care be affected by opium addiction? If at all possible, I would love for Susana to write an article on the effects of opium addiction and how to prevent people from becoming addicts.
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rlf5659
Intolerant of willful ignorance.
11:12 PM on 06/23/2012
I have seen the effects of this addiction and it is not pretty. Extreme weight loss, loss of healthy hair, nails, skin, muscle tone. Slurred speech. I have been told it is a euphoric feeling of being in complete control when the truth is you are so far out of control you no longer see anything but the next pill. How do you prevent it? Stop the doctors and pharma companies from even putting such a toxic substance on the market!
03:21 PM on 06/24/2012
The problem with taking drugs off the market is that the drug is being taken away from people who really need it.  I also feel that you are thinking very close minded here.  I don't believe that a drug company says "Hey, we can make money off this.  Who cares if people abuse it?".  I mean, consider the case of cough medicine or hand sanitizer.  People abuse those substances, but I don't think they should be taken off the market because people can't be responsible with them.  And even worse, these substances can be acquired without a prescription from a doctor. 
iflew
Pro Publiae Bonae
10:36 PM on 06/23/2012
Someone prescribed oxycodone for an abdominal pain I had. The stuff was terrible. It was like being dizzy without dizzyness. I tossed most of out.