“For every complex problem there is an answer that is clear, simple, and wrong,” – H.L. Mencken.
The current opioid abuse epidemic in the US is a complex problem, and like all complex problems there are a variety of causes. While patients blame doctors, doctors blame health systems and insurance companies, health systems and insurance companies blame pharmaceutical companies and politicians look for the least politically connected scapegoat, everyone is involved.
1. Pharmaceutical companies – Drug companies are for-profit corporations. They make money when they sell their products to consumers, so the more they sell the more money they make. So an “epidemic” where massive quantities of their products are consumed would be good for profits.
But… Pharmaceutical companies are sensitive to public opinion and lawsuits. They have been responsive to the abuse of their products and have attempted to reformulate them in order to make them resistant to abuse. But drug abusers are a creative lot. For the reformulation of one opioid they discovered they could get around the changes by popping the pills into a microwave. New OxyContin Formula Is Said to Curb Abuses
2. Doctors – Physicians are on the frontline of the epidemic and are the gate keepers of the drugs. A few have become extremely wealthy operating “pill mills” – pain clinics that dispense opioids without a strong medical reason.
But… Until the 1990s doctors were criticized for ignoring pain, viewing those in chronic pain as weak or “whiners.” In that decade there was a conscious effort by the medical profession to pay more attention to pain as medical consensus, backed by supporting studies, suggested that pain treatment sped the healing process. As the American health system evolved into a consumerist model whereby patients began to be seen as “clients” and “customers,” doctors were encouraged to make their patients happy by giving them what they wanted or face complaints and bad online reviews by disgruntled patients.
3. Healthcare Systems – Unlike other countries most American healthcare systems are for-profit corporations. These companies are beholden to shareholders and have followed business processes to maximize profit and minimize cost used in other service industries such as restaurants and retail. As a result they have encouraged their physician employees to treat patients as customers, some even going so far as to state “the customer is always right.” Therefore they have actively encouraged doctors to over-prescribe antibiotics and opioids to keep their customers happy.
But… Over-prescription of opioids opens them up to potential lawsuits made by the loved ones of those who died from the abuse of opioids. These corporations are often sued for malpractice alongside the prescribing physicians, and are viewed as having the “deepest pockets” for monetary settlements. The threat of lawsuits and the damage to corporate branding that results as well as the monetary damages has forced these companies to discourage physicians from over-prescribing opioids. As a result many clinics and offices owned by these health systems have signs at the front desk stating that their physicians do not prescribe opioids.
4. Insurance companies – Because insurance companies pay for opioids they encourage abuse. In many cases generic opioid-based medications are covered while more expensive non-opioid and less addictive pain medications are not.
But… Insurance companies also pay for the treatment of drug addicts in addiction treatment or when they are hospitalized after overdosing.
5. (last but not least) The patients themselves – Americans have unreasonable expectations for medicine. They believe that taking a pill should cure them and make them just as they were prior to their accident or illness. Some even believe that because opioids are legal and prescribed by a doctor they are not harmful. Many people who would never shoot or smoke heroin have no problem taking an opioid pill from a friend when they don’t need one. They have also become spoiled after being encouraged to treat going to the doctor the same way as going to a Burger King. They believe they have the right to get what they want from a doctor, and if they don’t they should complain.
There is no “but” excuse for patients. Ultimately I believe the patients themselves are most responsible for their actions just as a heroin junky on the street or an a drunk behind the wheel of a car. They need to understand that pain is a part of life and that its treatment leads to more problems such as potential addiction and death than it solves. Studies have even showed that long term opioid use actually makes the brain more sensitive to pain – not less. Prescription Painkillers May Worsen And Lengthen Chronic Pain
Photo by Grumpy-Puddin