It all started in 1990 the deaths from unintentional drug overdoses in the United States increased by over 500%. It is noted that most of this rise can be attributed to prescription painkillers and these painkillers now kill more people; more than heroin or cocaine combined. So we ask ourselves, where are all these pills coming from? Not Mexico and not all from those Florida Pill Mills. It looks like they are coming from prescriptions generated by doctors in your local community who are trying to help patients like us with real pain. It is true conscientious and well-trained doctors are partially to blame for the rapidly rising death rate with Americans from prescription pills.
It kind of went this way. In the 1980s and 90s the medical community recognized that patients in pain were often undertreated and this rightly concerned a lot of people. Doctors didn’t do a good job asking about pain or treating it properly when they did identify it. Even worse when they looked at this they found affluent white patients were much more likely to get their pain addressed compared with poor or minority patents. So in response to this doctors were encouraged to think about pain severity as the fifth vital sign. To add other item medical students were instructed that patients could never become dependent on narcotics if prescribed for legitimate pain. Then to add insult to injury opioid pain medications like Oxycodone were framed as safer alternatives to nonsteroidal anti-inflammatory drugs or NSAIDS. Some of this was pushed by drug companies that made them and some was driven by patient pain advocacy groups. As a result we went too far in the wrong direction. Between 1999 and 2010 the amount of opioid narcotics prescribed by American doctors tripled. Narcotic prescriptions have doubled for children since the 1990s. Take a look at these figures. In 2011 enough hydrocodone was prescribed to medicate every American around the clock for a month.
Another point to be looked at is that doctors are more likely than ever to diagnose patients with chronic pain syndromes. The Institute of Medicine estimates that 100 million Americans have chronic pain so that would mean 1 in 2 people have chronic pain. It is hard to know what changed so drastically to drive these massive numbers, it’s either on the diagnosis or the treatments of such pain. In some cases drug rehab is required to get off prescription drugs.
So medical guidelines are already in place to state that doctors shouldn’t be choosing opioids for most patients with chronic pain. Doctors also need to start scaling back on prescription opiods for acute pain and give patents with new pain a high dose of ibuprofen. If the pain is bad enough doctors can add a prescription for a limited number of opioids to be filled only if absolutely necessary and then give a big warning with that prescription like: “These drugs are highly addictive, even in short term use. These drugs have been associated with death, even in therapeutic dosing. These drugs, when accidentally ingested by children are fatal.” Doctors need to stop fearing patient satisfaction surveys and talk honestly to their patients about pain.
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