In the February 22/29th edition of Jama (*1), the editors described a report issued by the CDC in a splendidly titled tome, Morbidity and Mortality Weekly Report.
Throughout the dryly presented data were intertwined subtle sirens of alarm: The rate of unintentional drug overdose deaths in the United States has risen over 600% in the years between 1997 and 2007.
We are not talking about heroin or methamphetamine or crack. We’re talking about prescribed analgesics. Prescribed. According to the CDC, “drug distribution through the pharmaceutical supply chain was the equivalent of 96 mg. of morphine per person in 1997 and approximately 700 mg. per person in 2007,” a dose high enough for everyone in this country to take a standard 5 mg dose every 4 hours for 3 weeks.(*2)
The report continues its assessment and finally makes this stunning observation: “Prescription drug abuse is the fastest growing drug problem in the United States…and has been driven by a class of prescription drugs called opioid analgesics.”
It goes on: “For every unintentional overdose death…nine persons are admitted for substance abuse treatment, 35 visit emergency departments, 161 report drug abuse or dependence and 461 report non-medical uses of opioid analgesics.”
Why? How could this be? Are these drugs being stolen? Manufactured by thugs in a trailer in the desert? Sold by wayward pharmacists? Smuggled from Canada? Hardly that dramatic. In fact, we are being addicted by the people we trust the most: “In an attempt to treat patient pain better, practitioners have greatly increased their rate of opioid prescribing over the past decade.”
Did someone say there was a war on drugs?
Allow me to share a more personal and human rendition of these statistics. One was a patient (name and details changed) whose situation was far too common, and one was a personal experience I had after a back injury.
The patient came to me with minor anxieties and some depression in large part due to unresolved grief. She was in her mid-thirties, a nurse, without major medical complications. Almost all her complaints centered on her fear of abandonment in relationships. Early on in treatment, she slipped at work (trying to move a large man from bed to a wheel chair) and injured her shoulder. After MRI’s and doctor visits that lasted months, they finally determined that she had some injured tendons. They put her on Vicodin. They refused her any other form of treatment.
That was 15 years ago. Needless to say her doses increased dramatically over the years as did her anxiety, her depression, and finally she was able to witness the abandonment she so feared. Her marriage fell apart. She was so addicted to the Vicodin that the withdrawal was more frightening than the dissolution of her family.
I have seen this scenario in different forms at least a hundred times. I have made phone calls begging physicians to please reconsider their choice of medication and allow for other medical solutions: acupuncture, physical therapy, massage, homeopathy, mindfulness meditation, hypnosis. With the exception of a few truly open-minded practitioners, the answer was a uniform “no.”
Why would anyone object to an alternative treatment if it brought relief at lower cost and without the risk of addiction and all the associated medical risks?
I found this out for myself personally not more than a few years ago. I fell (hard) and twisted my back. When it happened, I was more embarrassed than in pain and told myself (and everyone else watching), “Oh, I’ll be fine. It’s fine.” Within the time it took for my adrenal glands to stop pumping, the pain became intolerable. I could not walk. My husband took me to urgent care and they told me it was a muscle sprain because there was nothing on the x-ray. They urged me (I mean this literally) to take pain killers.
I said, “No, thank you.”
The doctor on staff looked at me cross-eyed and said, “What do you mean, ‘no, thank you?’”
I said, “I mean no. I don’t want them. How about some aspirin or ibuprofen or something like that?”
He reluctantly gave in and wrote the prescription but not without saying, “You’re going to be sorry.”
The pain was not going away as quickly as I’d hoped but I had seen what opioid analgesics could do and was determined to do whatever I had to do to avoid it. After putting up a fight with the insurance company that lasted two months, I finally went for an MRI where they found the bulging disc that was impinging on my sciatic nerve.
I found a physical therapist who was a hands-on genius and she relieved the pain with a combination of deep tissue massage and abdominal strengthening. We also used guided meditation. She used to tell me to “imagine the butter melting” as she focused on releasing the Iliopsoas, particularly Psoas Major which is the muscle that connects the hip to the spine. It was miraculous and immediate joy.
It was getting better. I was still in pain and not as limber as I used to be, but it was moving in a good direction. And I was willing to work hard to get better. That is, until the insurance company insisted on a new doctor. He looked over my chart and said, “You’re going to need Vicodin.”
I said, “No.”
Once again, that same look: “What do you mean, ‘no?’”
I said, “I don’t want dope. The massage and exercise works. Why can’t we continue that and forget the drugs?”
“Because you’re at maximum improvement. You can get the drugs but not the therapy.”
It was my turn to look at him cross-eyed and I said, much to the amusement of the nurse in the room with us,
“Are you crazy? Who are you working for?”
“According to the insurance company, this is medical standard now.”
I wanted to ask him when the insurance companies and bureaucrats became the arbiters of medical ethics and practice. It became clear to me that because of the structure of medical care today, people who would have otherwise had options and been good doctors, were being led in another direction, a new “standard” set by insurance companies and pharmaceutical interests.
Instead, I just said, “What about your oath?”
I looked at him and said, “Yes, you are,” and that was that. I walked out. No therapy and no Vicodin. And I had to pay for my own massages and take responsibility for my own recovery. And perhaps this is simultaneously the crux of the problem <em>and </em>the solution. Taking charge of my own healing instead of laying it on the doctor’s shoulders and demanding an immediate pain solution was not easy. In fact, it is an ongoing decision because I still have days with spine-shivering pain. But it has been infinitely better than what I’ve seen with my patients, people who had been struggling with aches and pains or broken hearts turned into addicts with broken homes, empty pockets, and symptoms so wildly erratic they were sometimes mistakenly diagnosed as bipolar instead of addicted. So rather than getting them off the opioids, they were given ever-increasing doses of medication that eventually made reaching–or treating–them impossible.
So, this war on drugs we’re waging? Maybe we should start in the doctor’s office. And it seems to be up to us in more ways than one. I don’t see the pharmaceutical companies leading the battle. Do you?
*1. CDC Grand Rounds: Prescription Drug Overdoses–a U.S. Epidemic, MMWR, 2012;61:10-13, cited in The Journal of the American Medical Association, February 22/29/20120, Vol. 307, No. 8, page 774