Last minute update:
Yesterday, as I was drafting this, federal officials arrested six former employees of a drug company for flat-out bribing some doctors to overprescribe fentanyl, which is 40-50x stronger than heroin, the cause of many opioid deaths.
As I’ve said in other posts, this is a complicated subject so don’t jump to conclusions until you’ve read it.
Yesterday, in Opioids. Alarm, and I mean YOU, I posted about how dreadful and drastic the opioids problem has gotten, citing (as just one example) a small high school in Maine where five percent of kids have been dying in every class. Think of how many were in your graduating class, and imagine 1/20th of them dying before graduation.
At the end of that post I noted that the problem seems to start with too-easy access to too many legitimately prescribed pain pills. I’m going to paste in parts of an email exchange I had yesterday with Ben Miller @Miller7 of the U of Colorado / Denver, one of the key people on the project we’re working on. Like a brush fire, the danger is real and lethal, and while we all think about it at a systemic level, we should also be taking action – demanding action – to prevent the preventable aspects of the problem.
See what you think about this. As always I’m interested in hearing from providers on the front lines.
- What % of problem cases and deaths are heroin (street drug) vs fentanyl (abused and overprescribed powerful prescription narcotic) vs diverted manufactured pills like oxycodone? (We didn’t get around to answering it, but as I said yesterday, it commonly starts with stolen pills and progresses to heroin, as well as pill overdoses.)
- Re diverted “legitimate pharm,” is anything being done to audit where the manufactured pills go?
- If not, why not? Is it all pharma lobbying resistance?
- (I’ve had this question ever since open-market Viagra started showing up in emails ages ago.)
- Is anything being done to audit legitimacy of prescriptions, and try to stamp out excess?
- I know a case where, after knee surgery, the patient had ONE HUNDRED Oxycodones left over.
- She was recovering well so she only asked for 30 but they prescribed 120 … because Medicare allowed it.
- Someone else at the meeting noted that it’s a lot easier for the doc to write one big prescription that’s sure to be enough, especially for a controlled substance, than to have to go through the paperwork repeatedly in smaller batches.
Ben replied “These are the right questions and the right issues.”
He also sent links to the broader issues (not just opioids) of overprescribing and overspending, and the industry’s pressure on Congress – for instance this TV news series. “Deep and problematic,” he says.
“And yes to auditing and high prescribers (especially for CMS). See here for some really nice data on that. However, it is a difficult thing to monitor.”
The brush fire analogy
Someone at the meeting talked about better medical education, and I said “But that takes years, and we have people dying now!” To Ben, I compared it to preventing fires around San Diego:
Seems to me this is absolutely parallel to brush fires around San Diego – a reliably identified source of fires is careless smokers and careless campfires, either clueless people or slackers who think “who cares” … it’s useful to train people to be smarter in coming years, but meanwhile it sure would be useful to stamp out the “leaky” causes. (You can just as easily visualize it as gasoline leaks that turn otherwise-innocuous sparks into disasters.)
While we fight the criminal stuff (heroin), we sure ought to be doing what we can to reduce gas tank leaks and careless smokers.
Readers, I don’t have any specific actions to request from you except to be citizen fire alarms: warn people about this, take it seriously, start thinking of something to demand change. The system sure isn’t doing it for us.
Note: chronic pain patients are not the problem!
Don’t blame people who’ve always had the need; I know people who truly need these pills. For a riveting tale of how badly this can be misunderstood, see this post by my friend @HurtBlogger after the travesty she experienced as the sole patient voice – ignored on the opioid panel at the Medicine X conference this year.
Legitimate need is not the problem any more gasoline or campfires should all be wiped out.
This is going to take a long time to fix, and surely someone close to your family will be hit by it. Think about who that might be. Let’s stand up as citizen patients – somehow, I don’t know how – and demand fixes that work.
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