Pain is real. It leads to depression, isolation, and drastically diminishes our quality of life. Health practitioners should have the goal of guiding patients towards relief from pain, or at least minimizing its crippling effects on those afflicted with pain. Many do, as reflected by the various pain doctors who encourage a whole body approach that balances medicine, lifestyle changes, exercise, diet, and counseling, among other modalities of treatment.
However, for some, other people’s pain is simply the starting point to a lamentable course of treatment to quickly recommend highly addictive prescription drugs. Whether this is from doctors who are not properly trained in medical school with the intricacies of pain management(1) or from doctors who zealously push or naively prescribe narcotic drugs(2) for other reasons is still up for debate. What cannot be seriously challenged are the facts: 40 people die every day from a prescription drug overdose. The number of deaths in 2008 was nearly 15,000(3), more than three times the level in 1999.
We need to stop thinking that drug addiction means cocaine or heroine, dirty needles, and street dealers. Compared to overdoses on prescription drugs, cocaine and heroine combined don’t surpass that 40 person per day figure in the United States.(4) The addiction du jour comes in a bottle and is dispensed initially by your local pharmacist.
It was only a matter of time before lax regulation of prescription narcotics led to very dangerous practices. The most troubling was probably the development of “pill mills.” Essentially, a pill mill is a facility that employs doctors or other health practitioners who all too easily give away prescriptions for narcotic drugs to anyone entering their facility with a complaint of pain.(5) The willingness of doctors to look the other way, or to create entire practices where prescribing a narcotic is the only option that is given serious consideration to a patient with pain, opens the door to the curious coupling of prescription drug addicts and drug dealers.
For years, Florida was the growing hotbed for pill mills. A melting pot of legislative apathy combined with virtually no oversight of prescription practices meant that doctors could order, and prescribe, as many narcotics as they wanted to as many people that asked for it, with no incentive to question the wisdom, legality, or efficacy of their practices. The problem, however, was not isolated to Florida – and even the Florida problem itself had connections in our own backyard here in Michigan. Recently, a Livonia-based company called Harvard Drug Group LLC entered into an out of court settlement with the Drug Enforcement Administration after being accused of failing to design and maintain a system to detect suspicious orders for controlled substances. (6) Many of the company’s orders came from pain management clinics in southern Florida that were the targets of scrutiny and investigation.
In fact, pill mills are showing up in our state, too. Last year, federal agents and local law enforcement raided a pain center in Monroe, Michigan. Authorities allege that about 4,000 patients received prescriptions for more than 2 million painkillers in a two-year period, many without actually seeing a doctor. In some cases, patients received prescriptions despite the fact that they had been given the same medication elsewhere.(7)
When pill mills outnumber McDonald’s, as they did in Broward County, Florida, something is grotesquely wrong.(8) When the state’s law permitted the clinic to prescribe the drug and then dispense it directly through a cash sale,(9) it was only a matter of time before oxycodone would overtake cocaine as the drug of choice in South Beach. And while Florida’s laws may have changed such that sales of oxycodone dropped 97% in one year alone, what we can learn from the Florida epidemic applies just as much today here in our own state. The risk is still real, and states neighboring Florida are currently experiencing dramatic increase in oxycodone sales.
Pain killers should not be relied upon to manage chronic pain. Yet, in 2010, the CDC tells us that there were enough pain killers prescribed to Americans so that everyone in the country could have a one-month supply.(10) If the goal of pain killers is to address acute pain, for example from a broken ankle and surgery to reduce the fracture, then patients prescribed these powerful pills need to be taught about the extremely addictive nature of the drug. You wouldn’t give your friend your blood pressure medication just because she complained of feeling lightheaded, yet all too often I overhear conversations where friends will literally ask each other if they have an extra oxycodone or vicodin to “help me get through this.”
Pill mills won’t survive if the demand for them is not there. The demand won’t be there if we take active measures to reduce the likelihood of turning people into prescription drug addicts. Maybe if you were instructed that you should keep your pills locked up, that you should throw away the leftover pills once you no longer need them, that you should not use them with alcohol or other sedatives, that you should be aware if you have other conditions that predispose you to pain – then, maybe, just maybe, you might stop to really ask yourself if taking a prescription narcotic is actually what you want to do.
Physical therapy addresses pain, yoga addresses pain, weight loss can address pain, therapy can address pain, and non-narcotic medication can address pain. I’m not trying to belittle someone who suffers from chronic pain, but I do challenge us to be as responsible as possible when addressing pain. Part of that responsibility has to entail a frank, honest discussion over the dangers of narcotic drugs and the efforts and motivations of people who identify it as a quick solution to a long-term problem.