Review: A Doctor Changes His Mind About Opioid Prescriptions
In Greed to Do Good, a former CDC physician calls the agency's war on opioids a disaster.
When the Centers for Disease Control and Prevention (CDC) urged doctors to cut back on opioid prescriptions in 2016, Charles LeBaron thought the advice made sense. LeBaron, a physician who was a CDC medical epidemiologist for nearly three decades, believed doctors had been too loose with pain medication, contributing to a dramatic increase in opioid-related deaths. In this context, he thought, it was perfectly reasonable to recommend greater restraint.
As LeBaron relates in his book Greed to Do Good, he had a change of heart a couple of years later, when he suffered agonizing pain as a result of staphylococcal meningitis. The pain was so bad that he contemplated suicide when it seemed he might not be able to obtain the oxycodone he needed to relieve his torment.
Now LeBaron intimately understood how patients desperate for pain relief could start to look like addicts desperate for a fix, driven to switch doctors, hoard pills, and move from one pharmacy to another. He also understood the downside of discouraging doctors from prescribing opioids. While curtailing prescriptions might prevent some nonmedical use, it also hurt bona fide patients.
The CDC's notionally optional advice resulted in widespread restrictions imposed by legislators, regulators, insurers, pharmacies, and medical providers. The human costs included abrupt medication "tapering," appalling undertreatment, patient abandonment, suicide, and a surge in drug deaths as nonmedical users replaced reliably dosed pharmaceuticals with iffy black market products.
The CDC's main error, LeBaron argues, was treating the opioid "epidemic" the way it had long treated communicable diseases: by trying to stop transmission of the "pathogen" at "the most accessible point." That mentality, he says, obscured the point that the "pathogen" in this case was a boon to patients like him, who needed it to make their suffering bearable.
