Did Doctors Overtreating With Opioids Cause the Overdose Crisis? A Soho Forum Debate
Doctors Adriane Fugh-Berman and Jeffrey A. Singer debate the harms of prescription opioids.
HD DownloadHas America's overdose crisis been caused by doctors overtreating patients with opioids?
That was the subject of this month's Soho Forum debate, held at the Sheen Center in downtown Manhattan.
Adriane Fugh-Berman defended the proposition, "America's overdose crisis is the result of doctors overtreating patients with opioids." She's a medical doctor and a professor of pharmacology and physiology at the Georgetown University Medical Center. She argued that the overdose crisis traces back to pharmaceutical companies convincing doctors that opioids were safe and effective, causing rising rates of addiction.
Jeffrey Singer, a surgeon who is also a senior fellow at the Cato Institute, took the negative. He argued that the rate of overdoses and the rate at which doctors prescribe opioids aren't correlated. The real culprit, he said, was drug prohibition.
This debate was moderated by Soho Forum Director Gene Epstein.
Narrated by Nick Gillespie; intro edited by John Osterhoudt; event photography by Brett Raney
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No grasshopper, they did not.
Ditto.
The Opioid Crisis came about because the Media needed something for the general public to be panicking about. Opioid use was indeed going up, but mostly because drug use in general was going up, particularly among populations that had not seen it before.
Remember when Rush Limbaugh had an Oxycontin problem, and it wasn’t his fault but because someone prescribed it to him? It wasn’t the prescription that did it.
and it wasn’t his fault but because someone prescribed it to him?
IIRC, several doctors prescribed it to him, all totally unaware of the other prescriptions.
The willingness of doctors to victimize these poor people is just unconscionable.
It was the pills themselves. They jumped out of the bottle, held him down. Pried his mouth open, and jumped in.
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It was Dr, William P, Siverstein of Omaha, Nebraska who caused the opioid crisis, He died in 2003 so there’s nothing we can do now, lets just put it behind us and move on. Cross that problem off the list.
It wall also old man Winters, who owns the abandoned pharmaceutical production factory outside of town. He would have gotten away with it too. If it weren’t for some meddling kids.
Yes. Doctors should stop prescribing street heroin laced with fentanyl.
So, no actual libertarians to take the “The people taking opioids were the cause of the opioid crisis.” position?
You’d think between Doctor A saying, “Big pharma tricked doctors into giving people unsafe drugs.” and Doctor B saying, “The government trapped people between a metaphorical rock of a treatment regime and a metaphorical hard place of self-medicating.” some libertarian somewhere might get a clue about doctors, big pharma, and the government all working together to literally force treatment on people who neither need nor want it.
No. I know people who were “overprescribed” pain killers and got addicted. They didn’t end up living under a bridge.
There comes a point, after someone has screwed up everything they’ve tried, that each new misfortune sparks the reaction “What have you done this time?”. Not “What happened to you?”.
Governments screw up everything they do, without exception. The things they seem to do moderately well, like militaries, national health systems, pensions, court systems, and so on, only seem well-handled because they are monopolies and have no competitors to be compared with.
So this topic brings the immediate question, “Does the government have a role in this field?”, with the immediate answer “Hell yes” because of all the regulations, from manufacture to certification to prescription to doctor and pharmacist regulation, that it takes no time at all to conclude that government is far more responsible for the opioid crisis than any other party.
Try roads, bridges, health and science research, and universities.
If you thought you had a point there, you didn’t communicate it very well.
If you think roads and bridges (why list them separately? Have you found bridges somewhere without roads? How did you find them without the roads?) are a natural government monopoly, you are dead wrong. Roads are a government monopoly now only because the government forbids competition. Roads used to be all private, for a long time, and worked perfectly well. Besides which, most roads are actually built by private companies under government contract, so the only thing government brings to the table is coercive eminent domain, inefficient taxation and redistribution, horrendous work policies which inflate the cost, and oh yes, corruption as to location, construction, maintenance, and operation.
Health is a laugh. I won’t go into that, there’s not a thinking person alive who thinks government health care is better than private. Well, except the elites, who get a better variety of government health care at the expense of the serfs stuck with the unwashed masses variety.
Plenty of scientific research is done privately. But as a matter of actual facts, you are misinformed in two ways:
* Government-funded research is full of woke bullshit, as any skim through any scientific journal would show you.
* Basic scientific research is incredibly overrated. Almost all technological progress comes from working engineers extending previous usage by safe increments.
The problems with government-controlled education are too well-known for you to get away with pretending they are stellar performers. Any further comment is pointless.
I don’t expect you to put any credence in anything I write, so there’s no point in trying to write a super-long comment with all sorts of references.
A, funding is not the only function governments perform in infrastructure though it is the only entity with the resources to fund the huge projects modern civilizations require. They also design, engineer, organize, and set the standards, either by employees or subbing it to privates. I’m a builder and I sub most of the work my company does and I dare you to say that means I don’t do it, or have responsibility and deserve credit or blame for how it comes out.
Similarly, without public funding, mush research does not happen because short term goals and limited budgets largely define what private companies do. That’s not a knock on them, but dismissing what governments do – and we own the government as tax payers and citizens – is just a flip of that simple minded analysis. By the way, the public teaching hospitals is where most – not all – of the best and cutting edge medicine is going on, and that with the added burden of non-paying patients they are assigned.
Maybe you’ll send your kid to Vanderbilt instead of UNC or UF, but most of us can’t afford that and both of those public universities are among the top 30 private and public universities in the nation.
The effort to be ideologically pure and dividing the world into good things and bad things, good tools and bad tools, is really beneath you man. Somethings are best done small and privately and others can only be done with large government investment. Why fight that reality and try to fit everything in one side or the other. Given that the public owns the government entities, it’s not like we don’t have ultimate control, though you’re sharing that with 330 million other Americans. If we didn’t, we probably don’t have the money for the big things.
Very first sentence is wrong: “though it is the only entity with the resources to fund the huge projects modern civilizations require”
If you knew anything about actual big projects, you would know there are thousands of private ventures which work perfectly fine without government funding or oversight.
The standards you brag about are overkill and suffocating. Private industries have plenty of standards of their own, which evolve and adapt far faster then government regulations, and actually encourage cooperation among competitors.
By the way, this cooperation among competitors is the hallmark of markets, and governments go out of their way to stomp it out.
When I said governments contract out most highway work, you saw a perceived insult and not the reality — you had said private organizations were incapable of such projects, and I merely pointed out that it is actually governments which are dependent on private organizations for doing the work.
You did not respond to my remarks about how little scientific research is actually useful, and that almost all technological progress comes from incremental engineering research.
The rest of your rant is ideological claptrap, devoid of anything to respond to. I gave you concrete examples of private initiatives taken over by government. You respond with a propaganda rant. Try again.
If you knew anything about actual big projects, you would know there are thousands of private ventures which work perfectly fine without government funding or oversight.
^
One the very biggest projects in the Bay Area in recent years was the Apple Campus, which is 100% private.
Kaiser throws up hospitals at half a billion a pop like they’re McDonald’s franchises.
As a matter of fact, the public agencies I’ve worked for, managing public works projects, have been uniquely incompetent at managing large projects as compared to the private sector.
One of the most instructive comparison is transcontinental railroads. There are, I believe, four: three financed with public land grants and subsidies, all rampant with corruption and incompetence, for instance the very first one involving two companies who finished by building alongside and past each other for a few miles just to get those extra subsidies and land grants.
One, Northwestern I believe, was entirely private, and was the only one not ridden with incompetence or bankruptcy, and showing a profit.
the very first one involving two companies who finished by building alongside and past each other for a few miles just to get those extra subsidies and land grants
And Stanford, Huntington and Co. made a pile on federal railroad grants by snaking tracks in loopty-loops through the Sierra foothills. Billions and billions in today’s dollars to no purpose whatsoever.
I actually know some people who worked on the Apple Campus, and my understanding (my construction experience is all public) is that that sort of thing is actually much easier for a privately funded entity since they can hire and fire contractors at will, and can multi-prime a project with far, far greater dexterity than entities that are bound by public contract code. As I understand it, Apple goes through contractors like someone with severe allergies goes through tissue paper, which just isn’t possible on a public job.
One of the biggest complications with the Bay Bridge replacement project was that it was so big and costly that no one company could bond the whole thing, so the owner-agency was forced to multi-prime, but where each contract had to be let out through public bid.
Anyone who’s been involved in a large construction project knows that structuring the contracts, and thus the construction schedule and matrix of responsibilities, that way is . . . suboptimal.
And I feel like we had some cost and schedule overruns on that project, in addition to the . . . design/execution flaws.
A, no private consortiums can approach the ability of the federal government to fund it’s projects. Don’t be silly.
Of course the federal government is dependent on private companies and citizens. It’s usually not a competition in anyone’s mind except yours and fellow government haters. As to competition, most government projects have strict rules on bidding, and while some might be fast tracked to previous suppliers and subs, the majority aren’t and those rules are strictly enforced. No one wants to go to jail. Competitive bidding on private projects are under no such rules and may or may not even occur.
We don’t always know how much scientific research is useful but that is also often the point. Incremental research is indeed what most of it is. I don’t get how this is a general complaint.
The ideology is all on your side A. I’m a pragmatist who believes in using available tools without the chip on my shoulder which is weighing you down. I have made payroll for over 40 years in the construction business and so I am the “job creator” so many on the right want to lionize, as if the people I rely on to do those jobs are lesser humans somehow. Obviously I swim in the waters of private enterprise – I’ve only done one public project and it was funded by a private charity – but that doesn’t translate to hostility to those building bridges, campus dorms or science labs.
Abide not in dualism is some Buddhist quote – no, I am not one – but applies. Strict ideological reasoning is an attempt to find one simple answer in a complex world. There are no demons and angels and many ways to do most things. Use the best. In our current discussion, government in democracies are under the control of citizens and not some alien force. We can all argue about what it does and how – you can’t do that with Tesla or Microsoft – but we’d be stupid to not use it as a specific and powerful tool to accomplish large projects which are not necessarily the money makers which attract private business. We can hire them as necessary and good for all.
Maybe you’ll send your kid to Vanderbilt instead of UNC or UF, but most of us can’t afford that and both of those public universities are among the top 30 private and public universities in the nation.
There’s an argument to be made in favor of the public university system. In CA we have probably one of the best public university systems in the world (UCB being generally ranked as the #1 public university globally), and it’s very popular among CA voters.
OTOH, like so many other things in CA, what you’re looking at is a state service that formed before any private market really had a chance to provide it.
The very first universities and colleges in CA, including the University of California, started as private entities. The original University of California in Oakland quickly (like, within months) became a ‘state university’ when the land-grant (i.e. public) university in soon-to-be-Berkeley had failed utterly and needed something that at least resembled a school to occupy its site, and thus contracted with the University of California, which relocated to the site.
The rest of the UCs started as research stations and satellite campuses, slowly transforming into standalone universities as the demand for higher education developed in their respective areas.
The California State Universities were started as teacher-training facilities (graduate and research programs forbidden) to support the growing public school system. For their first several decades they issued teaching certificates only. I think it was in the ’60s that they started issuing other degrees, and in the ’70s that they were allowed to have graduate programs, although they still don’t do research (technically).
Again, in response to market demands.
Had these systems never been founded, would we have fewer colleges? Possibly. But we might actually have had more sooner.
However, as an employee of a public university I can tell you unambiguously that regardless of the history we would spend less and would almost certainly be able to lower our tuition if we privatized.
Square, can you provide an example of a private university that is cheaper than a public of equal quality? By the way, the NE has limited public universities compared to the rest of the country and I don’t believe any of the privates which developed without them around are “cheap”.
Yes: universities abroad are much cheaper, both public and private.
In the US, there are effectively no private universities; even nominally private universities receive most of their funding from the government and are overpriced and inefficient as a result.
The roads and bridges are maintained by local governments, healthcare has become far more broken today since Obama imposed EMR and administrative tasks that literally consume >50% of physicians time, medical scientific breakthroughs are principally done by biotech, and given the collapse of the relevancy of universities in America, you might consider other examples to support your argument that government has a roll in doing anything well. These might work: rising gas prices, spiraling inflation, censoring opposing opinions, increasing violent crime, fostering division in the nation, inciting violence against SCOTUS Justices, enriching the pockets of their offspring….these will give you a running start
None of that makes any sense Yat or just isn’t true. You should check the research budgets of our larger state Us, which are primarily funded by private grants and companies. You think they like throwing money away?
PS Inflation is market driven with governments trying to curb or adjust for it. Guess what happened in 2020 that broke supply chains and stifled consumption – let me know when you have it. You do know that inflation is world wide and that oil prices are part of that right?
You should look at the research coming from those universities. It is 90% junk.
Have you seen those reports on how much scientific research is actually reproducible? Obviously not, or you wouldn’t spout so much propaganda about how wonderful and marvelous it is.
So, I guess the billions in research produced under grants from industries and non-profits are all just mad money no one cares about, and that explains why we are so backwards and there are no new scientific achievements anymore. Thanks for the heads up.
Government funded research is corruption on a massive scale. Yes, research would better be left to private foundations and industry completely. Ditto for education.
Inflation comes from government, period. Google for any chart of inflation from 1800 to the present.
* It has lots of little wiggles up until WW I, and stays remarkably flat and inflation free from 1800-1914.
* There are little raises at the start of wars and corresponding drops back to the previous norm after the war. Guess what — wars are caused by governments.
* 1913 saw two major financial changes — the Fed and the income tax. The Fed gave the means to control the money supply, while the income tax gave the ability to expand the government budget, previously dependent on tariffs and booze taxes.
* WW I had the usual inflationary rise, and Woodrow Wilson’s policy was to fight the usual deflationary drop after, leading to 18 months of recession as deep as 1929-1930. But because Wilson had a stroke and was incapacitated, no one dared do anything beyond fighting deflation, and the recession was over much faster than after 1929.
* Inflation then stayed more or less flat until 1929. It’s been nothing but inflation since.
Supply chains and economies were not broken by the pandemic, but by the government lockdowns and economic sabotage inflicted by governments. There were pandemics in the late 1950s and late 1960s, both of which I lived through, both of which killed more people than COVID, both of which did not include government economic sabotage as a means of fighting them, and both of which did not disrupt economies or supply chains.
Your ignorance is appalling, but typical for a statist.
Guess what happened in 2020 that broke supply chains and stifled consumption
Lockdowns, vaccine mandates, and restrictions on travel?
Square, no and as I have shown here numerous times, people stayed home on their own out of fear and lock downs added about 6% to that number. That’s a market response to the pandemic, not a top down cause. As to vaccines, as is clear now, in all states, red and blue, the unvaxxed made up the majority of new covid cases, and by large numbers the hospital admissions and deaths from covid. Getting vaccinated – thanks Pres Trump and Biden for getting them out so quickly – was an economic booster which gave people realistic confidence to engage in the economy. Too bad so many dummies listened to anti-vaxx idiots like Diane and are now dead.
For some other “obvious” government monopolies which you left out …
Air traffic control was invented by US airlines, either just before or just after WW II, I forget which. It quickly got so many airlines voluntarily signed up that the government stepped in and took over.
Radio frequency allocation was handled privately by amateurs until a bunch of would-be monopolists pushed Herbert Hoover, as commerce secretary under Coolidge and then as President, to push through legislation handing control over to the cronies, which included the major radio networks, tired of having to play fair and eager for that monopoly control so delighted in but cronies and statists alike.
The lawyer ABA and medical AMA were pushed through by doctors tired of competition. Did you know that the various mutual aid societies (Elks etc) used to hire doctors at a flat rate to provide health care for their members? The AMA detested this competition, and pushed through government occupational licensing, under the AMA’s control, so they could revoke medical certifications of these mutual aid doctors.
As for the ABA and lawyers, it was the same deal; pushed through by lawyers to restrict competition and raise the prices they could charge the public, at the same time making so much of the legal field as complicated as they could so that non-lawyers had little hope of doing anything on their own. See, for instance, how many states forbid holographic wills; they have to be done through lawyers.
Your ignorance is fun to behold.
Not sure who you’re talking to her A, but your comment on the AMA and Bar confirms a weakness of markets and free enterprise, the tendency of power to congeal. Add that to boom and bust and the necessity for a referee with power becomes obvious.
No, your response shows you can’t read, or at least refuse to respond to what was written.
To recap: the ABA and AMA were direct responses to competition lowering doctors and lawyers incomes. The market was working fine, providing medical and legal care that suited the public fine, but the doctors and lawyers forced through occupational licensing which decreased the availability of health care and legal advisors.
Try responding to that, instead of making up some unrelated bullshit.
He is not paid to think, but only copy/paste talking points from his handlers.
Or he does it for fun.
Yeah, you geniuses are adept at stringing together 5 or 6 paragr… I mean words.
A, you’re not the boss of me as I used to tell my older sister. Many say please and I will. Otherwise, like you I’ll post what I want.
And finally, I wonder if this is the first time you’ve been hoisted by your own petard examples. There was some clown a few months or a year or two ago who posted a similar comment, and listed similar fields, I think adding dams. He got several similar replies and never bothered answering any of them.
I doubt you’d tell us if this is a repeat performance.
Don’t know what you’re talking about and don’t care. If I see a reply I’ll answer, but the format of this board does not always make that easy. There is a limit to how long after a thread begins I will check it.
Yes, governments have screwed up all of those. QED
If they do a good job with pensions, then why are they trillions of dollars underfunded? Except for a few exceptions, they do a terrible job with pensions. They over promise benefits and underfund the costs.
“The real culprit, he said, was drug prohibition.”
We have a winner!
I had a very responsible supervisor who had a legitimate knee problem who ended up a complete junkie and I know a well off client who’s son – in his 20s – did the same, though I can’t vouch for his work ethic before. The employee charged tools on my accounts – which h had always been trustworthy on before – and pawned them to keep going until I caught on. He stayed fucked up for at least 4 years (as I heard through the grapevine) but may be OK now – or not. Did these 2 not get proper warning about the dangers, or too many renewable prescriptions? I don’t know that, but I can attest to the legitimacy of their initial health problem and at least one of them’s character.
I’m wondering if opiods just effect some people differently than others. Every time I take them, they don’t make me feel anything but less in pain (I’m probably also less coherent, but that isn’t really nourished from an internal perspective). I’m not sure what high people are chasing with them.
I’m not sure what high people are chasing with them.
Same here, and I’ve wondered the same thing you have. I’ve had addicts tell me it’s just the greatest thing in the world and they live for it, but I actually don’t enjoy opioids even a little bit. My daughter had a similar experience during a hospital stay a few years back – there was a nurse who was just obsessed with dosing her with Oxy at the slightest provocation, but my daughter really didn’t like the stuff, and said it mostly just made her feel sick.
I don’t find them reducing pain as effective as ibuprofen. And I don’t get high off them either.
Yes, opioids do affect different people differently.
However, physical dependence with long term use is inevitable; everybody gets that. Addiction, on the other hand, is highly dependent on the individual.
While there were certainly some doctors over prescribing, I doubt there were as many as the anti-opioid crusaders claim.
Pain has become a chief complaint in patients today unlike any other period in healthcare. It isnt the fault of physicians that patients are failures at handling life, e.g. obesity, Type 2 Diabetes, hypertension, heart disease, strokes, etc
And there seems to be a particular cycle where when my grandfather was on his deathbed 25 years ago they refused to give him morphine even though he was white-knuckling the bedrails in pain, since they didn’t want to risk his getting addicted and it affecting the quality of his life going forward.
He was 85 and had cancer in pretty much every part of his body.
Many people complained of this kind of thing at the time, and it seemed like about 10 years later it had swung the other way where if you went to a doctor and complained of some slight ache they’d send you away with an Oxy prescription.
I think now we’re on the verge of going back to the way it was 25 years ago because doctors have been overprescribing due to the new fixation on ‘pain management.’
Physicians trusted their patients to be honest. So much for that.
In 2019 the majority of the top 10 prescribed pharmaceutical generic drugs pre-COVID, are for chronic medical conditions patients caused themselves, much like opiate addiction. Heart disease, type 2 diabetes, hypertension….all related to lifestyle choices.
https://www.goodrx.com/drug-guide
Americans are more miserable than ever. That is their on fault
Yes, and the medical profession is responsible for that, because what they are lobbying for is guaranteed to disconnect lifestyle choices from the costs and consequences of those choices. That’s not only bankrupting the US, it is also making Americans sick.
But why should that surprise us? Doctors may fool themselves into believing that they are selflessly interested in the health of their patients, and at the individual level they no doubt are, but their collective economic interest is actually the opposite: the sicker Americans are as a whole, the more money and power the medical profession amasses.
The best system in terms of health outcomes is a free market in medical services and medical insurance, with no tax breaks or incentives, and at best minimal government-instituted barriers to entry and almost all drugs being OTC.
Okay, so you would rather leave people suffering because you don’t approve of their life choices.
Evolutionary forces and natural selection rule. Follow the science.
You’re asking the wrong question. It’s not a question of what I “let you” do or what I “approve of”.
People need to pay for the consequences of their lifestyle choices; price signals are the only way that they can make reasonable and rational choices.
If health insurance rates tripled at 25% body fat (as they should, based on risk), people would get the price signal that would cause them to lose weight and the obesity problem would solve itself. But by using the law to destroy price signals, people don’t even know the costs of their lifestyle choices.
About a year and half ago, I slipped on ice and had a traumatic spinal cord injury. I am in constant pain, piss through a tube that goes into my abdomen and have muscle spasms through out the day. Years ago I would have died, but medicine has devolved enough where it made me a quadrapelegic. Yet, now, I can’t get anything prescribed that relieves the pain.
What is happening is that “new treatments” are developed to ease the pain like Botox shots at over $8,000 per treatment every six weeks.
I would rather have died.
I’m sorry to hear that. However, opioids are unlikely to be a solution to your problem. They don’t generally work well for chronic pain, inevitable produce dependence and tolerance, and have serious side effects.
There are no simple answers for chronic pain, but there are many approaches you can try and chances are you’ll find something that helps.
Actually, physicians do bear responsibility: they have lobbied successfully for hiding the true costs of these diseases from patients (by lobbying for America’s insane medical insurance system) and they are selling the fiction that they can fix a lot more medical problems than they can actually fix.
Actually, physicians do bear responsibility: they have lobbied successfully for hiding the true costs of these diseases from patients (by lobbying for America’s insane medical insurance system) and they are selling the fiction that they can fix a lot more medical problems than they can actually fix.
Physicians absolutely bear some responsibility, but the examples you provided do not apply.
Hospitals are run by administrators with MBA, CPA, JD degrees, not MD/DO degrees. Physicians in private practice spend far too much money employing clerks, accountants, bookkeepers, receptionists and other people to handle the insurance coverage / billing / reimbursement / overrides / prior authorizations / coverage overrides, etc to deal with private third party payers. CMS is even worse. It would be a dream to deal directly with patients on a cash basis as not too long ago. Im all for bartering. However the first thing most patients do when they enter a physician’s office, is wave their insurance card, then expect VIP treatment. As if. Medicine is broken precisely because of the govt intrusion, with Obama making it far worse. As for lobbying, most physicians do not belong to the AMA. The AMA represents less than 30% of physicians and that happened because the AMA backed Obamacare.
Life involves survival. You win some, you lose some. There are no guarantees regarding health, disease, pain and physical ability. Lifestyle choices, exercise, health nutrition are the most important determinants in having healthy outcomes, not that Americans appreciate this message from physicians for the past 40 years.
Some physicians are greedy bastards. I’ll grant you that. But most of us went to medical school, trained in an area of medicine, and put in the hours because we see it as a vocation. Sadly more than 50% of physicians, depending on the specialty, are burnt out, a recent phenomenon in the past 20 years. Connect the dots
You can’t separate your calling to help people from the fact that you have become part of a cartel that is advocating authoritarian government, bankrupting the nation, and making people sick. Unless you are actively fighting against that system from within, you’re part of the problem.
Americans don’t “appreciate that message” because your profession has actively lobbied to destroy any mechanism by which Americans would receive the necessary feedback to change their behavior.
And that shouldn’t surprise us: the sicker the population gets, the more powerful and wealthy your profession gets. Whether you are consciously aware of it or not, that drives your decision making, starting with the fact that you assume that more physicians and more medical care are a good thing.
QED
Doctors over-prescribing was a symptom, not a cause.
In 1996, the Joint Commission for Accreditation in Healthcare, began pushing greater emphasis on pain management by doctors, and in the following years several State Medical Boards (California among them, so many “blue” states likely followed suit based on that) began increasing prosecution of doctors accused by patients of “insufficient pain management”. From what I’ve found, it seems like this had roots in some palliative care cases, where the case against heavy pain-killers is pretty weak, but the reaction from many doctors was to get less aggressive about trying to impede “drug seeking” patients; the implementation of social-media style “rating” systems in the ACA (with those ratings being tied to eligibility to treat the increasing pool of patients covered by medicare/medicaid) further reduced incentives for Docs to worry about after-effects such as addiction or whether long-term opioid treatment was even warranted or beneficial. If a patient demanded a 90 day supply of Oxy for a stubbed toe, every legal and regulatory incentive was stacked to compel the doc to just give the prescription; at the same time, there was increasing research showing that opioid treatment is really only effective for acute pain treatment, and that many chronic patients were worse due to the meds they were told to expect/demand (and in the patient’s POV, withdrawal symptoms were conflated with a return of the “original” pain for many if/when they did try to get off the meds).
The over-reaction in the opposite direction that hit around 2016 probably compounded the problem by too quickly cutting off many patients who had become dependent/addcited to long-term medication they should never have been allowed, and also coincided with the increasing emergence of fentanyl being cut into many “street” drugs (because it’s easier to smuggle, cheaper and more available to the dealers).
In the current situation, the preponderance of unregulated and dishonestly packaged Fentanyl is probably the much bigger part of the problem since there’s likely not as many of the chronic pain prescription patients being left to try to self-medicate as there were 6-10 years ago, not to mention that some of the increases in the last couple years have some connection to the mental/emotional traumas and isolation that was deliberately inflicted as part of the Covid shutdowns in many highly-populated states.
The idea that there’s somehow one predominant (or sole) root cause to an issue that’s now killing 100k people annually is likely a fallacious framing of the entire question, but similarly it’s ludicrous to rule out factors that were only a significant contributing cause, or were more significant at earlier phases in the development of the problem.
Can’t wait for your article on hormone blockers…
Probably want them to start handing them out to kids on chewable gummy form.
Has America’s overdose crisis been caused by doctors overtreating patients with opioids?
I like how you never even have to consider the effect of personal choices when you ask the wrong questions.
Unless you are unconscious and in the emergency room, you are responsible for what goes into your body, not your doctor, not anybody else.
If you take opioids, that’s your choice, and the consequences are your responsibility.
NOYB, most of us don’t read or even understand the legalistic language on the warnings – they are there to keep the manufacturer from getting sued, not to provide necessary information – that come with most medications and are incapable of making informed judgements about them. That’s what we rely on docs to do, just like we rely on a variety of expert opinion on many things in the advanced civilization we live in where division of labor is the reality which allows us to achieve so much compared to our ancestors. Of course skepticism is always in order, but very limited dealing with technical questions beyond our personal knowledge.
This response does not pass the Turing test. It is the words that are missing, the inappropriately inserted aside, and the random manner in which it uses contractions that give it away.
Did I say anywhere you couldn’t rely on experts/doctors in making your choices? But who you consult and what decision you make after consulting them, it’s still your body and your responsibility.
That’s how our “advanced civilization” functions: division of labor AND personal responsibility.
If you don’t like it, you should have yourself declared legally incompetent and seek a guardian for yourself.
The opioid “epidemic” is the “elephant in the room”, especially in the US. There is a place for opiates, particularly with the acute pain management of severe injuries (broken bones etc) and malignancy. But apparently more recent generations expect to be “pain free”. The great mistake was the tying of a subject Pain Score (1-10) to the objective, time tested Vital signs (BP, pulse, RR & temp). This so-called “5th” vital sign was created & subsidized by BigPharma ~ 1999. If one compares this advent and the sales of OxyContin, the graphics are virtually parallel. Pushing sales and absurdly claiming “minimal” evidence of addiction was a money maker. If you’re a “high prescriber” of opiates at least 1 in 4 of your patients are on their way to potential addiction. This isn’t “rocket science”; for example, is a fellow who cannot quit smoking; usually has too many drinks daily (& may have even failed alcohol rehab); maybe a divorces or two, gonna do well with opiates? No! Addictive personalities must be kept away from long term opiates or at a minimum in a chronic pain management program. There are too many non-addictive, healthy alternatives. Oh, and since many of these types have depressive disorders and opiates are depressants, there is additional lethality. There are still providers who will gladly “write..rather than fight”..this scourge” and they are known colloquially as the local “candy man or woman”.
Your numbers mean that 3 in 4 may be denied pain medication needlessly, in particular since you suggest that a tendency for addiction may be predictable.
Ultimately, you can’t solve these issues within our highly regulated insurance and medical care framework. There simply is no top down policy that makes this work. The real problem is that our medical system has eliminated all price signals, so neither physicians nor patients get any valid information on actual risks.
Opiates are a great way to get relief from pain
How do people get help from pain with the opioid crisis
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