Pedaldad posted:IWe all agree that there is an opioid epidemic. We all agree that there are a certain amount of physicians that have played a role. But let me shed some light on my background vs others that have chosen to write some very inflammatory, inaccurate, and unproductive remarks on this topic.
I agree there were some inflammatory remarks. As we clearly learned there was poor control of it's prescribed use and were intentionally misled on it's potency and addictive effects. I think the Purdue current lawsuits and previous settled and criminal prosecutions prove that.
I am surgeon in my early 50s, and know full well what medicine was in the 90's as well as today. For the past decade I have been part of the ortho faculty in a level 1 trauma center at one of are nation's largest academic institutions. This means my partners and I take care of the patients no one else wants - the train-wreck traumas(literally and figuratively), the homeless, the uninsured, the chemically dependent - they all get dumped on our front door with injuries that make most look the other way. So I am an authority on this thread topic.
I am very grateful for physicians like you and your partners. I do appreciate your opinion and responses, I may not agree with them but for the record I disagree with many authorities from Nobel Laureates to law enforcement officials (the radar was not properly calibrated).
I know what constitutes a peer reviewed scientific article, and the citation referenced above simply doesn't come close, but it is not void of poignant information. The referenced citation is actually a newsletter from the National Institute of Drug Abuse. The excerpt chosen is misleading, it leaves out the sections that states 21 - 29% of people prescribed opioids misuse them (patient not complying with how they were prescribed, i.e. personal responsibility) and this directly leads to an opioid disorder in 8-12%. Additionally 4-6% of those that misuse the opioid medications will develop heroin addiction.
Newsletter from the NIH that referenced peer review journals, again we will just have to agree to disagree on the scientific value of those journals. Yes, there is patient misuse that contribute to this problem, but again IMO this is an expected result from a poorly designed system of dispensing a highly addictive but necessary medication.
The internet is a great thing, but medical sources are being cited that people really don't understand. Additionally, using inflammatory hyperbole -"giving out prescriptions likeHalloween Candy" or "lead to addiction in a matter of days" is grossly inaccurate and irresponsible as to the source of the problem. It clearly is abuser driven as this newsletter suggests.
I read the references via pubmed and even read the articles' references. I won't lay out my CV here but I did understand. Yes there was hyperbole, but this is a very personal topic and we are on a public message board and this is quite tame relative to political debates on a baseball thread.
My pain management colleagues can treat patients that require opioid pain medicines for years without them ever developing physical dependence or psychological addiction with proper counseling and patient compliance to the dosing regimen.
Yes, the majority learned to do it right and they should be applauded. However, the fact is we are in crisis and it was over prescribed.
Referring to the AMA as a credible source of medical information shows a complete lack of understanding as to what the AMA is. It is not a medical organization. It is a political organization with a political agenda, not a defender of medical integrity. In fact, it only has about 10-12% membership of the practicing U.S. medical docs. Most members are hold overs from the ]70s, or have a political agenda that coincides with the AMA. Membership cost is nominal (less than $500 per year) but most of us choose not to participate because we don't agree with a political organization that pretends to be a proponent of healthcare.
I don't disagree about AMA's political agenda. However they and the ACS opiod task force also support changes to prescription practices.
Personally, I never write for opioids for anything other than significant trauma and post-operative pain control. Very rarely more than a few days, never more than 2 weeks even in the most dire injuries/surgeries. Heaven forbid you show up on the operating table with a crushed limb. But if you do, I promise you that you part of your medical management will include a scheduled regimen of opioids to assist in pain control. I will promise you that you will appreciate it.
Again, I thank you for your dedicated and tireless service to others. I have had post-surgical prescribed short dose opiods and I was grateful for them.
I also promise you that if written responsibly by the physician (almost always the case) and if you follow that regimen (less frequently the case), you will run little to no risk of addiction. If you abuse/misuse it, that is where the problem is.
The road to misuse/abuse is complex, considering the highly addictive nature of this controlled substance. How it gets misused and abused is relevant. Clearly if the pad was not part of the problems, we would not have PMDPs