Jason D. Fodeman, M.D. internal medicine resident, writes an interesting post about the prescription drug crisis. He says:
The tragic death of Whitney Houston has once again shined the spotlight on the abuse of prescription drugs and the doctors who prescribe them. Legislators, experts and pundits are blaming physicians for liberally prescribing narcotics, but an honest debate must also examine how government policy has helped foster this crisis.
The abuse of prescription medications is not limited to Rodeo Drive and the Upper East Side. It is a national problem. From Crenshaw to Harlem, and practically everywhere in between, it plagues the practice of good medicine in both the inpatient and outpatient settings.
Inevitably, doctors with the power to prescribe these medications have found themselves at the center of the storm. Are physicians avaricious enablers looking to profit off the addiction of others or are they merely pawns desperately trying to stay afloat navigating the system legislators and regulators have established?
His answer is no, that’s it’s more complicated than that. I’m afraid physicians are being let of the hook. Please go read his whole post.
Chiropractors (and I am one) work with many pre and post-surgical patients suffering with back pain, joint problems, head aches, etc. The vast majority of patients use at least one medication. Most, many more. A scary number have used meds for non-medical reasons. They are not alone.
In the last couple years, easily over 50% of the patients are on some form of anti-depressant. Nearly 100% of patients who went to their MD’s first for some ache or pain are prescribed narcotics or muscle relaxants. No, that is not an exaggeration.
There is nothing quite so appalling as seeing a patient “not there” due to some psychotropic med or who is suffering drug withdrawals from trying to get off a narcotic for a relatively innocuous discomfort.
My feeling is that the medical profession, while harried and pressured by patients, just don’t see the harm in the medication. Most view it as an objective good and a benefit in the modern medical world. And while medications, and even narcotics, are indeed amazing advances, they are dangerous because they are so powerful and effective.
Very few docs watch their post-surgical or quasi-surgical (trying to not have patient go to surgery) patients closely. Many give huge prescriptions for narcotics instead of being circumspect and forcing the patient to come back for more meds if there’s trouble or prescribing something less pain-masking but easier to wean from.
A patient has to be very medication-wary themselves and press the doctor for alternatives.
Pain medication of the narcotic variety are psychologically as well as physically addictive. They remove the feeling of pain everywhere — body and mind. People don’t realize what pain they’re living with until it’s not there. Dangerous.
The solution to the problem of over-prescribing: doctors need to get into the mentality of least interventionist policy necessary. They also need to better monitor patients on psychotherapeutic and pain meds.
Most importantly, patients need to educate themselves. There’s this notion that narcotics or psychotropic meds are no big deal. Many friends and patients are shocked when I tell them something like this:
Caffeine –> Speed –> Ritalin, Adderall, and Dexedrine (ADD medication) –> Crystal meth
Those are stimulants, just as an example. There’s a reason why kids are smashing Adderall and snorting it. It’s a rush and it is more powerful than regular old speed.
Here are the order for narcotics:
Codeine (e.g. Tylenol #3) –> Hydrocodone (e.g. Vicodin) –> Oxycodone (e.g. Percocet, Oxycontin)
Percocet and Oxycontin, well all of these drugs, but especially these last ones are highly sought after as street drugs for a reason. I watched a post-surgical friend go through withdrawals, have trouble sleeping, get the shakes, etc. As his friend, I knew that he wasn’t feeling pain from the surgery anymore. He had a great surgeon, who was paying attention, but was still a wee bit lax. So his wife and he talked and he agreed that he was wanting the medication because it felt good but that he wasn’t feeling pain so much. He was scared by this and so were we and so, his wife helped wean him. It was a tough week. And this was a guy who had needed the medication very badly. He recovered fine, but he had to gut it up for a few days.
Here are the order for muscle relaxants which are also addictive (did you know that? most don’t). Good site about meds generally:
Carisoprodol (Soma). This drug’s dosage is 350mg every eight hours as needed for muscle spasm. Soma is typically prescribed on a short-term basis and may be habit-forming, especially if used in conjunction with alcohol or other drugs that have a sedative effect.
Cyclobenzaprine (Flexeril). This medication can be used on a longer-term basis and actually has a chemical structure related to some antidepressant medications, although it is not an antidepressant. Usually it is prescribed as 10mg every six hours as needed to relieve low back pain associated with muscle spasm, or it can also be prescribed as 10mg at night as needed to help with difficulty sleeping. Flexeril can impair mental and physical function, and may lead to urinary retention in males with large prostates.
Diazepam (Valium). Valium is usually limited to one to two weeks of use, and the typical dosage is 5-10mg every six hours as needed to relieve low back pain associated with muscle spasm. Because of its habit-forming potential, and because it changes sleep cycles and makes it very difficult to sleep after stopping the drug, Valium should not be used long term. Patients should also note that Valium is a depressant and can worsen depression associated with chronic pain.
Mind you, most patients with back pain alone are on multiple medications. After two meds, no doctor can predict the interaction.
Both patients and physicians are far too casual about their medication use. I haven’t even included anti-inflammatories or anti-depressants or anti-psychotics (over used now for depression and/or ADD off-label), or NSAIDs.
Did you know that the NUMBER TWO cause of death in the United States is prescribed medication poisoning?
“Deaths and hospitalizations associated with prescription drug misuse have reached epidemic proportions,” said the study’s lead author, Jeffrey H. Coben, MD, of the West Virginia University School of Medicine. “It is essential that health care providers, pharmacists, insurance providers, state and federal agencies, and the general public all work together to address this crisis. Prescription medications are just as powerful and dangerous as other notorious street drugs, and we need to ensure people are aware of these dangers and that treatment services are available for those with substance abuse problems.”
While Dr. Foderman is right to bring attention to this very important issue, I think he lets doctors and patients both off the hook.
Americans are far too pain-avoident these days. Unwilling to suffer even a tiny amount, patients are asking for and getting, or just being given, very powerful medications that have far worse consequences than the discomfort would itself.
This is a cultural problem as much as it is a medical one. Escaping from pain creates more pain.
Bonus: All the celebrities who have died from prescription med overdose. Add Whitney Houston who had Xanax, Valium, and alcohol in her system.
Yesterday, my esteemed co-blogger John Hawkins wrote a post stating that he agrees with John McCain about regulating nutritional supplements. They’re both wrong.
First, it’s important to examine how effective the FDA is in protecting the people when it comes to regulating drugs. Not very. Deaths from prescription drugs are “soaring“. Check out this recall list. That means that these drugs were approved as safe.
Second, an FDA approval gives a false sense of safety. Any substance designed to manipulate physiological functions is inherently dangerous. An FDA approval does not change that.
Third, unregulated nutritional supplements cause a tiny percent of deaths. See table.
Now, all sorts of claims are made about supplements, but those are already regulated. People go through trends and often spend money on “worthless” supplements. Some nutritional supplements really help a person’s health. Some supplements offer only the placebo effect.
If a dude buys a supplement to enhance his “performance” and “size”, he’s stupid, but most of the time, that’s not fatal. Viagra, on the other hand, can be.
I would suggest that regulating this industry further is just an expansion of the nanny state and another way to infantilize the consumer. More than that, it’s a push by the medical industry because they’d like to put their competition out of business. They’d like to be the only ones to make nutritional recommendations and claims even though they have far less training than chiropractors and nutritionists. This is an economic argument and a desire for market share and nothing more.
So no. I don’t want the government pushing their nose into nutritional supplements. Mind their own damn business and cut the debt. I don’t want one stupid bureaucrat telling Americans one more thing about how they should live their lives.
Also, I think the FDA is pretty much bought and paid for by drug companies. Too much to get into now..but there are many experimental drugs that could help people. My opinion is to let people try them. It’s called choice.
Too often, people die while waiting for a drug to be approved when a drug has been used for years in another country safely. The FDA process also makes bring a drug to market so expensive that it creates a monopoly for huge pharmaceutical companies.
Free up the market. Tell people they’re on their own to research it. Let freedom ring when it comes to drugs and supplements. We should be opening this market, not giving the government more control.
Now, probably every single person attending the National Organization for the Reform of Marijuana Laws conference in San Francisco voted for President Obama and really, the President, himself probably wink-winks at pot use. (Kinda like he’s actually pro gay marriage, for a single payer health care system, and wants to tax all people, not just the rich, into oblivion.) Still this image is probably not what President Obama wants out there for public consumption.
The goal is to look middle of the road, while secretly having the politics of a hippie communist that will “remake America” with a tad more subtlety (via the Washington Post):
What I love about this picture is that he looks soooo Cuban, so dear leader of a Banana Republic.
Note: It’s satire.
A Mess South Of The Border
I wondered if Bush had some sort of deal with the Mexican cartel.
The team manager, Claudio Corti, said: “We’re absolutely stunned by what’s happening and by the behaviour of one of our riders. He seems to have secretly used banned substances, hiding everything from everybody in the team.”
Oh, puhleeeze. Does anyone believe that?
It seems like the time of drug free competition ended some time back in the 70s when Eastern European “women” looked like Arnold Schwartzenager. In fact, I think Arnold is really a woman….a really buff woman.
Too much time and effort go into testing these yahoos. If people want to kill themselves to ride their bicycle faster, I say more power to them. What say you?
Cross-posted at Right Wing News