A Path To Intended Death And A Gateway To An Opioid Epidemic
The authority to diagnose, treat and prescribe provides physicians with extraordinary influence over a patient’s life. What appears to be a simple act of prescribing medication can bring with it both intended and unintended consequences.
The impact of prescribing is illustrated when a lethal dose of Secobarbital is ordered for the terminally ill, and that dose results in a patient’s death. Death is an intended consequence, and death is now sanctioned through legislation in the six states where physician-assisted suicide is legal.
However, there is another type of prescribing for non-life threatening conditions that is wreaking havoc in the U.S. and bringing with it unintended consequences. Physicians writing opioid prescriptions to manage pain post-injury or following surgery have propelled the country into a crisis of addiction, suicide and unintentional death as a result of opioid overdose and the escalating use of the cheaper opioid, heroin, across all demographics.
This public health epidemic is an American one.
No other country in the world consumes the amount of prescription painkillers that we do here. According to CNN medical correspondent Dr. Sanjay Gupta, as of 2011, 75 percent of the world’s opioid prescription drugs are prescribed and swallowed up in a country that makes up less than 5 percent of the world’s population, leading to the most common cause of unintentional death in America today– drug overdose. He adds: “having traveled all over the world covering natural disaster, wars and famine, I am fully confident we Americans don’t have 75 percent of the world’s pain.”
How did this start? In the mid-1990s, there was a social movement that said it was unacceptable for patients to have chronic pain, and the pharmaceutical industry pushed the notion that opioids were safe. Legally prescribed drugs such as oxycodone, hydrocodone, codeine, morphine, fentanyl and others have become household names.
There is no other medication routinely used for a nonfatal condition that kills patients so frequently. In 2012, 259 million prescriptions were written for opioids. This is more than enough to give every American adult their own bottle of pills, resulting in a quadrupling of deaths since 1999. In 2014, nearly 2 million Americans either abused or were dependent on prescription opioid pain relievers.
The media’s current focus is on the real and gut-wrenching teen and young adult epidemic. The elderly are also casualties of this crisis. According to a 2014 USA Today analysis of data collected from IMS Health, a group that tracks drug dispensing, “the 55 million opioid prescriptions written in 2013 for people 65 and over marked a 20 percent increase over five years—nearly double the growth of the senior population” itself. The number of elderly patients on opioids continues to balloon, despite the fact that this class of drugs has more severe effects on older bodies.
No other country in the world consumes the amount of prescription painkillers that we do here.
Those in the age cohort just below 65 are seeing spikes as well. Since 1999, deaths increased by 265 percent in men and more than 400 percent among women ages 45-54. Women were found to have the highest risk of dying from a prescription painkiller overdose because they are more likely to have chronic pain, be prescribed prescription painkillers, be given higher doses, become dependent more quickly, use them for longer time periods, and “doctor shop.”
What is the difference between dying from an opioid overdose or an overdose of Secobarbital? Lethal doses of medication and overdoses both end in death. An opioid overdose is an unintended tragedy while a Secobarbitol overdose is intended. Both start with a prescription written by a physician.
Physicians have the power to change the trajectory of unintended consequences.
The right to prescribe brings with it a responsibility to do no harm. But, the challenge is to figure out how to help a patient in pain without hurting society.
Image courtesy WikiMedia Commons