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The prescription opiate conundrum

Within any health care system the are many complex relationships between the parties based on economics and the provision of what is clinically deemed to be appropriate care. The current so called ‘epidemic’ in the US relating to the abuse of narcotic painkilling medications and their inevitable social spillover into the street use of heroin is, if the numbers quoted by certain governmental agencies and media outlets, are alarming. This increased shock value in 2014 is exacerbated by the fact that sugar brown in all it s increased purity has made its stealth like way into the bedrooms and veins of white affluent suburban kid, leaving the black ghettos as it climbs the social ladder.

Drug addiction does not discriminate but color does and when the crack/heroin problem thrived in the inner city ghettos of NYC, Chicago and DC the national press did not seem too interested in covering the issue with an eye to remediation. The general view at that time was that these AA populations had brought it on themselves and were for all intents and purposes left to their own very limited devices.

Well now that the heroin epidemic has insinuated itself into the garden suburbs of leafy New Jersey the issues has become public policy number one. Whatever opinion one may hold regarding the racial disparities there is one fact that is inescapable, and to properly get to and understand this fact will require a short history of legal pharmaceutical drug industry.

AT the start of the century there were a number of large pharmaceutical labs in both Europe and the US most of which you will know some. These companies helped out with the war effort and so after the cessation of WWII they were given multiple tax breaks and industry incentives, which allowed a larger number to commence operating outside of the law. They manufactured potent narcotics and a multitude of anti-virals, anti-biotics and mind altering substances. These companies grew in power and financial standing and soon used this money to start their vast campaigns of bribing the US congress into passing lax laws that allowed them to indiscriminately advertise(not allowed in Eurpoe) on all media forms and create enormous teams of attractive female reps that would divide doctor territories and then relentlessly harass the doctors till they started prescribing their pills of pain. The reps would concoct wonderful stories of how effective and harmless the medications were and would entice the naïve doctors to conferences in exotic locations where they would continue their narcotic brainwashing.

Now although many would say the physician is individually responsible for the dispensation of the medications it seems almost discriminatory that the recent attacks on the medical profession by the DEA and the local licensing boards have not as part of their greater strategy taken aim at the executives of the large pharmaceutical companies, who are the manufacturers and drug dealers. I fear this is another example of big government corruption in which the monies donated from the large pharmaceutical companies have silenced the DEA and other prosecutorial authorities, and therefore the easier target is the lone physician, who in most cases is just trying to honor his oath and help patients with debilitating pain. I do not however think this will happen unless there is an enormous public campaign that holds these companies accountable. Alternatively they should be stopped from advertising as is the case in Europe, which has a compensated smaller fraction of addiction and synthetic drug abuse.

The recent spate of stories of famous people overdosing on usually heroin can have an initially glamorizing effect , but the truth of a drug addicts life is one of intense misery. There is no question that this social problem needs addressing but before any effective solution is implemented all parties concerned must have an honest discussion.

Just to give you a little background on the migration of synthetic opiates in to the medical management of non-malignant chronic pain conditions it was about 1993 that a distinguished neurologist from the Memorial-Sloan Kettering Hospital in Manhattan began proposing the use if these medications in small doses in patient with no cancer but chronic pain. This shift in thinking opened the therapeutic gates for synthetic opiates such as fentanyl patches, oxyconton, Percocet and and host of other variants. The intention was to controlmpian as effectively as possible as pain had just become one of the vital signs taken in the post-operative recovery room before discharge and it had therefore gained the sameclinical eminence as BP and Pulse. Treating pain aggressively in the first 24 hours after surgery was seen as beneficial as it lowered the cortisol stress reaction and allowed a quicker recovery and rehabilitation of the patient. It can be seen therefore that the intentions and theory were both good and based on scientific reasoning.

Fast forward 10 years and the situation seems to have developed some probl;ems that need correction. However it would be a an uneducated mistake to introduce draconian legislation that hurt the patients that need these medication most and which would essentially turn the clock of medicine back 40 years. There are without questions elements of society that have criminalized the traffic of these substances but it is inhumane to punish the good doctors and deserved patients whose lives have been made livable by the addition of synthetic opiates.

Overall there needs to be a moderate well though out plan that addresses the problem but continues to support the life saving programs for chronic pain patients. The issue of narcotic use is far too important to allow it the become a political football. That would be a crime.

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