A great deal is made of the ‘War on Drugs’ in this country, and while it’s important to try and keep illegal drugs from falling into the wrong hands where they can be used for harm, there’s a much easier and possibly even more important battle over drugs that we simply aren’t fighting.
I’ve mentioned the epidemic of pain pill abuse a few times before on this blog. Prescription narcotics rank among some of the most addictive substances, activating exactly the same systems as heroin and cocaine. While they do have legitimate uses, they also have a huge potential for abuse — one that very few doctors, legislators, or even patients seem to be aware of. And while I’m always in favor of educating people about the nature of addiction, the epidemic of pain pill abuse has passed the point where education alone will be enough to stem the tide. It has been reported that 3% of the nation’s physicians supply more than 67% of the pain pills, a vast number of which get diverted, or are taken because of addiction rather than chronic pain. Those 3% of physicians must be aware that at least some of their patients are inappropriately dependent on the medication, and yet no attempt is made to limit it. No, education alone is no longer the answer in this battle against rampant abuse of drugs.
Thankfully, this battle isn’t one that requires actual violence, like the devastating fighting that can occur when police try to seize quantities of dangerous illegal substances. Fighting pain pill abuse won’t require us to police the nation’s borders against well-armed cartels of smugglers and profiteers. We know exactly where the the massive supply of inappropriate pain pills comes from; the prescription pads of physicians. Every prescriber of these pills is registered as a physician, and is a well-known figure in their community. All it would take to fight this epidemic is a few sentences written into the law restricting overprescription of painkillers, and a few DEA agents with a computer. That’s all it would take to essentially shut off the supply of prescription pain pills that are being diverted or taken inappropriately. Physicians who prescribe buprenorphine for addiction are limited to 100 patients each; if we exceed that limit, the DEA comes calling. How is it, then, that while we are kept strictly to our limit, other physicians can write for thousands of patients to get an unlimited number of painkillers, without any monitoring of progress or tracking of prescriptions? Take Michael Jackson’s death as an example. How was it possible for a single physician to order that many medications without a single red flag going up anywhere in the records of some pharmacy or pharmaceutical company? How is that no one every questioned him? If all the medications were for a legitimate course of treatment, they needn’t have been stopped, but it should at least have been looked into. The lack of oversight when it comes to prescription painkillers is appalling.
I understand that government intervention is often inefficient and can easily go wrong, but in this case it is vitally necessary. I have had more than one patient who was caught scamming my office, taking buprenorphine prescriptions while also going to another doctor for narcotic pain pills, either to take them in conjunction with buprenorphine or sell them on the street. These patients are usually discovered via the pharmacy, the point where their two prescriptions interact. The thing we need to do, then, is get the pharmacies on board and begin tracking some of these prescriptions from the point of sale. Obviously we need to protect the availability of narcotic medications for all those who need them for legitimate purposes, but there also needs to be some effort to control what is, in fact, a dangerous family of substances with therapeutic potential. Our current strategy — completely unrestricted flooding of the market — is resulting in nothing but widespread addiction, overdose, and massive diversion of prescribed medications.