Are we to blame for the heroin epidemic?

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Category : Medical Rants

During my training in the 70s, heroin use dominated our substance abuse horizon.  We saw many patients with IV drug related complications.  We saw heroin overdoses.

For the next 30+ years, we rarely heard about heroin.  Over the past 10 years we have seen increasing opiate abuse, but the opiates came from prescriptions.  Over the past 2 years, heroin has once again reared its ugly head.

This article blames physicians for opiate addiction – Doctors Play A Role In The Opioid Addiction Epidemic, Study Finds.

To begin to figure out how many, a team at the Mayo Clinic, led by pain specialist Dr. W. Michael Hooten, analyzed the medical records of 293 patients given a short-term prescription for opiates for the first time in 2009. These patients were being treated for acute pain — from traumas such as sprained ankles or major surgeries — so their doctors did not expect them to become long-term users of painkillers.

Yet just over 1 in 4 of these patients went on to use opioid painkillers for longer than 90 days, researchers found. A quarter of this subset engaged in so-called long-term use, defined as receiving at least 120 days’ worth of pills or more than 10 separate prescriptions.

In our defense, the pain lobby has put pressure on physicians to relieve pain. We are supposed to have patients grade their pain (1-10). Pain relief became a major focus for patient satisfaction and even quality.

Then legislatures figured out that many patients abused opiates. So they thought they could legislate opiate prescribing and ameliorate the problem. The opiate producers knew they had a captive audience, so their pills had significant costs.

So now we have expensive opiates and physicians encouraged to decrease prescribing. In comes the Mexican Cartel seeing a business opportunity. Heroin is relatively inexpensive to produce. It comes with a captive audience and many repeat sales. Bingo – we have a heroin epidemic. People can buy heroin more cheaply than prescription opiates (even if they could get them).

But heroin packages do not come with a potency description. Addicts do not know how much they are injecting.

So we have a marked increase in heroin overdose deaths.

And since they are injecting, we have a significant increase in infections (especially endocarditis) related to less than perfect hygiene.

We started this cycle, under pressure from the pain control lobby, but biology (some people really enjoy opiates) and addiction have made this a major problem. Once again few politicians understand the problem and their solutions tend towards draconian strategies.

We will once again be fighting this problem for many years (just like the 70s and 80s). And, oh by the way, we will have more hepatitis C and hepatitis B and HIV infections.

Comments (2)

There is a lot about addiction that seems murky to me. In the Mayo Clinic study referenced in this article, the majority of people handled the pain meds appropriately. Only 21% got a second prescription, and only 6% persisted for more than six months. The study does not have any information on the percentage that entered illegal channels to continue the use of opiates.
In my career, the vast majority of patients used opiates reluctantly and had few problems with quitting if they got a good antineoplastic response. Asking them about pain pill use was as useful as an MRI and a lot cheaper.
In my personal life, I had lots of left over Percocet after a surgery even though I certainly enjoy a glass of wine.
We need to figure out the biology of addiction.

I agree with RCentor’s post. We physicians didn’t place Fentanyl into street ‘Heroin,” nor did we ‘contaminate’ marijuana with PCP or other drugs of abuse.
Many states and cities now issue naloxone to first responders. How many of these entities look deeply at WHY these drugs are being used? What is it in the locales which pre-dispose people to use these drugs? Are there no other challenges for men, women, boys and girls or ‘Ze’s, etc.’ to find? Have parents failed their children. What factors predispose certain states, cities, etc. to increased or decreased drug use?
To assign the blame to physicians (and other ‘providers’ for drug over-use and abuse seems intellectually lazy, almost medical malpractice enticing, yet leaving us physicians blamed for the ‘ills of society.’ Perhaps if all of those never or no longer engaged in the practice of medicine, especially politicians, Social workers, and Administrators in the Medical Industry-Federal, State, Local, and Hospital arenas only looked deeply in their mirrors, the answers would suddenly appear in 42-64 point Fonts.

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