The heroin epidemic – some thoughts


Category : Medical Rants

As a medical student and resident, I saw many heroin addicts.  We got used to managing right sided endocarditis and overdoses.  That epidemic diminished greatly until recently.  Susan Collins points out the likely source of the current epidemic – Susan Collins cites possible tie between hospital patient surveys, overprescription of opioids.

“In the meantime, however, we are concerned that the current evaluation system may inappropriately penalize hospitals and pressure physicians who, in the exercise of medical judgment, opt to limit opioid pain relievers to certain patients and instead reward those who prescribe opioids more frequently,” the letter added.

As often happens, bureaucracies create rules without carefully considering the unintended consequences of those rules.  If they had consulted practicing physicians about this emphasis on pain control, perhaps the physicians would have predicted this consequence.  “But the letter questions whether pain management should be part of the equation. Four of five new heroin users were first addicted to prescription opioids, according to the National Council on Drug and Alcohol Abuse.”

So what should we do?  Here is a radical idea.  We should test medical marijuana as an alternate management strategy.  Many studies are addressing this issue.  Here is a reference that gives mixed results – JAMA Meta-analysis Finds Mixed Results for Medical Marijuana Use

Marijuana does have complications, but they are less frequent and rarely fatal. IN STATES WITH MEDICAL MARIJUANA, PAINKILLER DEATHS DROP BY 25%

We need to think creatively about the opioid epidemic.  Physicians must share the blame.  Bureaucrats must share the blame.  We should work together to advance new solutions.  While we wait, more people are dying from heroin and other opioids.

Comments (5)

[…] Should we use marijuana to battle the heroin epidemic? […]

A loud, unequivocal statement from our medical societies that pain is not a vital sign would be a good place to start.

Speaking from personal practice experience, i have had hundreds of patients wean or reduce off narcotics and utilize cannabis as their primary source of pain control. I have also had handfuls of patients stop tobacco use and replace with cannabis use, and lastly, i’ve had patients state that cannabis helped them stop alcohol (recover from alcoholism). I see it every day, and my biggest obstacle isn’t justifying cannabis, but rather trying to let other physicians aware of its medical importance. Especially since the AMA originally opposed cannabis becoming illegal back in the 30’s.

I believe medical marijuana should be tried,as for some people,it is an effective pain reliever.
I question the accuracy of the 4 out of 5 heroin addicts were prescription drug addicts first-we recently lost a family member to a heroin overdose-who had never abused prescription drugs,nor been addicted to them.
A friend recently lost two of his sons a month apart due to heroin overdoses-neither of them were prescription drug users.
Oldest daughter’s high school class of 450 has seen 55 kids dead from heroin overdoses in recent years,most of them were not prescription drug addicts. They went straight to heroin.
heroin is readily available and inexpensive.

Something else not often discussed in relation to the “opioid epidemic” is that it is not all those prescribed opioids that are the cause of the problem-it is those who abuse the medication that are the problem.
There are people with severe,chronic pain who do in fact need to be prescribed opioid pain meds-I know,as I am one of those people. I have well documented medical reasons for my chronic pain,clearly visible via x-ray or MRI,and simply by looking at my rt leg.
What I think will happen is that it is pain mgt. patients who will suffer because of the opioid epidemic” even though we are subject to random urine screenings and random pill counts to verify that we are not abusing the meds,or diverting them to the black market by selling them
Another problem is the absurd cost of the “tamper proof” versions of time release narcotics-such as Oxycontin and MS Contin,which do not work as advertised anyhow as both release 60-70% of the dose in the first hour,leaving 30-40% to be released over the course of the next 11 hours-(MS Contin supposedly lasts 12 hours,in my case,it lasts 6 at best,more often about 4 hours.)
There are quite a large number of older people who’s health insurance either does not pay for the drugs at all,or due to cost,their coverage hits it’s
limit in a month or so. These people can not afford to pay full price for these drugs,so the sell some to make ends meet,or to cover the cost of the prescriptions.
The IR versions of these drugs are a fraction of the cost,work much better for pain control,and by switching to them over the extended release versions,much of the drug diversion would be stopped.
Most likely,rather than doing this,the new plan to deal with the “epidemic” of opioid overdoses,the vast majority of which are due to heroin,it will be decided to drastically curtail prescribing opioid drugs,and those of us with legitimate chronic pain will be the ones who suffer.

thanks greatly for your informed comment

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