The New Drugging of America

The CDC reports that the relatively recent epidemic of opium-addiction is now America's fastest growing drug problem. The source of most of these opiates is not the foreign cartels, traffickers and drug dealers depicted in Hollywood movies; it is pharmacies fulfilling prescriptions written by often well-meaning doctors for Vicodin, Oxycontin, Oxycodone, and other opoid pain relievers. According to the CDC, enough of these opiate-based drugs were prescribed last year to medicate every American adult with a dose of five mg of hydrocodone (Vicodin and others), taken every four hours, for a month, and have led to over 40,000 drug overdose deaths. Today there are more overdose deaths involving opoid analgesics than heroin and cocaine combined, and the public consumption of them costs health insurers approximately $72.5 billion annually. The urgent problem is the addiction of a vast number of patients whose pain but not their underlying causes are managed. While the consequences of this prescription-driven epidemic may be largely invisible to the general public, it is all too clear to doctors like myself who specialize in sports medicine, physiatry and the treatment of a range of painful conditions.

Just recently a 71-year-old patient saw me for a painful swollen knee. One year previously she had undergone total knee replacement and after the post surgical discomfort had subsided, the knee pain began. She explained that her surgeon prescribed she continue her physical therapy, but the pain worsened. She went back to her surgeon, who then prescribed Oxycontin, an opiate pain reliever. When the initial dose did little to relieve the pain, she was told to increase her dose, and continued to do so over the next two months. By the time she sought my help, not only was still in pain, but she had become addicted to the medication. The problem, which not unusual in such cases, is that the opoid had partially masked the underlying problem. I had requested a knee MRI, which found chronic synovial inflammation of her knee, which is treatable with steroid injections. By judicially providing this treatment, the inflammation was relieved and pain was gone. But not the addiction. For that, she needed a 30 day in-patient rehabilitation center to safely detoxify her and help her reform her drug habit.

I wish I could say that this case is atypical but unfortunately, it is not. Such addiction is becoming common. Part of the problem is doctors. Some busy surgeons find it more efficient to write a prescription that might work for the pain, than to spend time attempting to find its cause. Another part of the problem is patients. Many sufferers demand immediate pain relief, and, instead of fully following their doctor's advice, increase the dosage by seeking prescriptions from multiple doctors. Part of the problem is the government's failure to better police prescriptions. But whatever the causes of this epidemic, the results are tragic for the patients, especially since with rigorous evaluation many of the cause of the pain can be solved -- and without recourse to opiate drugs.