I am writing in response to Dr. Orman’s letter of June 11 regarding the closing of his pain clinic. While his letter is accurate in spelling out the frustrations that we physicians face in getting our opioid prescriptions filled, it is important to ask why this is happening. We are in the middle of an opioid epidemic. In 2017, 20,000 people died in the U.S. from accidental prescription pain pill overdose. These pills are coming from our prescription pads, the vast majority being legitimate prescriptions for patients in pain. To give you an idea of the magnitude of the problem, in 2013 one respected local pharmacy in Sonora was filling prescriptions for over 100,000 opioid pain pills per week. That’s over a million pills in 10 weeks from one local pharmacy in a small town. What is happening to all these pills?
Which brings us to the heart of the problem. It’s estimated that over half of pain pill users get their pills from family or friends. Patients share them. Kids steal them from grandma’s medicine cabinet. House guests get their hands on them. Soft-hearted chronic pain patients “help out” friends or family going through withdrawal. Left over pain pills sit in medicine cabinets waiting for the wrong person to use the bathroom. It has proven impossible to stop this illegal diversion. Obviously something has to be done to reduce the number of pills finding their way into our kids’ parties and onto the street.
It didn’t used to be this way. When I graduated from med school in 1970, we were taught to use these medications short-term for severe pain so as not to get our patients addicted. Then in the late ’80s, one small study promoted the ideas that if patients took them as directed for genuine pain, they were not habit-forming. Time has proven this to be false, and this loosening of doctors’ inhibitions has led to our current epidemic of overdose and death.
Ideally, we doctors would recognize our role in the problem and begin restricting the use of opioids to end-of-life care or short-term treatment for acute pain. We would educate our patients that Norco, Oxycontin, Dilaudid and others are not well-suited for the treatment of chronic pain due to the rapid development of tolerance, in addition to being highly addictive and potentially lethal. We would start switching our opioid-dependent patients over to buprenorphine (Suboxone), a modified opioid that is a superior pain medication and carries no risk of overdose. This drug requires a special license when prescribed for addiction, but any doctor can prescribe it for pain. Since we have been slow to do these things, those trying to do something about the opioid epidemic have applied pressure first to the drug wholesalers, and now to the pharmacists.
Doctors are trained to weight the benefits of a treatment against the risks. Time has shown that the risks of opioid therapy for chronic pain far outweigh the benefits. Simply put, 20,000 deaths a year is an unacceptable “side effect.”