Prescription Drug Abuse: Why only policies will not stop this epidemic

The below article was published on NJ.com by Dr. Shuvendu Sen of Raritan Bay Medical Center. Dr. Sen has been an important partner and served as a panelist for our Do No Harm symposium last October at Robert Wood Johnson University Hospital. Dr. Sen's valuable insight into the opioid abuse issue helped make Do No Harm a success and we are proud to publish his editorial.

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It was always there. Physicians overprescribing controlled substances weren’t born last night. For decades opioids have been prescribed with complete comprehension of their deleterious effects. There was knowledge that these prescription drugs introduced addiction. That these drugs were sold on the streets were also known.

Why this fracas about this new found epidemic? What has triggered the nation’s nerve so fiercely? Not difficult questions. Agonizing literature of infants born from mothers hooked onto narcotic prescriptions, now suffering from both adverse and withdrawal effects finally dented an utter nonchalance that had shrouded the practice of medicine. This was a disaster that was waiting to happen. We now have an epidemic that has spilled into a new generation.

I have always been a firm advocate of governance in education. It is dangerous and fatal to have knowledge that does not possess conscience. More so in medicine, that is dynamic, rapidly evolving and ultra-sensitive. And here lies the tragedy of this epidemic. The very same men and women who are in the business of saving lives are the points of entry to this new avenue of human annihilation. For those hardened in sin, statistics may not matter. But the look of twenty thousand Americans dying every year from prescriptions can be downright nauseating.

What starts with a simple prescription becomes a heinous circle of multiple drug abuses. According to Centers for Disease Control and Prevention’s press report (October 2, 1014), increase in heroin overdose deaths may be linked to widespread prescription opioid exposure and increasing rates of opioid addiction. As Grant Baldwin, PhD, M.P.H, Director, Division of Unintentional Injury Prevention, CDC said “This study is another reminder of the seriousness of the prescription opioid overdose epidemic and the connection to heroin overdoses.”

Humans have always hurled defiance when challenged. And we are doing our bit. Albeit, slowly. Painful slow steps, measuring every mud, as if these are foreign policies that must appease all corners. A few months ago, the Drug Enforcement Administration mandated that doctors will no longer be able to call in certain prescriptions by telephone, and patients will not be allowed to get refills on the same prescriptions. The state of New York is becoming the first in the country requiring controlled substances to be prescribed electronically. New Jersey is on the verge of passing a legislation (S 2366) that requires health care practitioners to inform patients of addiction potential of controlled dangerous substances prior to issuing prescription. Organizations like Partnership for a Drug-Free New Jersey has been relentlessly striving for a society rinsed of this menace.

All wonderful endeavors.

But, are we missing the plot? Are we doing enough with our cautious policies in the face of piled up deaths? In short, have we been able to identify the crux of the problem? Who’s at fault really? The physicians who prescribe, the pharmacies that dispense or the pharmaceutical industries that churn in such drugs?

Take a closer look and the whole pipeline will smell of dirt. To begin with, we have a disturbed mindset. A strange drug dependent nation we have become. On one hand we have studies showing that the commonest cause of acute liver failure is acetaminophen. Yet, on the other hand, one can walk into any convenience store and buy boxes of Tylenol like diapers. A complete disconnect of science and ethics.

The drug Percocet will give us a complete picture. It is a combination drug that has oxycodone and acetaminophen. One introduces addiction, the other insults the liver. Yet this drug has poured out of a physician’s pen with effortless ease.

Thus we continue. Hypothesis, trials and verdicts lying side by side with policies, deliberations and conflicting interests. And slowly but surely the practice of medicine has fallen prey to this implacable trait. Today’s trigger happy physicians prefer the rushed prescriptions and not the primordial organs with which our forefathers had once started our practice of medicine- ears, eyes and fingers on the pulse.

Unless that essence of medicine is revived this epidemic will continue. 

 

 

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