Opioids: Our Pain, Our Children and New Roads Forward

I grew up pretty poor in Los Angeles County. Even though I lived near rich families and nice suburban neighborhoods, I couldn’t identify with their way of life. From the outside in it looked like those families had it all, so they should be quite happy. But once you take a closer look, suburban areas are not always as perfect as they seem — especially when it comes to the lives of youth.

In fact, in a recent study of urban students in grades seven through twelve, the use of Oxycontin, an opioid, was found to be overused in almost 20 per cent of these students.[1] Fentanyl use in recent years has reached an all time high, killing thousands of students. In 2014, 20.5 percent of the U.S. population age 12 or older, or roughly 56 million people, reported using prescription pain relievers, tranquilizers, stimulants, or sedatives for a non medical purpose at some point in their lives. In 2016 alone, 42,249 US drug fatalities — 66% of the total — involved opioids. That’s over a thousand more than the 41,070 Americans who die from breast cancer every year. Governors are begging Congress to do more to address the issue.[2]

The matter of prescription drug abuse among youth, and specifically the uptick in opioid use, is a clear problem. Young people will, in order to cope with the challenges of these pressures from the point of view of their mental health, either get a legitimate drug prescription and overuse it on purpose, or they would steal prescription drugs from their parents or buy it on the street. Many young people in my community are more likely to use prescription drugs than alcohol because there is a mistaken perception that they are less harmful.

And doctors made that possible, along with the rest of our money-centered medical system and the over-prescription of these fatally dangerous classes of drugs.

How does this happen?

The ethical conundrum begins before a physician even graduates from medical school.

There are many instances in which students will be exposed to drug companies not only directly in the course of their studies, where drug presentations are common, but also on hospital rotations.[3] Because of this, it has been found that while 85% of medical students believe it is improper for politicians to accept a gift, only 46% found it improper for themselves to accept a gift of similar value from a pharmaceutical company.

The impact of this influence cannot be understated. These representatives from drug companies have a significant pull on the way that physicians are likely to organize their business, and the choices they make in offering samples and prescribing pills to their clients. There seems to be a direct effect on overprescription, but there is also a need to recognize that there may also be an impact on the ways in which physicians evaluate the benefits and side effects of the drugs, and this specifically affects primary care physicians handing out samples and prescriptions of opioids.[4] This is especially important when taking into account the fact that the latter stages of drug trials, once drugs have been approved by the Food and Drug Administration, are often administered on a broad scale by specialists in clinical or hospital environments in order to examine different longer-term effects, but these effects may not always be taken into account in the average physician’s office when a patient comes in with a complaint.

In fact, evidence shows that physicians are always going to be highly likely to behave in ways contrary to their professional principles when they keep company with drug company representatives. As Howard Brody, MD, PhD from Michigan State University, suggests, all major studies over recent years show that “systematic reviews of the literature confirmed a direct relationship between the frequency of contact with reps and the likelihood that physicians will behave in ways favorable to the pharmaceutical industry.”[5]

Pain medicine is one of the most challenging issues in health care, because we’ve traditionally relied on opioids, but that can shift. Cannabidiol, also known as CBD, can provide a different pathway to managing pain, and one that may be even more effective. Unlike opioids such as Fentanyl or Oxycontin or Vicodin, there are zero recorded deaths associated with its use.

While the medical community needs to begin to look at what it means to be transparent about how individual physicians get their information about new drugs and why they decide to promote these to their patients, we, as consumers, can begin to make better choices about the health care practices that we support. Even though it is not possible to guarantee that all medical care providers are taking the right path forward, we can start to become more reflective of whether the prescriptions we are receiving are the right choice for us, and for our children.

Our children deserve better, and so does our medical system.

— Klee

[1] Brands, B., Paglia-Boak, A., Sproule, B. A., Leslie, K., & Adlaf, E. M. (2010). Nonmedical use of opioid analgesics among Ontario students. Canadian Family Physician, 56(3), 256.

[2] Mulvihill, H. (2018). Governors to Trump, Congress: Do more to solve opioid crisis. KMTR. Retrieved from http://nbc16.com/news/nation-world/governors-to-trump-congress-do-more-to-solve-opioid-crisis-01-18-2018.

[3] Austad, K. E., Avorn, J., & Kesselheim, A. S. (2011). Medical students’ exposure to and attitudes about the pharmaceutical industry: a systematic review. PLoS medicine8(5), e1001037.

[4] Chressanthis, G. A., Khedkar, P., Jain, N., Poddar, P., & Seiders, M. G. (2012). Can access limits on sales representatives to physicians affect clinical prescription decisions? A study of recent events with diabetes and lipid drugs. The Journal of Clinical Hypertension14(7), 435–446.

[5] Brody, H. (2005). The company we keep: why physicians should refuse to see pharmaceutical representatives. The Annals of Family Medicine3(1), 82–85.

Pain Nation available on Amazon