narcotics, alcohol and smoking

Tuesday, May 29, 2018

There is an opioid epidemic in the United States. Whether it involves prescription narcotics or street drugs, people are overdosing and dying from drug abuse. Understanding how narcotic naïve people went from no use to death is important to understand, and it’s also important to know how some pharmaceutical manufacturers helped stoke the fires of narcotic addiction, but it’s also important to question our societal outrage when it comes to the consequences of narcotic abuse.

There are two major sources of opioids:

  • Prescription medications like oxycodone (Percocet, Oxycontin), hydrocodone (Lortab, Vicodin), tramadol (Ultram)
  • Street drugs like heroin and fentanyl (which is normally a prescription medication that is easily manufactured in street labs)

A confluence of unfortunate circumstances came together many years ago to cause an excessive number of narcotic prescriptions to be issued by health care providers.

  • There was a societal push to consider pain as the fifth vital sign (after blood pressure, heart rate, respiratory rate and temperature) and regardless of the reason for a medical visit, patients were asked about their pain. In the office for a routine blood pressure check…how would you rate your pain today? Teenager visit for a pre-participation physical…how would you rate your pain today? Cancer patient in for palliative care…how would you rate your pain? A subjective pain scale of 1 to 10 was used (and a smiley face, frowny face equivalent for little kids). Presumably, the expectation from either doctor, patient or both was that the goal was a pain rating of zero, regardless of how many drugs it took to get there. Federal mandates still demand that the pain question continue to be asked.
  • About the same time, corporate medicine began using patient surveys to rate provider satisfaction. How well did the doctor, nurse practitioner or physical assistant met your needs as a patient? The satisfaction metric rested next to productivity as an influence on salary and other benefits. If a patient was unsatisfied that their pain was not completely gone, then the doctor’s income could be negatively impacted. It was another impetus to aggressively prescribe pain pills.
  • And then there was Purdue Pharmaceuticals, maker of Oxycontin, a long acting narcotic pain pill. If only there was a wonder drug that could control pain and yet not become addictive, the world would be a better place. It seems that Purdue aggressively marketed their pain drug as just that, non- addictive, presumably backed by research that confirmed that contention. Providers started to write prescriptions and patient addiction grew quickly. It seemed that Purdue management had failed to act ethically when it came to their pursuit of profit.

Increased funding will be needed to address the opioid epidemic. In 2016, 116 people died every day from drug overdose. According to researchers, the opioid abuse will cost the US economy about $200 billion in 2020. In an article published in the Journal of the American Medical Association Journal-Psychiatry, authors from the Harvard University and the University of Michigan called on Congress to increase research funds, monies to purchase naloxone, the opioid overdose reversal drug, clean syringe and safe drug injection programs, foster care programs for children of addicts and funding of rural health care addiction programs.

We care a lot about drug overdose deaths, often because the victim is younger and there is an immediacy between taking the drug and the time of death. It seems that we don’t care as much and don’t have congressional hearings when there is a large time lag between ingestion, disease and death.

According to statistics from the Centers for Disease Control and Prevention (CDC), there are twice as many alcohol related deaths each year (88,000) as there are from opioids. In 2010, the CDC estimated the cost of excessive alcohol consumption was $2.49 billion, 25% more than opioids. People rarely die immediately after a drink or two or many, but chronic alcoholics shorten their lives by about 30 years, and alcohol is responsible for 10% of all deaths in working adults.

When it comes to tobacco, the death statistics are graver. 480,000 deaths each year are tobacco related. That works out to 1,300 deaths per day, more than ten times as many due to opioid overdose. That includes the 41,000 who die each year of second hand smoke. In all smoking causes 20% of all deaths in the United States and costs the economy more than $300 billion yearly.

Alcohol and tobacco are institutionalized and historically grandfathered as acceptable drug ingestions. Aside from drunk drivers, the death and destruction rarely happens contemporaneously. Society sees those diseases and deaths as reasonable collateral for acceptable social behavior, not to mention a great source of tax revenue to fix roads and pay for schools. Opioid abuse can be an immediate killer and those deaths make headlines. The deaths are indiscriminate and afflict people from all social and economic classes. The war on tobacco and alcohol failed. History will decide whether the current war on drugs will fare any better.

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gun violence

Monday, February 19, 2018

It’s February 19, and according to the Gun Violence Archive, there have been 1,983 gun deaths and 3,433 gun injuries so far in 2018. Yesterday 23 people died and 51 were injured. Normally, an epidemic of deaths from unnatural causes would be a major focus for the Centers for Disease Control and Prevention, but that is not the case.

The 1996 Dickey amendment stated that “none of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention (CDC) may be used to advocate or promote gun control”. While it may seem that gun violence research could continue, congress earmarked the $2.6 billion of the CDC budget that would have continued previous research specifically to traumatic brain injury study.

In 2013, the president directed the CDC to restart gun violence research. This lead to a CDC publication addressing gun violence in Wilmington, Delaware and suggesting opportunities for prevention, including focusing resources on potentially high risk violent youth. CDC then added that it was possible to conduct firearm-related research to address youth violence, domestic violence, sexual violence, and suicide, but that there was not the financial resource to do so. The Dickey amendment was reauthorized by Congress in 2015 and research efforts were curtailed.

There were 15,592 gun deaths and 31,185 injuries in 2017. These deaths do not include the more than 22,000 suicides recorded. More people were shot to death than were killed by drunk drivers. The question is why?

Violent video games and graphic movies don’t stop their content at political borders. People in New Zealand, Australia and Europe are exposed to the same online and entertainment content and yet, there are no masses shooting (345 last year, almost one a day). Similarly, people drink across the planet, but only in the US do people drive drunk without significant consequence…including thousands of deaths each year. What conditions exist in the United states that cause so much death and destruction.

Question are easy and answers are not. For that reason, the CDC needs to be empowered and encouraged to research and understand the epidemic of violence and offer explanations and recommendations. Ten times as many children died from gunshot wounds than from this year’s influenza epidemic and there does need seem to be the will in Congress to fund those who can help solve a public health catastrophe.

 

With the latest mass shooting in a Florida high school, students seem to be taking the lead and teaching us that being quiet and passive no longer is an alternative. We need to listen to those who can teach and it is not always the adults in the community.

 

 

 

 

 

 

 

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