Has Western Medicine Completely Botched Painkillers?

No one living today would want to live in the days before antibiotics, anesthesia and antisepsis were discovered. In those days, patients could and did die from treatments like blood-letting (bleeding the patient), use of leeches and electric eels. Some attribute the death of the first president of the United States, George Washington, to excessive bloodletting for a cold/pneumonia. 

But patients today face another risk that wasn't around in Washington's day: over-screening, over-diagnosis, overtreatment and overmedication. For example, up to 60 percent of people as young as 30 are told on the basis of their X-rays that they have "arthritis," presumed to explain their pain and often leading to surgery. But studies show that most abnormalities and age-related changes shown on X-rays or other imaging technologies are not the source of the patient's pain despite the way they look. This is why traditional medicine’s over-screening and technology-based decisions can do more harm than good. These tests yield provider payments but usually no answers about the source of a patient's pain.

Doctors have traditionally received less than six hours of formal training in pain management in their four years of medical school and are much better at treating acute pain conditions like a broken leg, chest pain or appendicitis than chronic pain. That is because the acute conditions have clear explanations and specific treatments. Unfortunately, in traditional medicine, chronic pain patients are passively shuffled through the system and not taught or guided about pain. They are given pain drugs, time off from work, kind attention and sometimes financial remuneration. These seem to help in the short run, but actually embed the patient’s conviction of disability and pain.

There is another problem. Passive exercise like range-of-motion maneuvers performed by machines is good for acute conditions like a fracture, but not for chronic pain which requires active exercise. Similarly, opioid drugs may be appropriate for acute pain, but are not appropriate for long-term treatment of chronic pain. Studies suggest they not only cease working but can actually increase your body's sensitivity to pain through a phenomenon called opioid-induced hyperalgesia.

Opioid Deaths

Deaths from opioid narcotics like fentanyl, hydrocodone, hydromorphone, morphine and oxycodone—and the heroin these drugs sometimes lead to—have become an epidemic in the United States, taking 91 lives a day. When prescribing guidelines were loosened over a decade ago, brazen pill mills popped up to capitalize on the opioid drugs' popularity on the street. As millions became addicted, Pharma then launched opioid addiction treatment centers to play both sides of the street.

“The drugs to treat OxyContin addiction like buprenorphine, sold as Suboxone, are opioid derivatives that are 10 to 20 times stronger than OxyContin,” says author and pharmacist Larry Golbom. “After eight hours of training, addiction specialists have a wonderful revenue stream. MAT—medication-assisted treatment—has doubled Pharma’s revenue.”

As the opioid addiction epidemic grew, lines between real pain patients whose opioid use had gotten out of hand and people posing as patients to resell the drugs on the street blurred. Pain clinics and pill operations began to cut off the patients they had originally wooed and the patients often turned to the more readily available and cheaper heroin.

"The problem is patients are started, develop tolerance, need a higher dose, get tolerant to the higher dose, use more than prescribed, ask for early refills, get switched to a 'pain management specialist,' who if they violate the pain contracts, get fired, discharged, and then they go to the street for the opioids," says James O'Donnell, a pharmacology professor at Rush University in Chicago.

Dangerous Combos

Opioid overdoses are characterized by coma, respiratory depression, shock, pulmonary edema and death. Here is how one occurred from a recently published pharmaceutical textbook:

"A 35-year-old male school teacher and wrestling coach in a southwestern state was seen by a sports-medicine specialist. The patient was taking hydrocodone/acetaminophen (e.g., Vicodin, Abbott) for chronic low back pain. The sports specialist was concerned about potential acetaminophen toxicity. He prescribed 'low-dose' methadone, 10 mg twice daily, and discontinued the hydrocodone/acetaminophen combination.

"The next day, the patient stayed at his parent’s home. He was very drowsy, sleeping on and off most of the day, and went to bed early. On the morning of the third day, his mother was unable to awaken him. He was declared dead by EMS technicians."

The patient died from toxic levels of methadone because he was presumably "opiate tolerant," and the attending physician was unaware "of the unusual (and cumulative) kinetics of methadone," says the article.

Narcotics were once only prescribed for post-surgery, post-accidents and cancer pain because they are so addictive. The liberalizing of opioid drug guidelines was a move by Pharma to increase revenue not help patients. The Sacklers, a New York family of physicians and philanthropists, parlayed their originally lucrative morphine franchise into OxyContin which they said they did not want to be “limited” to cancer pain. The rest is history.

Certainly Pharma created and perpetuates the opioid addiction crisis and should pay for it like Big Tobacco pays for the smokers it hooked and gave cancer. (Under the Cures Act, we the taxpayers pay.) However, traditional medicine, with its short-term profits orientation, is also responsible for the crisis.

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