Big Pharma, Opiates, & Physicians

Several months in Boston we had a rally against the new opiate on the market, “Zohydro.” Basically, Medical Grade ‘Heroin.’ We had the head of the Massachusetts AFL-CIO getting the crowd whipped up and chanting “Down with Big Pharma, Down with Big Pharma!”

While well intentioned, it is never going to happen. Big Pharma essentially laughed this off. Why not when you have the power to get the FDA to go against the ruling of its own select committee on the issue.

I see the issue in another way. Ask your Primary Care Physician how much training he or she had in medical school on mental health and addiction. The answer will probably flabbergast you. So this is what all doctors have received regardless of their speciality after med school. With the possible exception of psych.

Yet they can write scripts for opiates and other psycho-active drugs. You have all seen the TV ads for various psycho-active medications with the ending of the ad saying ‘So ask your physician if it might be right for you.’

What my primary care? The ads do not say to see your primary care for a referral to a psycho-pharmacologist. Just go see your doctor (PCP).

To get back to the ‘opiate’ issue however. Why could we not institute a plan such as the following: A primary care physician before writing an opioid script would have the patient submit to a urine tox screen to see what is already on-board. These screens would not only be qualitative, they would also be ‘quantitative.’

This would be done for all regardless if they have a prior history of drug or alcohol abuse/dependence. In this way the issue of discrimination is taken out of the equation right at the get-go. The scripts would be for one month at a time.

Doctors not complying could be held liable in the case of overdose deaths. Which by the way, the number one cause of opiate overdose deaths in the United States is not from illegal opiates such as Heroin, it is from legally prescribed opiates.

We are the number one country in the world for the consumption of opiates. A recent CNN story on prescription drug abuse: (http://www.cnn.com/2012/11/14/health/gupta-accidental-overdose).

In the United States, we now prescribe enough pain pills to give every man, woman and child one pill, every four hours, around the clock, for close to three weeks. For those of you interested, the number is roughly 274,302,000,000.

While Big Pharma is a concern I see the issue as more of a need for true physician education on addiction and mental health. Again, ask your primary care physician how many hours they had in medical school on addiction and mental health. Most of that training is academic, not clinical.

Even well intentioned doctors sometimes inadvertently set people up for addiction such as when they prescribe ninety percocets at a time after a surgery. “Here, take three a day for thirty days then just stop." "Just stop?" Are you kidding me? Why was the person not titrated down over the course of that month? Then when the patient asks for more the physician may think they are med-seeking.

Yea, Big Pharma is a concern, but what about the prescriber…