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    America’s self-inflicted opioid crisis

    Editor's Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Ken Fisher, MD, who is an internist/nephrologist in Kalamazoo, Michigan, a teacher, author ("Understanding Healthcare: A Historical Perspective") and co-founder of Michigan Chapter Free Market Medicine Association. The views expressed in these blogs are those of their respective contributors and do not represent the views of Medical Economics or UBM Medica.


    In the last few years, drug overdoses led by opioids have become the leading cause of accidental deaths, eclipsing that of automobile crashes and violence.


    Further reading: Isn't it time for a 21st Century Pain assessment?


    In 1995, the American Pain Society (APS) posited that there was a national epidemic of untreated pain and the patients reporting of pain should determine their treatment. The following year, the APS introduced the concept that the patients’ reporting of pain should be the fifth vital sign. A subjective scale from one to 10 was proposed. However, a neglected but serious problem was that pain is subjective and unique to the individual. 

    Many extraneous conditions may impact on the sensation of pain such as culture, psychological state (i.e. depression), nervous system disorders, drug-seeking behavior or other issues. Whereas the four traditional vital signs—blood pressure, pulse rate, respiratory rate and body temperature—are objective findings, they are unaffected by mood and other factors. Thus, when treating patients with pain, physicians must evaluate the various causes tailoring therapy to meet the needs of each individual. Dr. Fisher

    There is no doubt that many patients’ pain was not adequately treated and this had to be addressed. However, over-treating pain is just as serious a problem as its under treatment. 

    Organized medicine joined in this outcry that pain was to be seriously addressed. In 1998, the Federation of State Medical Boards published a policy paper stating that pain must be alleviated and controlled substances were a mainstay. The federation suggested that state medical boards should consider physician punishment if pain was under-treated. In 2001, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) with the force of Medicare/Medicaid payment withdrawal published a policy paper describing that treatment of pain in healthcare facilities was frequently inadequate and accreditation demanded prompt attention to this issue. 


    In case you missed it: Risk management lessons from an opioid trial


    With the need to pass JCAHO reviews, healthcare administrators were adamant that no patient should complain of pain, especially when under review. This blanket policy of immediately treating pain with powerful analgesics, mainly opioids, took emphasis away from alternative approaches. Emphasizing the use of opioids and focusing on patient description of pain led the way to the unintended consequence of opioid overuse. Meanwhile, the public was actively pursuing the use and greater availability of mood-altering drugs.

    Next: We must address our "drug-obsessed, pleasure-seeking culture" 

    Ken Fisher, MD
    Kenneth A. Fisher, M.D. Nephrologist, and author, latest book, Understanding Healthcare: A Historical Perspective", available ...


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