After reading thousands of articles and opinions since 2000, on what caused the opioid crisis I fail to see any single cause or primary contributor. The majority of us contributed to how we got here. Through a trillion times a trillion individual choices, whether by action or inaction, by intent or ignorance, this is a problem of government, industry and it’s citizenry, there are few innocents, so ultimately it’s a problem not just with our systems but with our humanity.
Pre-release data reported by the Associated Press on 2019 opioid overdose deaths indicates that for the first nine months of 2019, opioid overdose deaths rose grew at a faster rate when compared to the same time period in 2018.
The amount of opioids prescribed in the US peaked in 2010 and then decreased each year through 2015. However, prescribing remains high and vary widely from county to county. Healthcare providers began using opioids in the late 1990s to treat chronic pain (not related to cancer), such as arthritis and back pain.
Last week the Washington Post featured an article in the “Outlook” section by Dr. James D. Hudson, a pain management specialist, lamenting Americans’ “Dangerous Fear of Pain,” arguing that the efforts by doctors to make their patients “pain free” has largely contributed to the overdose crisis.
This update on trends reflects changes on how chronic pain has been viewed and managed as America’s struggle with opioids continues. It’s often insightful to look back at how our government viewed chronic pain and compare that to how they have responded. This report from the CDC published thirteen years ago in 2006 stands in stark contrast to the 2016 CDC Guidelines for Chronic Pain Management, at a time when anti-opioid zealots had clearly gotten the upper hand. More importantly is how our healthcare system has responded, indicating what appears to be an effort to cherry pick the data which fits an ideological point of view. New concerns are rising for America’s elderly as the use of non-opioid chemical restraints increases for managing behavior which in some cases, is due in part to chronic pain.
If we adopt the vector model of disease when addressing addiction for any valuable medicinal, whether it’s opioids, benzodiazepines or any other controlled medicine, what’s at stake is our ability to ease and cure human suffering, not prevent addiction.
The Health Insurance Portability and Accountability Act (HIPAA) was designed to make private health information more portable, not more private. It’s primary intent invites, even encourages violations of personal privacy with regards to health information.
This ruling by the Office for Civil Rights at the U.S. Department of Health and Human Services signals a major step forward for the chronic pain community, sending a clear message to healthcare providers who attempt to delay and thwart efforts of patients seeking access to their medical records.
In this series of articles I will attempt to update the historical context of how the opioid crisis began, the forces which contributed to it and how it evolved. This is a look backwards based on what we’ve learned. The growing body of evidence paints a picture which is anything but a simple prescribing problem. The other question I’ll ask is who profits from how we got here and who profits from the methods used to address it.