Prescription Opioids: Have we gotten any better?

In the Aftermath of Purdue Pharma: Have We Gotten Any Better?

Several weeks ago, a friend and colleague shared that she was going to have a knee laparoscopy to repair a minor tear in her meniscus.  This wasn’t her first knee repair, and so she approached the procedure without much trepidation.   A few days before the surgery, she got a notification from her pharmacy that she had a prescription waiting for her. Confused, she traveled the short distance to the pharmacy to figure out what exactly had been prescribed to her without her knowledge. When she arrived, she found a prescription in her name for 15 Percocet for her post-surgical care, even though she hadn’t even needed a Tylenol after the first surgery. This was more devastating to our friend, as she had witnessed her son’s own 15-year struggle with opioid addiction after he was prescribed copious amounts of opioids after a minor surgery himself.  His addiction ultimately led to his tragic overdose death only four years prior.

In an outraged text message to several of the iTHIRST Team, our colleague shared, “They prescribed it without even telling me!! I just can’t believe doctors are still doing this after all that’s happened.  I’m fuming.  The message has not gotten out there.”

Indeed, the message still has not gotten out there fully.  Namely, opioids are still being overprescribed for minor procedures.  While there are, admittedly, many who suffer from debilitating chronic pain which must be managed by opioids, there is no doubt that there are still many prescribed opioids given to those who could get by with over-the-counter pain medicines for minor procedures. 

A recent article from The Washington Post, entitled, “Inside the sales machine of the ‘kingpin’ of opioid makers,” (May 10, 2022- link below) describes the history of this pattern of overprescribing which has recently come to light as the result of new evidence released in 1.4 million records from the nation’s largest manufacturer of opioids.  While Purdue Pharma has clearly garnered the most public attention and outrage, it has not been the largest manufacturer of opioids, nor even the worst offender when it comes to promoting overprescribing.  That dubious title belongs to the little-known manufacturer, Mallinckrodt, who literally had a stable of doctors, numbering in the hundreds, whom they could count on to write “a steady stream of pain pills.” The article states that between 2006 and 2014, Mallinckrodt had a 27% market share of opioids prescribed in the nation, compared to 18% for Purdue Pharma.  Mallinckrodt’s 30mg oxycodone tablet became the street drug of choice, so much so that the drug smuggling route between Florida and Appalachia became known as the “Blue Highway,” so named for the baby blue pill.

While the article goes on to state that many of those Mallinckrodt ‘preferred doctors’ went on to have their licenses revoked, were convicted of crimes related to their medical practices, and paid significant fines, it also reveals that in the middle of the crisis Mallinckrodt knew that their 30mgs were the most popular and they continued to promote them with reckless abandon.

One bereaved mother from Boston who lost two of her three children to overdoses stressed that the release of these documents would help heal families who want to know what happened to their child, where it started and who is to blame. 

In her book, Drug Dealer, MD,  Dr. Anna Lemke writes that the drug epidemic is not just the problem of a few ‘deviant’ doctors who overprescribed for personal gain, but rather, “ it is the result of a large population of well-intended doctors working in health care factories that prioritize through-put of body parts on an assembly line over whole-patient health…Pills that are addictive are particularly likely to be overprescribed because they provide patient-customers with short-term satisfaction and a proxy for human attachment—but not necessarily improved health.”

Upon arrival at the pharmacy, my colleague refused the Percocets. The pharmacy had to dispose of them.  Perhaps, for all of us in these situations, it’s time to use that oft-maligned slogan of the ’80s.  It’s time for us to “Just Say No.”

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