The problem with opioids.

Explosion? or Smoke Screen?

After their success in attracting a large audience to the Climate Change Forum  https://georgia9thdemocraticinfo.com/9th-events/ The White County Democrats are taking on another ambitious project.  Two weeks from today on November 16 they will present a panel of stake holder experts exploring the remedies for what has been described as a crisis of “The National  Opioid Epidemic.”    https://georgia9thdemocraticinfo.com/2017/10/25/coming-soon-from-white-county/

Being a nighttime shut-in I will not be able to attend. As a clinician with experience in both pain management and the treatment of addictive disorders the issue has stimulated a variety of random observations and thoughts on what I read, see and hear in both professional and public media

I really don’t understand the core factors driving the issue. It does seem pharma is behaving like pushers and following much of the model tobacco set.

Is this really that unique or just an example of nobody noticing until affluent white boys and girls are affected? Whether or not the fact of who the victims are give us a political tool.

We would have never gotten the ACA had it applied only to poor black people.

Among the other claims, I am not certain of is if the death rate is unique for this epidemic as the media seems to suggest. If this is the case I wonder at the breakdown of how many are actually suicide?  We know the proven suicide rate in the US is soaring  among middle aged men.

The marketers of pain medication operate as for any other product from tooth paste to cigarettes.. Beyond the seductive ads and perquisites to those licensed to prescribe.  Flooding the market, even giving the product away with hope and in the case of addictive products, the knowledge that once the product becomes a need long term profits will be at the least stable and likely escalate..

There of course have always been those rogue licensed doctors other providers who openly make a business out of writing prescriptions for addicts.  Many often operate under the label “Pain Clinic.”

Through the years  the FDA and the DEA has  by legislation and executive actions  been heavily weakened by GOP and the influence of Pharma business interests. Just recently the DEA enforcement power was weakened even further http://www.pennlive.com/nation-world/2017/10/tom_marino_and_the_drug_industrys_triumph_over_the_dea.html

Speaking of the political, what is the role of the increasing libertarian lean of the GOP? Doing away with the FDA and DEA to permit free unregulated access to all drugs is high on the libertarian agenda. The epidemic began in New England and the highest incidence is still in the Libertarian refuge New Hampshire Certainly the FDA has been a target for weakening by the libertarians on the basis of ideology

The development of these extended release forms seems to have given pharma a tool to make conscientious doctors pushers with their marketing of the notion of such things as necessary “maintenance” medications for chronic pain eg insulin or statins etc. This really is how addicts defend their addiction — as a metabolic necessity. This is WRONG WRONG. imo (as only opinion but someone who had some years of treating not only cancer pain but also that. such as Sickle Cell crises etc.) It not only enables addiction it is not as effective in treating the pain.

Then there is the question of treatment. It has been pretty well established that just throwing money into a program and letting the locals decide doesn’t work. Neither will subsidizing insurance companies and letting them decide.  And of course the big elephant is; just how effective have the traditional, mostly religion based, Twelve Step Programs been?   Is it time to take a broader critical look at them?

The White County participants certainly will have a lot to chew on.  It is good to see a beginning here in our North Georgia region.

 

W. Lorraine Watkins, M.D. — 2 November, 2017

 

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