The Swinging Pendulum of Opiate Prescribing – June, 2016 – Cmdr John Burke
In the several decades I have been in the business of following the diversion of pharmaceuticals, I have noticed a pendulum effect regarding this issue.
In almost everything important in life, balance is usually paramount; extremes are rarely the answer
However, finding balance is difficult and requires work. Balance requires careful thought, weighing the pros and cons, and taking an action that can be accepted by most individuals because getting everyone to agree is virtually impossible.
This holds true regarding the prescribing and dispensing of prescription drugs, especially controlled substances.
Sometime in the early 1990s, it was thought that our nation’s pain sufferers were being undertreated for pain.
Once it was determined that Americans were undertreated for pain, pharmaceutical companies began producing stronger and longer-acting medications that required fewer pills each day and that provided a steady release of pain medication
OxyContin was developed and prescribed liberally to treat chronic pain and cancer pain, and it thrived on the market for several years with little or no diversion issues.
The diversion issue started in Maine, for some unknown reason, when it was discovered that OxyContin could be compromised and then injected or snorted for a superior high.
In late 1999 or early 2000, the abuse issue hit the media and only accelerated from there.
This went on for a little over a decade until Purdue Pharma was able to reformulate OxyContin and produce an abuse-deterrent formulation (ADF) that hit retail markets in August 2010.
Around the same time as the OxyContin reformulation in 2010, Mexican drug cartels realized that if addicts were unable to achieve a good high with the ADF of OxyContin, they would need a replacement.
That is when heroin was reintroduced into our society
Purity levels of heroin exceed 50%, meaning it can be successfully snorted or injected.
Clandestine fentanyl is added for more kick and leads to even more overdose deaths
Lately, prescribers are getting suggestions for prescribing guidelines,
The CDC guidelines were suggestions but have been universally, and wrongly, interpreted as fixed rules.
Once again, the pendulum has swung back:
abusers are getting the attention and pain patients are left to wonder how these new guidelines will impact their daily lives if their physicians decide to cut them off.
I fear the latest scrutiny on physicians may negatively impact legitimate pain patients.
This is yet another example of how balance is so important:
physicians need to address those scamming them and procuring pharmaceuticals from multiple prescribers while safeguarding their legitimate patients who would have trouble living without their medications