NEPA Vital Signs - Winter Spring 2018 - 26

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The Opiate Epidemic:
A Prescriber's Perspective

o how did this happen and who is
responsible? Why is it so prevalent
in Lackawanna County compared
to the rest of the state? The answers are
complex and multidimensional. Physicians
are often made the scapegoat; after all, four
out of five new heroin addicts started out
misusing prescription medications.
A few statistics that help to explain the
risks of our county...

did not adequately control pain according to
patient surveys faced disciplinary actions or
financial penalties. We wrote prescriptions
for opiates saying to take them every few
hours only as needed to treat pain, not realizing that given time they all would become
dependent or addicted. Over time, patients
would request and often demand higher doses
and increased frequency to control their pain.
Tylenol or Motrin were no longer effective;
only Percocet worked and patients became
incensed if you refused to comply to their
demands. Trying to avoid conflict with our
patients, we often complied to their demands,
not realizing the monster we were creating
and the ravenous and insatiable appetite that
would follow. Pain and anxiety are part of the
human condition that we all have to face at
some point in our lives. Our quick fix society
doesn't want to invest the time and effort
involved to solve the problem. Instead, they
want a pill, not recognizing the potentially
devastating risks of addiction.

Lackawanna County in particular has 41%
more narcotics prescribed per patient than
the rest of the state. Out of a population of
214,000 people, 11% are uninsured,17% are
on medical assistance, 19% are on Medicare
because of disability or age and 13.6% fall
below the poverty level. This data comprises
a large population of potentially depressed
and anxious people because of lack of work
and financial stressors. They often turn to
their family physician for help with their
pain, depression and anxiety. Pain is a subjective symptom resulting from injury or illness
Why and how we become addicted is
and emotional stress and depression can dependent on whether the origin of our
accentuate the patient's perception of pain. pain is physical, emotional, or spiritual.
Many populations carry an inherited gene,
All physicians take an oath to help relieve which results in addiction once adequately
pain and suffering but at the same time to do exposed. Others are so damaged emotionally
no harm. Early on, the easiest, safest and most as a result of actions done by or against them
affordable solution was prescribing opiate that they can't find forgiveness, resulting
medication. The pharmaceutical industry in anger and overwhelming pain. Finally,
informed us that the risk for addiction many have a spiritual void that they are
was minimal when used appropriately for trying to fill inappropriately in their quest to
our injured or ill patient population. More feel better. No matter the cause, the evil of
appropriate treatments, then and now, are addiction is continuing to grow, destroying
often financially out of reach because of lack our families, schools and society.
of coverage or excessive copays established
by health insurance companies. At the same
How do we stop this epidemic? First, we
time, pain became the fifth vital sign in hos- must understand our role as physicians in
pitals and emergency rooms. Physicians who creating the monster and look critically at our
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NEPA Vital Signs - Winter Spring 2018

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