Researchers say most patients only use a portion of prescription painkillers after surgery, leaving the pills available to abuse by others.
Even in an epidemic, some medical professionals are slow to change.
This is what some experts are saying regarding the current opioid abuse, addiction, and overdose crisis affecting the United States.
Doctors continue to prescribe large amounts of addictive painkillers to patients with acute — i.e., short-term — pain.
Those prescriptions can have lasting effects not just on the patients, but their loved ones as well.
A recent study published in JAMA Surgery using data from surgery patients in Michigan suggests that slightly more than a quarter of the pills prescribed were consumed by patients.
The size of those prescriptions also equated to greater use.
Or, as the study authors say, if the doctor gives you 30 pills, you’re more likely to take 16 and leave the rest in the medicine cabinet.
Other research suggests common surgical procedures can leave patients holding onto as many as 200 painkillers and 90 percent of them are not disposed of properly, leaving them available to friends and family.
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Too often, when patients feel better, they stop taking their medications, which is also often the case with antibiotics, said Carol Clayton, PhD, a translational neuroscientist with Relias.
“As patients find themselves getting better, they often forego the remainder of the drug regimen, including in the case of the pain experience,” she told Healthline.
That’s when drugs end up sitting around, either waiting for the patient’s latest bout with pain or, more often than not in a country beset with addiction, ending up on the street because of their high resale value in a sea of seemingly endless customers.
Old habits, new consequences
The situation has, essentially, created a recipe for diversion, or the spread of prescription drugs to those whom the drugs aren’t prescribed.
It crosses criminal justice approaches and political views in an unprecedented and systematic cycle of drug addiction that begins with well-meaning patients following well-meaning doctors’ instructions that, too often, can end in an overdose.
Dr. Gloria Dunkin, the medical director at Futures Recovery Healthcare addiction treatment center in Florida, says most doctors prescribe opiates because, in most cases, they are “following old habits,” but after surgery patients usually do not require more than three day’s worth of pain medication.
“For the non-addictive population that receive opioid prescriptions, I find they are generally unaware they are being overprescribed by their surgeons,” Dunkin told Healthline. “And oftentimes, many people do not consume medications in fear of developing a substance dependence.”
And with good reason.
After those three days, the likelihood of developing physical dependence on pain medications increases significantly, Dunkin says.
“An example of this overprescribing can be seen following procedures such as root canals,” she said. “And, as a result of overprescribing and addiction awareness, it’s becoming increasingly difficult to obtain a prescription for pain medication.”
Now, fearful of violating the Hippocratic Oath and doing harm to a patient, some doctors are reluctant to prescribe opioid painkillers, drugs they were once told had a low likelihood of addiction and abuse.
Poised on profits
In her book, Dopesick, journalist Beth Macy documents the decades-long patterns that netted painkiller manufacturers billions in profits.
“The rate of casualties is so unprecedented that it’s almost impossible to look at the total number dead — and at the doctors and mothers and teachers and foster parents who survive them — and not wonder why the nation’s response has been so slow in coming and so impotently executed when it finally did,” Macy wrote in the prologue to her book.
It started primarily by pharmaceutical company-led campaigns directed at an epidemic of untreated pain, dating back to the 1990s, and resulted in a five-fold increase in opioid overdose deaths since that time.
“For decades, surgeons and physicians have been trained that one of the measures of quality healthcare is adequate pain control,” Dr. Brent Boyett, chief medical officer with the addiction treatment center Pathway Healthcare, told Healthline.
In dental school, Boyett says he attended a lecture on pain management of patients that had undergone dental surgery. The lecturer was a renowned oral and maxillofacial surgeon who highlighted the different medications available, namely opioid painkillers.
At the end of the talk, one of his classmates asked: “How do we know how much pain medication a patient needs after a surgery?”
“Just give them enough that they don’t have to call back for more,” Boyett recalls the lecturer replying.
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That, to him and others, shows how little those with prescription pads were trained to respect the potential risks that came along with opioid medications.
“There is really no standard,” Boyett said.
Those and other like-minded prescription patterns was fueled by drugmakers such as Purdue Pharmaceuticals, which markets and makes OxyContin, a drug that first ravaged rural mountain towns before spreading out to create the country’s current opioid overdose epidemic that surpasses both gender and race.
The over-prescribing of potent opioids for non-cancer pain — such as back problems and post-surgical soreness — left many unused painkillers sitting in medicine cabinets, rife for the taking by those who were not only chasing highs but those trying to fend off the painful symptoms of opioid withdrawal.
So why have doctors been prescribing these potentially lethal drugs for so long?
Because, as Macy’s book and other reporting since then shows, the makers of these drugs spent millions each year plying doctors with branded freebies, comped lunches, and fancy dinners to reap the most in quarterly bonuses, which could be up to $100,000.
And those campaigns are most often highly effective.
A study by CareDash.com suggests that doctors who took payments from drug companies were 14 times more likely to prescribe opioid painkillers.
Doctors have been more likely to prescribe opioids and other painkillers because insurance providers, from private companies to federally funded programs like Medicaid, are more likely to sign off on reimbursements.
The bottom line
Now that the opioid epidemic is no longer relegated to the backwoods and steep slopes of Appalachia, medical professionals are looking for better ways to deal with a patient’s pain than continuing to refill their opioid prescriptions.
Still, there’s some lag getting everyone on board.
Dr. Anita Gupta — a board-certified anesthesiologist, pain specialist, pharmacist, and author — says the practice continues because, like others, some doctors and health systems are slow to new behaviors.
“We need new policies that champion change and stop the current flow of opioids to patients who need and often want other options,” she told Healthline. “Too many of these pills are ending up on the streets, flooding schools and communities — leading to overdoses.”