OPIOID CRISIS: What role have doctors played in creating the opioid crisis?

Many admit overprescribing of opioid medications helped create epidemic

In the early 1990s, the number of painkiller prescriptions filled at U.S. pharmacies increased by 2 to 3 million every year.

Around 1996, they jumped by 8 million, as doctors quickly became part of a painkiller prescription-writing bonanza.

The makers of Oxycontin launched a marketing campaign with a video promotion called, “I Got My Life Back,” where a doctor enthusiastically endorsed the drug.

The campaign profiled six patients whose pain was stopped because of the powerful pill, catching the attention of doctors around the country and eventually patients — who asked for it by name.

In 1998, North Carolina Dr. Alan Spanos made a convincing statement about the drug’s effectiveness.

“There’s no question that our best, strongest pain medications are the opioids. They don’t wear out. They go on working,” Spanos said. “They don’t have serious medical side effects, and so these drugs, which I repeat, are our best, strongest pain medications should be used much more than they are for pain.”

It was a statement that sold doctors, who believed they finally had an answer to help patients get rid of pain.

Around this same time pain was put on equal status with blood pressure, heart rate, and temperature when measuring a person’s health.  Doctors were encouraged to ask patients about their pain level and many felt compelled to aggressively treat it.

Physicians were penalized for not making patients 100 percent pain-free

At the time, Dr. Parveen Khanna, who now works at Pain Medicine Physicians of Jacksonville, was a medical student. She said she remembers the pressure to prescribe and address pain in a different way.

“The patient became the judge,” Khanna said. “If you don’t prescribe them, or treat the pain the way they want to, you get bad reviews.”

Duval County Medical Society Foundation president Dr. Sunil Joshi said it wasn’t just the marketing but major studies that refuted what doctors had always known about opioids — that they are addictive.

“So then you start looking at all that, and you feel like the drug is not habit-forming or addictive, so you feel like it’s OK to prescribe it,” Joshi said. “It’s only after time that you feel like that might not be the best approach.”

Joshi told News4Jax that led to 90-day and 30-day prescription limitations for acute pain.

“Patients who had pain felt like they were doing better on these medications, and so suddenly this was the way to do it,” Joshi said.

During that time prescriptions exploded, going up 8 million in one year.

“Patients were not thinking that this could be harmful to them,” Joshi said. “They were just trying to take care of the pain and make it zero, and physicians were also leaning towards the same principle.”

Who’s responsible?

Now, people — like 31-year-old Allison Peryam — are wondering at what point the doctor must take responsibility to say that there’s a problem and the medication is no longer being used for pain but as a result of addiction?

 

Peryam lost everything to her opioid addiction, including her two children, ages 2 and 4. It was an addiction that began with a legal prescription for pain at 20 years old after injury that required surgery.

“When I took it for the first time, I knew that I loved it. I loved every minute of it, and I wanted more and more and more of it,” Peryam said.

She believes one question from her doctor could have prevented her downward spiral. But he never asked her about a past of addiction to drinking or drugs.

The painkillers weren’t her first experience with drugs, Peryam confessed, but they were her favorite.

“I would say probably about a month into my prescription I started taking more because I thought if one was good, two or three would make me feel better,” Peryam said.

She said her prescription ran out but her body needed the drug, and she knew what to do.

“I would start calling my doctor and tell him I was in a lot of pain, so I took more than I was supposed to. The milligrams of it is not working, I need something stronger, I need a higher dose. And he would do it, he would call it in for me,” she said.

She said even as she started asking for more and more drugs, her doctor was never alarmed — but he should have been.

“I’ve been to jail. It comes to a point in your life where you say to yourself, ‘Are you going to live like this for the rest of your life and be OK with it?’ I think everybody has a purpose in this life and mine isn’t to be out on the street using every day,” Peryam said.

She’s left with pictures and daily video calls with her children — and an ongoing fight within herself to get it all back.

Peryam said she wishes someone had warned her before she became addicted.

“The only thing that I’m angry about is that they never told me. You know when you smoke cigarettes there’s a warning label on the side? There was no warning label on my prescription bottle,” she said. “It just said it might make you drowsy, don’t operate heavy machinery. It never said you might become addicted to this.”

She said 11 years later she believes she can beat her addiction.

“I’m grateful that I’m still here and that I can carry the message and hopefully save someone’s life. I’m not going to save everybody’s life, but if I can reach one person, then I know that I did my job and, unfortunately, my friends just didn’t get it and their thought probably was, ‘I’m just going to do it one more time,’ and a lot of them that was the case. They did it one more time and it took their life,” Peryam said.

Joshi said that doctors must be conscious of their patients’ struggles and pay attention to how much medication they’re giving.

“I think that, without question, we have to take some responsibility here because these medicines are coming by prescription and we have to realize, at some point, we’re only treating pain for these patients and we’re only treating it for a brief time,” Joshi said. “If we’re prescribing large amounts of it, we may be contributing to this problem. Not just for that patient, but for whoever they may be sharing these medications with.”

Guideline changes

In 2014, the guidelines from the American College of Physicians changed. It now recommends that patients should physically see the doctor to get a refill instead of just calling the office. Doctors are also encouraged to address acute pain with shorter prescriptions and no refills.

Dr. Justin Spooner, of Beaches Laser Spine and Pain, is also a psychiatrist. He believes doctors have the responsibility to be part of the solution and that means being proactive.

“You really need to be a little bit of an investigator but also you do need to take patients on their word,” Spooner said.

Spooner said being proactive also applies when it comes to physician training and education.

“Many physicians are,” Spooner said. “We have a medication that makes you feel good when I give you more, and doctors are aware of the risk of not always prescribing according to their best judgment.”

Khanna said that when prescribing opioids, she uses a checklist to determine a person’s risk for addiction. She also has the patient answer questions to rate their sleepiness, and sign an agreement that they won’t share or abuse the drugs. Khanna said the responsibility falls on her to consider all of this when prescribing opioids.

Khanna said doctors really don’t want to cause harm and can find themselves in a situation where, unknowingly, they may have contributed to a death of somebody who has overdosed.

“It doesn’t feel good,” Khanna said. “Sometimes, you feel a little guilty at times; that ‘I should have recognized the problem,’ perhaps, but as I said, we are not law enforcement. We are not trained.”

Joshi said all doctors have to make the tough judgment calls because if not, the results can be deadly.

“The physician needs to go to bed at night feeling like they did what was right for the patient,” Joshi said. “Ultimately, when physicians are looking at it that way, being altruistic for the patient, they will always do the right thing.”

As for the “I Got My Life Back” campaign — it was repeated two years later and patients still raved about Oxycontin. It wasn’t until 15 years later in a separate documentary that at least two of those patients or family members said the drug was addictive and after many years of use actually ruined their lives.

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