A Plague of Pills
A prescription for every man, woman and child!
Northern Inyo Hospital CEO Dr. Kevin Flanigan told The Sheet on Wednesday that he believes the State of California is approaching a tipping point with regard to prescription opioids and the public health problems they cause. “If nothing were to change, I bet that we would have a couple dozen deaths [in the Eastern Sierra] in the next year or two.”
According to the California Opioid Overdose Surveillance Dashboard, a database created by the California Department of Public Health, there were 17,877 opioid prescriptions written in Inyo County in 2016. According to the 2010 census, Inyo County has a population of 18,260 people. That’s 98 prescriptions for every 100 people who live in Inyo County.
According to the same database, there were 5,987 prescriptions written for opioids in Mono County in 2016, which, according to the 2010 census, has a population of 13,909 people.
The figures were more striking in Trinity and Plumas Counties, which both reported having more opioid prescriptions than people in 2016.
According to the Center for Disease Control (CDC), the amount of prescription opioids sold to pharmacies, hospitals, and doctors’ offices in the United States nearly quadrupled from 1999 to 2010. According to the same report, deaths from prescription opioids such as oxycodone and hydrocodone, have more than quadrupled in the United States since 1999. However, deaths from prescription opioid overdose have largely leveled off since 2010. Despite reductions in opioid prescribing in recent years, opioid-involved overdose death rates continue to increase, and the CDC reported in July 2017 that the economic burden of prescription opioid overdose, abuse, and dependence is estimated to be $78.5 billion each year in the United States.
The CDC also reported that higher rates of prescribed opioids were associated with small towns that serve as regional gathering places for larger rural communities. The CDC called these regional commercial centers “Micropolitan Areas.” Generally speaking, California lagged behind the Midwest, Southeast, and New England when it came to the quantity of opioids prescribed per capita in 2015. However, Central and Southern Nevada and Northern California had some of the highest prescription rates per capita of any region in the country.
According to Dr. Flanigan, that four-fold increase in opioid prescriptions nationwide was the result of a philosophical shift in American’s thinking about pain that radically changed the national medical community’s treatment of pain. “The philosophy became that people shouldn’t be in pain,” said Dr. Flanigan. According to Dr. Flanigan, pain was re-named “The Fifth Vital Sign,” which resulted in patients, even those who were not seeking treatment for pain, being asked to rate their pain on a scale of one to ten during routine medical exams. Doctors were expected to take their patients’ pain more seriously, which sounded at first like a good thing, but as Dr. Flanigan said, “then, if you don’t control it, it’s a problem.”
Dr. Flanigan said that it is not uncommon for doctors’ contracts, which ensure their employment at a hospital or clinic, to include clauses that make their renewal dependent, in part, upon patient satisfaction surveys. In the late nineties and early 2000s, hospitals and clinics faced pressure to assess doctors on how diligently they treated their patients’ pain. “We started asking patients, ‘Was your pain adequately controlled?’ If they say no, ok, you [the doctor] lose your job,” said Dr. Flanigan.
Dr. Flanigan suggested that, “arguably, the pharmaceutical industry drove that shift, because they could sell more pills.”
Dr. Flanigan said that the medical community mistakenly assumed that prescription opioids would be as effective at treating pain in the long term as they were over the short term. “We assumed that if opioids are good for acute pain, they must be equally good for chronic pain. We also assumed that if some is good, more is better. That was a leap of faith that turned out not to be true.”
As both doctors and patients subscribed to the new standard of care, some patients began to expect expedient pain relief from their doctor’s visits. “Some doctors will refuse to write a pain prescription. But then some patients who really need a prescription will find another doctor, or in some cases, purchase it elsewhere. You have to ask yourself, am I willing to keep you on this low dose narcotic so you keep seeing me and I can treat, for example, your lung disease? Or your heart disease?”