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Drugs and other drugs, part 2

I remember a while back how a young man and a young woman were taken to the hospital where I used to work. They had overdosed on heroin, a very pure heroin, and they almost died. Back then, writing about them was a gamble. The town really didn’t have that many heroin overdoses, and anyone who did overdose would become widely known. So much for HIPAA, right?



Greg Proops once joked that people take drugs because drugs work. Indeed, they do. People wouldn’t spend millions and millions of dollars on a product that didn’t work. If they’re smart, though, they’ll have their addiction bought and paid for by their health insurance.

Thanks, Obama!

According to CDC, prescription drug abuse is at an epidemic level, and I believe it. I believe it because of the number of people I see at my clinical lab job and hear from friends and colleagues who go to the doctor with a minor strain or sprain and ask for narcotics to deal with pain. When the healthcare provider refuses to give or prescribe pain medication, the patient usually complains. Because medicine in the United States is a business subject to supply and demand, and bad PR, the provider wants a retuning customer client and — in may cases — acquiesces to the demands of the patient.

Yes, there are those instances where the “heavy duty” painkillers like morphine need to be used. A broken bone that is protruding through the skin is just a little bit too painful, I’ve heard. So is a severe burn, or a gunshot wound. But do you really need a narcotic to deal with a sprained ankle?

The problem with pain is that it is subjective, and experts on the matter are trying to give it some objectivity. But our pain tolerances, though based on our common biology, are also influenced by culture, past experiences, and other factors. What is a minor inconvenience to me may be a huge amount of pain for you. What can be no pain to you can be enormous pain to me.

So how do we fix it? How do we tell people that the pain they are feeling does not warrant a prescription for narcotics? I imagine that it would be hard to tell someone that they have to live with pain. (Hard because no one should live with pain.) And, if the painkillers work, then why not take them? Same thing with other drugs. If they work, why not take them?

This gets us into a philosophical discussion on how life should be experienced, and that’s a can of worms I don’t want to open right now. I just wanted to give you some food for thought on this while “painkillers are killing people” thing. (It’s certainly one more thing I need to add to the list of things I’ll seriously have to think about in about three years.)

Featured image from the CDC Public Health Image Library, Debora Cartagena.

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René F. Najera, DrPH

I'm a Doctor of Public Health, having studied at the Johns Hopkins University Bloomberg School of Public Health.
All opinions are my own and in no way represent anyone else or any of the organizations for which I work.
About History of Vaccines: I am the editor of the History of Vaccines site, a project of the College of Physicians of Philadelphia. Please read the About page on the site for more information.
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2 replies

  1. What really enrages me is, the prescription narcotic abusers actually ruin things for my wife, who has severe back pain due to inoperable disc disease.
    Even to the point where one physician repeatedly wrote up a treatment plan, with narcotic analgesia, but then prescribed a dose less than 5% of what his treatment plan stated.
    After complaining about it, he “didn’t feel comfortable” prescribing the medication, even though he was prescribing it due to arrhythmia induced by pain, as confirmed by a cardiologist.
    Needless to say, we fired that physician and found one who would at least abide by her written treatment plan *and* had further input on other health issues that were concerning (it turned out that my wife had become mildly diabetic, which the first physician completely missed).

    Meanwhile, in SE Pennsylvania, heroin is still not uncommon and it’s recently been proposed that police officers carry and administer Naloxone.
    To be honest, I never thought I’d live to hear of a law enforcement officer carrying and administering Naloxone.
    But then, I never dreamed of a police officer carrying and using an AED.


    1. The police in El Paso, Texas, and Las Cruces, New Mexico, used to carry Naloxone all the time. Heroin coming up from Mexico is incredibly easy to get there. You can get heroin too easily there. The hospital I mention in the post above is in PA. You just knew when heroin came in because we’d have the one or two kids who either tried it for the first time or had been clean for a while and then fell back into it and took their usual dose. To add insult to injury, those OD kids (because they were young adults and younger) would be charged with a crime, not really offered a chance to get clean for good.
      The whole thing is messed up, and it’s only getting messier now with this “call to arms” over prescription drugs.
      Sorry to hear about your wife. You’re right, the addicts and the bad docs are ruining it for patients who really do have unbearable pain.


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