• Chart of the day: Opiod toll

    From a Wall Street Journal article that is worth reading in full:

    opiod toll


    • Well, that’s only a slightly misleading figure…

      Fascinating article though.

    • There is a similar graph that charts the increase in narcotics sold annually as measured in pounds per citizen, yes, pounds not ounces. It is a very similar graph. Let’s all remember that each pound requires one or more written prescriptions, signed by a physician and dated within the last 6 months. I can not even guess how this healthcare problem could be solved? It probably begins by asking the question: who is the most co-dependent, the physician or the patient?

    • That is a good article.

      On the one hand, a lot of people in long-term care do validly need opiates or other strong painkillers. Untreated pain is a major problem in facilities. The Drug Enforcement Agency’s actions have generally made it harder for nursing facility residents to get quick access to pain medications. For example, someone’s pain might spike after they get transferred in to a facility, but the pharmacy needs written authorization from an MD, and it can take time to get their hands on an MD. The MD can’t just verbally authorize an RN at the facility. There are medical conditions like spinal degeneration that cause severe and chronic pain. Whatever policy we set on drugs, we need to balance the harms of addiction against the severe pain that a minority of people suffer.

      And on the other hand, if you make it easier for people to get opiate medications, you increase the risk for diversion: you make it easier to divert, you increase the supply of drugs flowing through the system so a diversion is more easily missed (also an argument I think might apply to gun control btw).

      I’m not sure how the epidemiology of chronic pain versus opiate addiction works out. From the most recent National Survey of Drug Use and Health, it looks like about 10 percent or more of the entire population over age 12 abused opiates during the survey year (2010, I believe; very annoyingly, they report for ages 12 to 17 and 18 to 25, but not 25+, so 10 percent is a guesstimate).


      The IOM says that something like 100 million Americans have chronic pain, BUT they do not say how many have pain of a level that would rise to where they would need regular or irregular opiate prescriptions. Pain might be chronic enough to interfere with your work, but it might not be severe enough to warrant opiate management. On the other hand, the person with the degenerative spinal cord disease should probably get opiates. I’m at work so I’m not inclined to dig any further into this, but I’m guessing that only a small minority of the population with chronic pain should be on opiates – or am I wrong? Can anyone shed some light?


      By the way, any MDs know if there are any effective non-opiate painkillers that might be substituted for opiates?