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Prairie Doc Perspective: Opium, Oxycodone, Overdose
By: Richard P. Holm, MD - 03/16/2017

We are in the middle of an opioid overuse and abuse epidemic.

Opioids, also known as narcotics, are drugs which are either processed from the white tears of scored opium poppy fruit or made synthetically. Legal prescription opioids include morphine, oxycodone, hydrocodone, fentanyl, tramadol, whereas all these alone or in combination with heroin, methamphetamine, and cocaine are sold on the black market. An estimated 16 million people in the U.S. are abusing prescription or black market opioids, including 20 percent of our high school kids.

Abuse is one thing, but death is another. According to the Center for Disease Control, from years 2000 to 2015 the number of opioid overdose deaths quadrupled; with more than half a million-people suffocating to death from opioid overdose during that time. 91 U.S. citizens are dying from opioid overdose every day. Embarrassing news for the healing professions is that at least one-half of these deaths are from prescription medications and three-out-of-four heroin users were initially addicted to legal opioid pain medicines prescribed for so-called legitimate reasons. When they could no longer get a refill of the prescription pain med, they turned to heroin.

This has all happened during the era of the electronic medical record with progressively obsessive government monitoring and discouragement of narcotic prescribing. I personally believe this speaks to how impotent oversight is in effecting control or change.

Causes for this deathly epidemic are myriad. For more than twenty years, we have been encouraged to ask patients to rate their pain on a zero-to-ten scale and quality parameters rate physicians poorly if they aren't addressing pain needs. Additionally, our whole culture has been almost hypnotized by pharmaceutical advertisements telling us that the answer to every medical problem is a medicine which is obtained if you "ask your doctor." Take it from me, it is easier to prescribe a pill than to say "no" to a demanding patient.

Still, we must say "no." Treatment for chronic pain means listening, encouraging movement, and insisting the return to function and work; NOT prescribing opioids. During the last 15 years of quadrupling of narcotic prescriptions, there has been no change in patient-reported pain across U.S. hospitals. Simply put, chronic pain responds poorly to narcotics, is always rated 11 on the 1-10 pain scale, and opioids should be avoided in treating chronic pain.

We are in the middle of an opioid overuse and overdose epidemic, to which there will be no end until doctors and patients say "No" to opioids and "Yes" to movement and return to function.

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