By Dr. John Jones
Simplicity Urgent Care
While many people don’t worry about taking prescription narcotics for everything from severe toothaches and backaches to post-surgery pain — they may want to reconsider.
On February 17, the CDC (Centers for Disease Control and Prevention) released a new report announcing that the rise in abuse and deaths from these pills has reached epidemic proportions. In fact, the overall number of drug-induced deaths — which includes all drugs, not just prescription painkillers, although it is attributable in large part to those — is approaching the number of deaths from motor-vehicle crashes.
Specifically, the CDC data show us that there were more than 27,000 deaths from prescription drug overdoses in 2007, a number that has risen five-fold since 1990.
Overdose deaths from prescription opioids are exceeding deaths from heroin and cocaine overdoses combined. Government officials report that drug-abuse deaths have also surpassed the number of deaths from suicide, homicide, and firearms.
What does this mean for you?
Clearly, chronic pain is a difficult condition to manage. It can be incapacitating and life-altering, and it can drive people to extremes to alleviate or curb its effects.
Plus, pain manifests itself differently from person to person, with some people experiencing varying degrees of pain for the exact same clinical scenario — from the obvious, such as an arm fracture in a child, to the more subtle like fibromyalgia or chronic abdominal pain in adults and the elderly.
So when a nurse says to me, “I don’t think this person is in pain as much pain as they say they are,” I ask: “What was the Pain Meter reading?” If you are raising an eyebrow, you aren’t alone. The nurse usually has the same reaction.
Understanding the Pain Meter
As doctors, we like to measure and test for certain conditions because we always strive to find objective data. But pain is almost impossible to directly measure. While we look at indirect markers, such as heart rate and blood pressure, it isn’t an exact science — and as doctors, we hate that fact.
That’s why we came up with the Pain Meter. Here’s how it works:
1. Ask yourself, on a scale of 1 to 10, what number would you give your pain?
2. Be honest. It doesn’t serve you to exaggerate.
3. Know that we have a multitude of pain relievers at our disposal — from Tylenol to Advil to Ultram to Percocet.
4. But there is a difference in the impact and long-term effects of each. Given the CDC data, ask yourself: If you knew you could become addicted to this drug, what choice would you make?
5. Then ask yourself this question: Given this data, what choice would you make for your child or parent if they were experiencing this level of pain?
Let’s say you are in tremendous pain, and would do anything to alleviate it. So what is the difference between Tylenol and Percocet? While each medication works to alleviate pain through a different pathway in the brain, some Percocet, Vicodin, Oxycontin, and Dilaudid are exponentially more addictive.
In fact, prescribing heavy-duty narcotics such as these drugs requires a special license from the federal Drug Enforcement Agency. Why? Because narcotics have the potential to help with severe pain, but they also have the potential to do great harm if not managed appropriately between the patient and the physician.
Do no harm
As physicians, we are obliged to help people, but our most important vow is, “Primum, non nocere,” which means: First, do no harm. It can be a fine line, but there is a line.
From my experience and observations as an emergency department doctor, in the last several years there has been an incredible increase of patients with complaints associated with prescription-pain medications, withdrawals, and overdoses.
This is consistent with the recent CDC data, as well as with another report from June 2010 indicating that the number of visits to the ER for the nonmedical use of narcotics rose 111 percent from 2004 to 2008. What’s more, these statistics matched the number of ED visits by 2008 for illegal drugs.
Why such a dramatic increase?
Most doctors and researchers link it to the jump in narcotic prescriptions being written in the United States.
Consider this: In 1997, drug companies distributed 96 mg per person of prescription narcotics. In 2007, this number had risen to 698 mg per person—which is enough for every American to take 5 mg of Vicodin every four hours for three weeks. Source: CDC
In 2008, two narcotics — hydrocodone and oxycodone — accounted for nearly 170 million prescriptions. Source: CDC
More serious markers of the difficulties with prescription narcotics were published by the U.S. Department of Health and Human Services, which looked at admissions to the hospital for substance abuse. Between 1998 and 2008, the number of substance-abuse treatment admissions rose from 2.2 percent in 1998 to 9.8 percent in 2008 — a rise of over 400 percent. Source: SAMHSA
The bottom line
These statistics are daunting, so here’s what you can do:
1. Whenever possible, opt for the least-addictive painkiller possible.
2. Ask your physician to refer you to a pain-management expert.
3. If you think you are getting hooked on your painkiller, ask your physician for help finding someone who can assist.
4. Know that you aren’t alone. The CDC reports show us that this problem is a growing epidemic. Asking for help is the best solution.
As always, feel free to contact me with questions: firstname.lastname@example.org.
About John Jones, MD, FACEP, FAAP
An emergency physician at INOVA Fair Oaks Hospital who is certified in both pediatric and adult emergency care, Dr. John Jones is a graduate of George Washington School of Medicine with an undergraduate degree from Dartmouth College.
He earned several departmental awards in research and medicine during his course of study. He completed his residency in emergency medicine at George Washington University, then began working at the Quincy Medical Center, where he taught residents and was also a clinical instructor at Boston University.
Dr. Jones then completed a two-year fellowship program at INOVA Fairfax Hospital for Children, and is now boarded by the American Academy of Pediatrics and the American College of Emergency Physicians — one of the few physicians in the country who is double boarded in both emergency medicine and pediatric emergency medicine.
Most recently, he worked as an emergency physician at Shady Grove Adventist Hospital in Rockville, MD, in both the pediatric and adult emergency departments. He also taught residents and is a clinical instructor at Georgetown University. He maintains affiliations with several professional organizations, including the American Academy of Pediatrics and The American College of Emergency Physicians. He is also active with the Urgent Care Association of America.
For more information, visit www.simplicityurgentcare.com.