Road to perdition paved with pain pills

My old colleague and science journalist Faye Flam recently wrote a superb article for Bloomberg News about the pain drug epidemic in this country. In it, she reviews some important medical and public health research recently published on pain drugs such as OxyContin, Vicodin, and others. These drugs belong to the family of drugs known as opioids, from the opium poppy. Morphine was the original derivative of the opium poppy. But the newer drugs are more potent — and more addictive.

Faye knows the medical industry well, so I was curious to read her take on the opioid crisis. She wrote a science column twice a week in the Philadelphia Inquirer and would call me periodically when I served as Director of the College of Physicians in Philadelphia in the late 1990s and early 2000s. She is a very brilliant woman (having graduated from Cal Tech), and I found she stands out among science writers. And her most recent article on the opioid crisis was no exception.

As I often report, individual studies have merit. But we also need to look at the grisly picture that multiple studies on opioid drugs paint together in order to understand their impact on contemporary healthcare in this country.

In 2014, doctors in the U.S. wrote about 245 million prescriptions for opioid painkillers. Turns out, those prescriptions resulted in 20,000 deaths per year. That’s one death for every 122 prescriptions written!

In the world of law enforcement, they call these kinds of drugs narcotics. And in the past, people viewed addiction to them as a criminal and public safety problem. Increasingly, experts in the field now view addiction to pain pills as a medical and public health problem.

So what do we do about the problem?

Politicians and government bureaucrats are flailing around trying to come up with new prescribing guidelines for doctors. But many believe that doctors must learn more about the science of addiction to ever get to the root of the problem.

Everything I needed to know about addiction, I learned from Billy Joel

During my first year in medical school at Penn, I vividly recall my first lecture about substance abuse, dependency and addiction. Dr. Sidney Schnoll walked over from the Philadelphia Veterans’ Administration Hospital where they were dealing with the onslaught of addiction problems in veterans who had recently returned from the Vietnam War. I had been there briefly, to see that surrealistic situation, myself.

Dr. Schnoll walked to the front of the amphitheater wearing jeans, a work shirt, and long hair in a ponytail. We had never seen a doctor looking like that. And we never heard a lecture like that either.

He said the best way to understand alcohol and drug abuse and addiction was to listen to two songs by Billy Joel.

The first song goes like this:

Captain Jack will get you high tonight

And take you to your special island

Captain Jack will get you by tonight

Just a little push, and you’ll be smilin’.

At first, I thought “Captain Jack” stood for Jack Daniels Kentucky bourbon. But Dr. Schnoll explained “jack” was like “smack” or heroin, the synthetic derivative di-acetyl-morphine.

This was all new territory for me.

Then, he played Billy Joel’s “Piano Man” about alcoholism:

It’s nine o’clock on a Saturday

The regular crowd shuffles in

There’s an old man sitting next to me

Making love to his tonic and gin.

Dr. Schnoll told us that we would understand more about substance abuse and addiction from Billy Joel than from all the lectures in medical school. He’d learned about it over at the VA getting his on-the-job-training that he never got in school.

And that still appears to be the case.

Walking the fine line between dependence and addiction

According to the story by Faye Flam, most doctors don’t know the difference between physical drug dependence and addiction. But that distinction can be a matter of life and death.

Dependence can happen to anyone who takes the prescription pain drugs for a long period of time. Including patients prescribed perfectly legal medications for chronic pain by physicians.

Dependency means the body metabolically adapts to these drugs, so they may physically require larger and larger doses. When they stop the drug, the patient feels unwell.

Now, let me make this important point. Dependency comes before addiction. About 10 percent of people have a predisposition to develop physiological addiction with changes in brain chemistry. But physicians can’t tell which patients will move from dependency to addiction.

My colleague, Dr. Charles O’Brien, now head of the addiction treatment program at Penn, told Faye that pain was once undertreated. But things have gone overboard in the other direction.

Later in the article, Faye discussed big pharma’s efforts to develop safer pain killer drugs. I’d better give Faye another call to remind her about all the non-drug, safe and effective natural approaches to pain that I know she has written about before.

While you are waiting for mainstream medicine and the media to catch up, you can learn all about relieving and reversing pain, naturally without drugs from my new on-line learning protocol.


CLOSE
CLOSE