Ross Parker was chief of the criminal division in the U.S. Attorney’s Office in Detroit for 8 years and worked as an AUSA for 28 in that office.
By Ross Parker
With the recent volume of media on the issue of the heroin epidemic, its overdoses and deaths, has come an effort to provide an easy explanation for the cause of and solution to this multifaceted problem. Much of the blame has been directed at doctors, who are charged with being either intentionally or negligently pill-happy with painkiller prescriptions. Their failures, it is charged, have made medical patients into addicts and, when the scrips became unavailable or too expensive, the patients were forced to turn to heroin and other opiates on the streets.
The tragic death of actor Phillip Seymour Hoffman who went from painkiller to heroin addiction and then to an overdose death is presented as a prime example for this explanation for the increase.
But the reasons for the current heroin upsurge are far more complex than the responsibility of a single group. Factors such as a failure of individual responsibility, insufficient education for kids, inadequate drug treatment resources, the emergence of Mexico as the dangerous big dog in shipping heroin up north, inadequate regulation and, yes, law enforcement, as well as a dozen other reasons contribute to the pandemic.
But doctors and their regulators do play an important role in this analysis and any feasible solution. It is not merely a coincidence that the country is in the midst of both a painkiller and a heroin overdose epidemic. The relationship between the two provide part of the cause.
The number of painkillers prescribed has quadrupled in recent years. Every day 44 people in the U.S. die from an overdose of painkillers. The number of deaths has skyrocketed from 4,000 to 16,000 annually. Experts from the health and law enforcement fields point to prescription drug abuse as a major cause of the epidemic. But they usually fail to add that 70% of these overdoses were by individuals other than the patient who obtained the prescription. Their access was from patients, many of whom legitimately needed the prescription, or from the street traffickers.
Which is not to say that medical profession doesn’t need to get its house in order. Reforms need to be made even if doctors are not the only or even the primary culprit for the contagion. It is true that a substantial percentage of physicians fail to find out about a patient’s history with controlled substances or their obtaining multiple scrips, even though this information is readily available. Plus many doctors lack the training and experience to identify opioid abusers and what alternative pain relief regimens could substitute for these drugs for patients at risk.
The February 2015 New England Journal of Medicine bemoans the absence of the use of proven medication treatment strategies both by physicians and drug treatment centers. The lack of insurance coverage, physician training, policy hindrances, and adequate resources are only part of the explanation for this failure.
Researchers of a study presented recently in the Clinical Journal of Pain found that many primary care doctors lacked an adequate knowledge base about opioid treatment and failed to appreciate the danger of diversion to non-patients. These two deficiencies often made the doctors prescribe them more often than necessary.
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