“[We] came to believe that a Power greater than ourselves could restore us to sanity.” –(The Twelve Steps of Alcoholics Anonymous, step 2)
This week I received a letter from Dr. Vivek Murthy, MD, MBA, who is currently the United States Surgeon General. In fact, every doctor in America was sent the same letter, and this is the first time in history that a Surgeon General has reached out individually to every physician in the United States. What public health crisis was so important as to warrant this historic action? Was it the Zika virus? Was it heart disease or cancer, the top two causes of death in the US? It was none of these. His subject was the opioid epidemic, a problem caused largely by our profession’s chronic mismanagement of pain. His letter states:
“It is important to recognize that we arrived at this place on a path paved with good intentions. Nearly two decades ago, we were encouraged to be more aggressive about treating pain, often without enough training and support to do so safely. This coincided with heavy marketing of opioids to doctors. Many of us were even taught – incorrectly – that opioids are not addictive when prescribed for legitimate pain.
“The results have been devastating. Since 1999, opioid overdose deaths have quadrupled and opioid prescriptions have increased markedly – almost enough for every adult in America to have a bottle of pills. Yet the amount of pain reported by Americans has not changed.”
(The full text of the letter can be found here: TurnTheTideRx.org.)
Early in medical school I was taught in a memorable lecture that it is shameful for a doctor to let a patient suffer pain. We were instructed to open the flood gates and bathe our patients in the sweet balm of narcotic goodness they needed. (The lecture was a bit more nuanced, but that was the very clear take-home message.) A year or so later during my clinical rotations I began to see firsthand a much darker side of the picture: drug-seeking addicts with insatiable appetites for controlled substances, manipulating every relationship with the goal of getting more drugs. I have seen how addiction can poison doctor-patient relationships in every specialty I rotated through in medical school and residency, in hospitals, clinics, and emergency rooms, and countless times during my career in neurology. Continue reading