America’s opioid problem, reaches critical levels!
The US pharmaceutical industry loves to chase doctors. Competition has driven the manufacturers traditionally, to push their products. Today, these institutions chase doctors, to get them to prescribe their opioids and synthetic drugs!
This piece is not just a shout in the wilderness. When it comes to taking opioids, the United States has the dubious honour of leading the world. Congratulations, America!
In terms of available data, for every cluster of one million Americans, almost 50,000 doses of opioids are taken every day. That exactly, is four times the going rate in the UK, and nearly eight times that of EU countries. Obviously, there exist some good reasons for taking opioids. Cancer patients continue to use these for pain relief, as do patients recovering from surgery (codeine and morphine are opioids, for example). However, if taken too many, then you have a problem. And America certainly has a large share of this problem.
A case in the point is the unknown, sleepy town of Kermit in West Virginia, that had managed to receive almost nine million opioid pills-according to a congressional house, committee. Ironically, only 400 people live in Kermit. At the national level, opioids already killed more than 33,000 people in 2015, reported the US Center for Disease Control and Prevention.
And, this figure has included deaths caused as a result of using heroin, an illegal opioid. Unfortunately, half of the deceased victims have involved the use of a prescription 'opioid' -that is, a painkiller available from a pharmacy with a prescription from a board certified doctor. The big question we ask: why does America -more than any country in the world -have an opioid problem?
Obviously, there are several causes for this malady. It is a matter of serious consideration why the American doctors prescribe -a lot of opioids to patients going through some kind of pain. Unlike most European countries, the US does not have universal healthcare paid for, by way of accumulated taxes. Instead, Americans are required by tradition and law, to get their own insurance -usually via an employer or through the government assistance programs.
'Most insurance, especially for poor people, won't pay for anything but a pill,' says Professor Judith Feinberg from the West Virginia University School of Medicine. She has gone to say:
'Suppose, you have a patient who is in his late forties. He (or she) may have lower back pain, you examine them-they have a muscle spasm'.
'In terms of the protocol, the best thing is physical therapy, but no insurance company in the US is willing to pay or provide cover for this benefit! And so, the practicing doctors get very ready, to pull out the prescription pad.'
She added: 'Even if the insurance covers physical therapy, you probably need prior authorisation (from the insurer) - which consumes a lot of time and paperwork.'
In today's civilized world, the US and New Zealand are the only countries that allow prescription drugs to be advertised on television. In response to public pressure, the American Medical Association had called for a ban on adverts for prescription drugs, in 2015. Unfortunately, this was not allowed to happen. Three months later, the extent of America's opioid culture was seen at half-time of the Superbowl--the country's most expensive advertising slot.
A 60-second ad was devoted to opioid-induced constipation. The advert was paid for by the pharmaceutical AstraZeneca -which advised 'sufferers' to visit their doctor, and 'ask about prescription treatment options'.
In the US, it is common for drug companies to court doctors, in their efforts to promote their products. 'When you're a doctor in the US, these detailing people (salespeople) come in from the industry,' says Professor Keith Humphreys from Stanford University. 'They are invariably smooth, friendly, attractive, sharply dressed, adorable, they're giving out gifts to everybody. They host dinners, they sponsor conferences, they sponsor junkets'. He further adds, 'That is going to affect prescribing'.
The US government, during the previous four years, has published the sums of money, paid by drug and device companies to doctors, and teaching hospitals. In 2016, the total figure was astonishingly, more than $8.0 billion. More than 630,000 physicians had payment records for receiving 'favors' of gifts from the pharma industry!
For example, Purdue Pharma - which makes OxyContin, a popular opioid painkiller- had made its construction with almost 80,000 transactions in 2016, worth more than 7.0 million dollars!
A serious, conducted in 2016, had probes into the link between doctors, the free meals they received from drug companies, and the medication they had reportedly prescribed. This study had discovered that receiving free meals was associated with an increased rate of prescribing the promoted brand-name medication'.
Pharmaceutical companies justify their actions by saying their representatives are 'merely sharing information with doctors'. However, Professor Humphreys has mentioned that there is a 'corrupting' influence, involved with every program!
'We need a pharma industry, it's not that it's wrong', he says. 'You simply can't let the fox guard the hen house'.
'I would create completely clear blue water between the people that manufacture drugs and all the training and operation of the healthcare system.'
Pharmaceutical companies also spend money on health care workers and organisations in foreign countries, where they either produce drugs locally, or export the same to such countries'. Dr Richard Frank is professor of health economics at Harvard Business School, and has served in the US Health Department from 2009 to 2016. He has expressed his belief that medical training in the US has not been 'good enough'. He goes on to remark that: 'Physicians have received almost no training in pain management'.
One of the representatives, before going into congress, was a thoracic surgeon, who had noted that he had gotten almost no training in pain management -and what he had learned, had came entirely from the professional experiences related with nursing staff, with whom he had worked. It is pertinent here to refer to a short letter written by Dr Hershel, in the year 2016, to the New England Journal of Medicine. It said that 'despite widespread use of narcotic drugs in hospitals, the development of addiction is rare in medical patients with no history of addiction'.
Sadly, this claim has been debunked, and the letter now carries an online warning note. But this specific letter of Dr Jick letter had an enormous impact. This year, Canadian researchers had admitted that the letter had been cited 600 times -usually to claim that opioids were NOT addictive! America's Veterans Health Administration - which runs healthcare for military veterans - had pushed forward in 1999, a movement that pain, needed to be recognised as the 'fifth vital sign'.
This gave pain equal status with blood pressure, heart rate, respiratory rate, and temperature. You can see this has received support from the fact that you are questioned by doctors or nurses, about pain, in the scale of 1-10. Again, in 2001, the Joint Commission-a statutory body, which certifies almost 21,000 US health organisations and programs - bears established standards for pain assessment and treatment. In 2016, the JC had released a statement that claimed that 'everyone is looking for someone to blame', for the opioid problem. The Commission has insisted that its 2001 standards did not 'require the use of drugs to manage a patient's pain'.
But Professor Feinberg insists that the VHA and JC's joint moves had symbolized that US doctors were under pressure to prescribe strong painkillers-such as opioids-when these may not have been necessary. She had explained: 'By the time you reach middle age, it's a rare person who doesn't ache somewhere'.
She further adds that - in a country where patients rate their doctors, and low ratings can affect doctors' earnings - the score can be influenced by whether patients receive opioids. The culture of medication in the United States, has definitely played its influential role in developing the habits and attitudes of patients.
'Some Americans', says Professor Keith Humphreys from Stanford University, believe that life is 'fixable'. 'I am 51', he boasts. 'If I go to an American doctor and say 'Hey - I ran the marathon I used to run when I was 30, now I'm all sore, fix me', my doctor will probably try to fix me'. 'If you try and do that in France, the doctor would say 'It's life, have a glass of wine - what do you want from me?'
In 2016, a detailed study compared how Japanese and American doctors prescribed opioids. It found that Japanese doctors treated acute pain with opioids in 47 per cent of cases--compared to 97 per cent in the US. 'There is obviously willingness, and a habit, of giving opioid pain relief that is not shared elsewhere' says Professor Feinberg.
The bottom line: Other countries deal with pain in much healthier ways. The culture and runaway ethics, in the US have pursued the philosophy that a patient in pain, is a door waiting to open with opportunities. If the dentists in the country cash pain, why not the doctors?
The writer is a former educator, based in Chicago