My Turn: Stop prescribing opioids

For the Monitor
Saturday, March 18, 2017

In a Wall Street Journal article of Dec. 17, 2012, “A Pain Drug Champion Has Second Thoughts,” Dr. Russell Portenoy, who headed the successful 1990s campaign for wider prescription of opiate pain medication, confessed that is was a mistake to have advocated for the safe use of opioids.

In the article, Portenoy somberly explained that it was an error to encourage doctors to prescribe opioids. He stated that he was wrong to say that they could be used safely. The article explained that opiate medicines were “long shunned” because of their addictiveness, but that Portenoy and his colleagues “rehabilitated” them for use in the 1990s for pain treatment.

Portenoy said he gave “innumerable lectures in the late 1980s and ’90s that weren’t true.” He says “clearly if I had an inkling of what I know now then, I would not have spoken the way I spoke. It was clearly the wrong thing to do.” That year, there would be over 15,000 deaths due to prescription opioids.

Any conversation about drug deaths should start here. Heroin was once prescribed briefly as cough medicine but was banned in 1924. The reappearance of opiates, as Business Insider reported in 2011, “is a chilling reminder of what life was like in the early 20th century when companies were permitted to sell anything to anyone, no matter how dangerous, regardless of the consequences.”

Legally, by prescription, we have created an epidemic of death. Instead of addressing the true cause, the powers that be point fingers at the very agencies that are earnestly dealing with this desperate proliferation. There is a stunning misconception that these agencies are somehow blameworthy in this scenario. They are not. They are the angels in this tragedy. They are the people who see the carnage. They comfort the families and provide services to the communities, the schools, the children and the babies. They are taking up the devastation and cradling it, even as the death toll climbs. One federal agency official described small-town EMTs, accustomed to car accidents and other emergencies, in a psychological battle against the daily task of carrying dead bodies from their neighbors’ houses.

Since the Portenoy article, regardless of its revelations, more than 100,000 people have died from prescribed opiates. That year, 258 million prescriptions for opiates were written. Predictably, the illegal opioid market has risen, meeting the demand created by the prescription market. This secondary market is also growing, notwithstanding the greatest efforts of every police force, fire department, federal agency and drug court.

Since 2007, deaths involving heroin have risen 340 percent – from 2,402 in 2007 to 10,574 in 2014. And still the medical provision of opiates thrives, despite the deaths and despite the confession of the physician who manufactured the opiate-prescribing craze among his colleagues.

Last year, legally prescribed drugs killed two-thirds of the 50,000 people killed by drugs. These deaths are the result of using opiates as medicine.

As early as 2010 the New England Journal of Medicine conceded that “this is an unintended consequence of an intent to treat pain better.”

The question that must be asked is, at what point does the “unintended” consequence become de facto intended? By continuing to prescribe drugs while not knowing who will die, but only knowing that hundreds of thousands will die, are we not agreeing that these deaths are the price we are willing to pay to prescribe them? It is so sad and so frustrating that the addiction death epidemic is being incubated legally, by a profession that has been duped into believing opioids have somehow been rendered safe to prescribe.

What if any other identifiable, continuing cause were taking this many lives? It’s inexcusable to ignore the driving force behind these deaths. Is ignoring the mortal danger of opioids an effort to justify the lack of action? Are we not aware that, for the first time in modern history, the life expectancy for Americans has dropped due to opioid use? It is cynical, if not culpably negligent, to blame treatment deficiencies or the heroin epidemic as causes of these deaths. Both are direct results of the demand created by prescriptions. Our society is committing everything we’ve got to this epidemic, but we are only addressing its symptoms. We presently lack the will to see the prescriptions for what they are.

The question is, do we want to reduce the deaths? If the answer is yes, the key to reversing the tide is in front of us. It will take an act of will. Someone – some state – must be strong enough to act against the legal drug market. It can be done. We have the strongest driving force behind this epidemic directly within our control, if we are willing to act. And we must act to stop the deaths. What point is there in alleviating pain for people if it’s going to kill so many of them?

Except in cases of end-of-life care, opioids should not be prescribed. Use them only when the risk of addiction is meaningless. To reduce overdose deaths to what they were before this epidemic, we must return to using opiates the way we did then – which is to say barely. What did we do for pain before opioids were available? We lived, right?

This is a crisis of the will to intervene, and ultimately, it is a crisis of conscience.

(Cecie Hartigan lives in Concord.)