Wednesday, November 12, 2014

Uncertain Health in an Insecure World - 8

“The Needle and the Damage Done

Neil Young’s 1972 song decried the overdose death of a Crazy Horse roadie and the heroin use by the band’s guitarist – signs of a troubling time in America, when inner city blacks were being decimated by the needle.

The developed world imports nearly all the opium and heroin that the less developed world produces. Despite decades of international police incursions, narco-terrorist threats and murders abound in Mexico & Central America. And despite Gulf wars and extended Southwest Asian military tours, the Taliban and others harvest the raw material unmolested. In 2013, Afghanistan produced more opium than the rest of the world combined (see Afghan heroin bag label).

But the gateway drugs to heroin have changed. In 1995, Purdue Pharma began marketing prescription oxycondone as OxyContin™, ostensibly to treat chronic pain. Prescription opiates quickly became the dark, slippery path to heroin addiction and death, particularly in affluent health-insured suburbia.

By the millennium, heroin was also a white persons’ problem.

In 2007, three senior Purdue Pharma executives pleaded guilty in U.S. federal courts to misleading doctors and patients by representing OxyContin™ as being less addictive than similar opiates. As Purdue’s “responsible corporate officers”, the execs bore responsibility for five years of addiction and abuse that brought billions of dollars of sales to the company. U.S. Department of Health and Human Services banned the Purdue executives from doing business with its health care payer (Medicare) for twenty years – a ruling that was recently unsuccessfully appealed.

Pick your poison.

Since 1999, U.S. prescription painkiller sales have quadrupled, and related overdose deaths have tripled. Last year’s 16,000 pain pill-attributable deaths were double those from heroin and cocaine. According to the U.S. Centers for Disease Control & Prevention (CDC), there are now >100 U.S. all-cause overdose deaths per day, making this the leading cause of injury death. The CDC reports that for every death, ten people are admitted to hospitals for substance abuse treatment.

Public outrage and policy responses have kicked in.

Grassroots local campaigns to make the opioid antidote naloxone (Narcan™) available to first responders have blossomed, saving some 3,000 lives per year in the U..S. Official state and federal efforts to regulate the number of prescription painkillers ordered via more restrictive narcotic drug schedules and a 30-day dispensing limit have received little traction.

These sobering statistics miss the point.

Blame does not lie solely with the heroin dealers, Afghan war loads or Pharma executives, but with some doctors and their professional governing bodies. Physician prescribing patterns and government-run drug coverage payment plans contribute to >12 million Americans admitting to using opiates like OxyContin™ for non-medical reasons in 2010. And doctors running illegal pill mills need to go to jail!

Most doctors are not trained to treat chronic pain.

2011 estimates were that suffering & disability from chronic back pain and cancer, fairly cited as a medical necessity for these drugs, topped 100 million Americans. In 2014, the U.S. Agency for Healthcare Research and Quality (AHRQ) concluded that the long-term use of prescription opiates for chronic pain increases the risk of “serious harm” to patients (i.e. overdose deaths, fractures, heart attacks and sexual dysfunction), with little evidence in support of a health benefit.

So, Neil Young was prescient when he stated the obvious about narcotic addiction, “I’m not a preacher, but drugs killed a lot of great men”.

The developed world has come full circle.

Sadly, the damage is being done all over The Square.

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