The Joint Commission of Hospital Accreditation requires hospitals to ask the patient for their level of pain, just subjectively. They require we use a 10-point scale, from 0 for no pain to 10 being the worst pain ever.
I knew instinctively that this was a bad thing and would lead to more narcotic addiction, as it did eventually. But in our patients, the pain scores went down as we detoxified patients from the narcotic medications. Significantly lower pain scores meant the patients were in less pain after stopping the narcotic medications.
When I published these results, I had to review the medical literature for opioid medications. I found others had published findings that opioid medications actually caused pain when taken for a period for a period of time and called it “opioid-induced hyperalgesia.”
Opioid is the term for narcotic pain medications, and hyperalgesia means increased pain. Hyper meaning increased, and algesia is pain. These results were published in national, prestigious medical journals as early as 2001. You would think most doctors would read and care about these results — but sadly, no.
Studies show that total annual cost burden for a patient with opioid abuse or dependence diagnosis was significantly higher than that for a patient with no such diagnosis, due to high rates of comorbidities, and utilization of medical services.
The total annual charges associated with an individual who was diagnosed with opioid abuse or dependence were 56% higher than the average annual per-patient charge based on patient’s charges.
In 2015, the average per-patient charge across all diagnoses and claims was $11,404. Comparatively, the patient average total charge for patients identified with opioid diagnoses in the same year was $63,356.
Patients in hospitals receive narcotic medications, whether they need them or not.
It is standard practice to start with Dilaudid or Vicodin on admission, whether the patient wants it or not. Some patients seek it out and even pursue fraudulent medical and psychiatric care to get narcotics. It seems doctors and hospitals make money off addicts as they increase their pain by prescribing opioid medications.
Many doctors and hospitals figure out that they make money from knowingly admitting and treating addicts for the consequences of their addictions. And they don’t even have to identify and treat the addictions. What is the incentive beyond good medical care to discontinue prescribing opioid medications?
There is a great incentive to increase prescribing opioid drugs to escalate medical utilization and costs from the opioid medications, and certainly to continue providing narcotic medications to supplement the bottom line.
All in the name of pain, even if not prescribing decreases pain. Why is it hard to get doctors and hospitals to do the right thing? The answer is: money-driven by addiction and ignorance.
Also, because the medications cause pain instead of reducing pain, physicians (particularly pain specialists), perform expensive procedures such as injections that have no medical value against opioid-induced hyperalgesia.
These procedures carry their own risks, such as spinal infections, paralysis, and increased pain. These procedures are on top of the money these doctors make for prescribing the narcotics in the first place … another money maker.
Pain doctors charge $1,000 to $2,000 per injections, that takes 10 minutes, and does no good as the pain problem is narcotics. Injections don’t work for opioid addiction.
Hydrocodone, a narcotic medication, is the most commonly prescribed medication of any kind, greater than insulin, even antibiotics — and it has been for many years.
Hydrocodone is a highly addicting medication, similar to heroin, so it is no small wonder it is greatly sought after. Remember, addiction is a powerful, instinctive drive; that we seek compulsively addicting drugs to the extent of life, liberty, and happiness.
As many as 16,000 people die a year from opioid medications, and 12,000 die a year from heroin. That’s 28,000 deaths from opioid drugs. Are they really worth it? When they don’t have benefit, don’t decrease pain, rather increase pain and cause disability and death?
Other reasons hydrocodone is so commonly prescribed is pain is very common, and is a major reason people seek medical care. Often the type of pain is chronic — sources of pain are muscle, skeletal, headaches commonly — a setup for developing an addiction to opioid medication.
Most people will develop an addiction to opioid medications if taken for weeks or months; if pain is chronic, the risk for onset of addiction is high.
Accordingly, addiction to opioid medications is the second most common drug addiction next to marijuana in the U.S. People of all ages become addicted, but the most common reason for becoming addicted is seeking medical care for common sources of incurable pain. Yet opioids bring no comfort, rather discomfort.
I performed peer reviews on patients who were addicted to narcotic medications prescribed by physicians. I also reviewed the dangerous and fraudulent prescribing of medications that were not medically necessary.
Patients were on large doses of Vicodin (hydrocodone), Percocet (oxycodone), Duragesic (fentanyl).
Because of addiction to the narcotics, the patients wanted to remain on the drugs; because the doctors knew very little about these medications, they either didn’t know about what the patients were experiencing or didn’t care.
Additionally, the doctors and hospitals profited. All they focused on was the patient’s complaint of pain, and their demands to get more drugs. Many physicians were intimidated or entrepreneurs.
They also didn’t know about the addictions that drove the patient’s demands and use. They were clueless that the opioids cause pain.
Narcotics are disabling because they lead to loss of function, poor quality of life, disruption of interpersonal relationships, unemployment, depression, anxiety, and increase rather than a decrease of pain.
Imagine the additional costs of unnecessary medical care for medications, doctor visits, and surgeries and what that does to costs of health insurance and government health programs.
The author is an anonymous physician.
Image credit: Shutterstock.com
