Substance abuse and overdose deaths are nothing new. People who use opioids are dying, and they will keep dying until we learn how to fix our bigger problem: the “stupidity epidemic.” We see and hear about the opioid epidemic every single day in the media, but no one is talking about the epidemic of stupidity, both in the medical and non-medical communities. We have thrown time, money and even tears at the opioid problem, yet we have failed to address the real problem that was created in the mid-1990’s when Oxycontin began saturating the market with its false claims as a non-addictive solution to our nation’s most prevalent medical complaint: pain.
We all know now that substance abuse of all kinds, including opioid abuse, is at epidemic proportions. Steps have been taken by governmental agencies, medical associations, law enforcement and community interventionists to solve this epidemic, but the data indicate opioid-related deaths continue to rise.
The stupidity epidemic is far more lethal than the opioid epidemic.
Certain “pain management” physicians are no less responsible for the misuse of these very powerful drugs than our colleagues in surgery and primary care (some of which advertise themselves as pain management physicians). They wanted and needed effective medications in their practice as much as Purdue wanted and needed to sell them Oxycontin.
When all of this began, I was a medical student who was shocked at what I was seeing. It was an entire medical community brainwashed into idiotic and wrong beliefs. It prompted me to spend time working at the World Health Organization in Geneva, Switzerland on the development of an international substance abuse education program. It was clear to me at the time that we were headed down a dangerous — and stupid — path. My “colleagues” were prescribing opiates for all, believing there were no dosing limits and opioids are not addictive as long as the patient had legitimate pain. I felt compelled to stand up for logic and common sense, even when my medical professors told me I was wasting my time. After I finished my medical training and began practicing interventional pain management, I refused to go along with the medical establishment when I decided to never write a prescription for Oxycontin. Inexplicably, many of these self-appointed “experts” still defend doling out Oxycontin instead of safer opioids.
In almost two decades working with chronic pain patients, I find the vast majority of my new patients do not want to be on opioids. The new patients that are already on high dose opioids think they have tried every option (because their other physicians have said so) and almost invariably, they have not. Some have been treated by physicians who are untrained in pain medicine. While that is certainly one level on the stupidity scale, I find it is far more common for these patients to have been treated with one or more board-certified, fellowship-trained pain management anesthesiologist physicians. I treat patients from many different states, and even from different countries, and if I named these “expert” physicians, I am certain you would recognize them because they are regularly interviewed in the media about the opioid epidemic.
It is shameful and hypocritical that the very physicians who were complicit in the creation of this issue now claim that we all have to stop prescribing opiates altogether for everyone. What is even more disturbing is that some of these physicians are still prescribing high-dose opioids and Oxycontin behind closed doors. I see it every day, and it is further evidence that the stupidity epidemic is far worse for patients than the opioid epidemic will ever be.
As the pendulum swings from one extreme to another, physicians are so afraid of “doing no harm” that they may actually be causing more harm. Whether the epidemic arose from the opioids themselves, false marketing or from the stupidity of the medical and non-medical community, I remain hopeful that we can, in fact, fix stupid.
When prescribing Oxycontin was the sexy thing to do, I held fast to the belief that the molecular and formulation science was fundamentally flawed and that it should not be prescribed for chronic nonterminal pain. Before states began approving the use of medical cannabis, these “colleagues” stated there was no medical use for CBD. Now they are all changing their story as the media changes its story. When I developed a comprehensive outpatient ketamine infusion protocol to reverse central sensitization conditions and began lecturing nationally as an expert on the topic, I heard from physicians, one of which is the head of a pain management fellowship training program, that the brain does not play a role in chronic pain! These physicians embody the stupidity epidemic, and yet we call them “experts.”
The stupidity epidemic has caused more suicides among the chronic pain community because of inappropriate pain management than accidental opioid deaths. Once we differentiate legitimate patients, physicians, medications and treatments from illegitimate ones, we find that chronic pain patients suffer many negative outcomes because of stereotypes, insurance denials and a fundamental lack of understanding of the complexities of pain.
Staying stupid has been the status quo for so long that we’ve come to accept ignorant and inhumane treatment as the way things have to be so we can stop people from dying. I am here to tell you that some patients would rather die than to live with the terrorizing effect pain has on their brain. I mean that in very literal terms; most, if not all, chronic pain patients have developed central sensitization, whereby their brains have actually undergone neural reorganization as a result of the chronic pain.
Opioids have been used for thousands of years to treat painful conditions. When used and prescribed responsibly (keyword: responsibly), certain opioids can safely help manage certain types of pain. The stupidity epidemic is what led us to this point and it’s what is preventing us from solving the opioid epidemic. If we want to start having real solutions, we need to start being honest by calling out the real problems.
Jay Joshi is CEO and medical director, National Pain Centers.
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