Future generations will look back on the opioid epidemic as the greatest tragedy of modern medicine. The recent 60 Minutes special about drug distributors really highlights that manufacturing and prescribing opiates was never about the best interest of patients. The pharma companies saw a business opportunity that could be exploited by offering patients a little pill to take their pain away. What person, given the chance, would choose to live in constant pain when a simple prescription could be the remedy? What doctor would deny their patient a chance to live without pain?
For many prescribers, the risks of addiction, diversion, and overdose were minimized as marketing teams, and pharma reps whitewashed opiate use and made them incredibly lucrative to prescribe. Some doctors and pharmacists crossed over to the dark side and knowingly overprescribed these medications becoming “drug dealers in a lab coat.”
Many more doctors resorted to using these medications because they truly wanted to give their patients relief from pain, only to find themselves trapped in an endless cycle of prescribing more and more opiates. Patients have come to expect and demand pain pills and are less and less willing to pursue non-opiate modalities of treating and managing pain. The culture in this country has become such that patients feel entitled to be free of pain, always reaching for that elusive pain score of 0. Our mistake as doctors was validating this culture and using opiates to placate our patients.
The situation becomes even more complex because provider compensation is tied to patient satisfaction and productivity. How do you refuse to prescribe opiates without jeopardizing your satisfaction scores and risking your own financial security? How can productivity be reconciled with the need to have lengthy discussions with our patients about their chronic pain and options for treatment?
We are not reimbursed for having those types of needed, in-depth conversations. Our incentive structures promote two goals: seeing high volumes of patients and making each of them happy. When it comes to opiate prescriptions, what makes the patient happy is usually at odds with what is best for their health.
When medicine is operated as a business, there will always be providers, systems, and companies that place profit above patient well being- that disregard morality in an endless attempt to generate more revenue. The segment with Bill Whitaker perfectly illustrated that greed, corruption, and power will inevitably trump what is best for the patient in the examining room. In the end, it falls back on each of us as providers to curtail our use of opiates and also help those now struggling with addiction.
Jenny Hartsock is a hospitalist.
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