The U.S. Drug Enforcement Administration announced a four-state crackdown on illegal pill mills, dubbed "Operation Pilluted" last month
This sweep resulted in the arrest of 22 doctors and pharmacists in Louisiana, Arkansas, Alabama, and Mississippi.
Abuse of prescription drugs has become a growing epidemic in the United States. In 2013, about 44,000 unintentional drug overdose deaths occurred, more than half attributed to prescription drugs. Seventy-one percent of those were opioid overdoses.
While the DEA and other law enforcement agencies work tirelessly to curtail the trafficking of prescription drugs through high volume "pill mills" and cash-only pharmacies, much of the abuse occurs in less obvious ways.
It is all around us.
Many physicians prescribe medical regimens of very high doses of opioids in high risk populations.
For example, a known intravenous drug user prescribed hydromorphone for chronic back pain may be crushing and injecting the pills to get a quicker and stronger effect.
An alcoholic with chronic pain may be prescribed high doses of pain medication and chase it with "a shot" because it works better that way.
An elderly woman may take eight-10 pain pills a day because it helps with her chronic arthritis while simultaneously using benzodiazepines and sleeping pills to manage her anxiety and depression.
These patients all have legitimate pain and obtain legal prescriptions for their treatment regimen, but this fails to address the underlying problem.
Doctors have limited time and patients often want what they know works.
Make the patient happy and give them what they want.
It’s much easier than having "the conversation" during a 10 minute interview and exam.
We can and should do better. We have newer approaches to managing pain, and, when pain medication is needed, we have newer tamper-resistant medications that deter abuse.
Responsible physicians treat the whole patient and do not just prescribe high doses and quantities of powerful opioids with no other treatments.
As patients, we must educate ourselves to see the difference.
Posts by Melanie Rosenblatt, M.D.
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