On Being Part of an Epidemic
I guess I could call myself Opioid Mitzi.
As an RN I was complicit in the opioid/heroin epidemic that is decimating this country.
How could that be? As an RN, I pledged to do no harm.
Yeah, well so did many complicit physicians who also pledged the same thing.
But I digress. This is a brief overview.
The story begins in the 1990s with a pharmaceutical company, Purdue, developing what they believed (I doubt that but maybe they did for a nanosecond) was a medication that could relieve pain and not be addictive.
However, the information that Purdue sent out with its drug reps to medical offices, hospitals, nursing homes, etc. implied that Oxycontin was not addictive when given for pain. This was not based on a study but a relied on a paragraph in a letter to the editor in a medical journal. Two physicians had studied a limited number of patients who’d been given an opioid medication for pain and very few had become addicted.
This was the Holy Grail of pain management — a pain pill that wasn’t addictive. The Word went out. People with severe pain, people with chronic pain were being saved by the Purdue Gods.
During the same time “pain” was becoming the “Fifth Vital Sign” — medical personnel were told to monitor pain as if it were as important as blood pressure, pulse, etc. Unfortunately no one noted that pain is very subjective and can be increased because of many things other than those easily monitored physically. And physicians were warned that if they had a patient in pain and did nothing (or little) to relieve it, they could be held accountable — legally.
Fortunately pain can be managed by more than medication. Alternative therapies like acupuncture and meditation could be used to help a patient’s suffering but no insurance covered these and other alternative therapies. People continued to suffer and looked to their physicians for relief. Prescriptions were written; after all, insurances would cover medication.
As an RN I went to many workshops that discussed all of the above. Nurses had to document a patient’s pain, using a smiley to grumpy face or a number system. That was part of our nursing assessment. We then made sure the doctor was aware of extent of the patient’s pain. The doctors had been to their own workshops and conferences (and dinners paid by Purdue where they learn of the great pill), so they “had” to do something and the something, many times, was Oxycontin. Me? I went back to my nursing colleagues and taught them everything I’d learned, everything that was wrong.
People did become addicted, needing more and more and more of the precious pills. Ethical practitioners wrote for only a certain amount. But Pill Mills appeared that would hand out prescription in minutes to anyone with the money. Those pills could then be sold individually. It took some time before the Pill Mills disappeared and those doctors indicted. By that time the addicts were moving on to heroin — cheaper. Hundreds of thousands of Oxycontin pills were shipped to small towns in Appalachia. No one was watching or no one cared — money was being made — lots of money.
If you would like a more complete review of this epidemic, I recommend Dreamland, the True Story of America’s Opiate Epidemic by Sam Quiones. Quiones spent months researching the problem on many levels — from addicts to physicians to families who lost a loved one. He even interviewed the heroin trade runners from Mexico.
The New York Times recently ran an article about “Origins of an Epidemic.”
But make no mistake, the biggest part of this epidemic did not start South of the Border. It started in board rooms and research centers here. Purdue Pharma should go down in history like Big Tobacco. They knew — they did nothing. But they made lots and lots of money.
Note: Fentanyl is a major killer. I saw this coming ten years ago. Before I retired, Fentanyl patches were being used in our nursing homes for people with chronic pain. We had to monitor that patches were being replaced and the old ones discarded as ordered. Unfortunately we had found that a used patch could be chewed by an addict.
As a person with chronic pain, I know there is no “magic bullet.” I take Extra Strength Tylenol and I try to manage mixing physical activity with rest periods — and a glass of wine daily.
But I’m one of the lucky ones who missed the Age of Oxycontin as a patient but I was in the middle of it as a health professional. Not one of my finer memories.
