Bad Medicine

Uncategorized / Thursday, June 11th, 2015

I love Anthony Bourdain. Although I truly don’t know how good of a chef he is, as I’ve never seen him actually cook anything, I enjoy his laid-back demeanor and the ease with which he is able to converse with people from so many different cultural backgrounds. Food really is a universal language.

Anyway, I have watched pretty much all of his episodes of No Reservations (I will never forget Bourdain bringing fellow chef, Alton Brown, to a strip club on the Atlanta episode) and was excited when he began his newer endeavor, Parts Unknown. This past weekend, at its usual time of 7pm on CNN, I began watching the Massachusetts edition.

I myself was born in Scituate, Massachusetts. My family and I moved away to NJ when I was 2 so I don’t really remember too much of my time there. But, I do remember some bits and pieces of when we went back to visit friends of my parents. I appreciated Bourdain’s look into the fishing, clamming, and lobster trapping industries of the area and a look at many of the long-ago abandoned industrial communities.

So you can imagine my surprise when the episode took a left turn delving into the record high rates of prescription opiate and heroin use in certain areas. Greenfield, Massachusetts, to be specific.

It’s no secret that Bourdain himself has a history of heroin addiction. It’s something that he’s very open about, so clearly this is a topic that hits close to home for him. In this instance, Bourdain targets Purdue Pharmaceuticals, the maker of OxyContin, as being at the center of the Opiate Revolution. He references a 1996 promotional video (which for the life of me, I could not locate. Kudos, Bourdain) and deceptive marketing strategies, in which Purdue stated that OxyContin was “addiction proof”. They went on to boldly proclaim in the video that less than 1% of those who use opiates long-term, including OxyContin, will become addicted.

Pure, unadulterated horse shit.

Of course, karma is a bitch, because in 2007 Purdue plead guilty in federal criminal court to deceptive marketing of the drug with “intent to defraud and mislead the public”. They were ordered to pay $634 million in penalties to defendents, largely based in West Virginia.

However, I have to make an observation here: although I appreciate Bourdain’s sentiment, the issue is not only with OxyContin. People become addicted to opiates of all different monikers.

Percocet, Roxicet, Vicodin, Fentynal, and Dilaudid, just to name a few.

It would be nice to be able to say, “That Purdue and their OxyContin. They really put us in a pickle, didn’t they?”

But that is simply not true.

The truth is that addiction to prescription opiates far precedes the OxyContin nightmare. Hell, if it didn’t, why would Purdue even bring up the “impossible” addiction potential? Obviously, it far outlives it too, otherwise we wouldn’t have the epidemic addiction rates in this country.

Seriously, an estimated 2.1 million people in the US with opiate addiction, of which 467,000 are addicted to heroin? This is unfathomable.

But, how did we get here? Well, that is a little more difficult to figure out.

One thing I know for sure is that if I had a penny for every person that comes to me for addiction counseling with a story that begins with, “Well, I had an accident/injury/surgery and my doctor prescribed me pain killers…” I would seriously be a millionaire many times over. Because for many, this is how it happens.

Often, opiate addiction is born from necessity.

And in some respects, I get it. Patients come to their doctors in pain of various causes, doctors took an oath to “Do No Harm”, and they want to make that pain go away. So, they prescribe the only medication that they believe can do the job – opiates.

And it’s true – opiates are REALLY, astonishingly good at what they were made to do – control pain. Probably too good. But, it’s important to note that they not only control pain, they also provide a secondary gain to people – they make you mentally FEEL GOOD. “Sense of euphoria and well-being” is how it is worded on the list of side effects.

So, imagine yourself as an individual with physical pain. You get prescribed a medication by your doctor that not only takes the pain away, but also the depression and anxiety that almost always plays co-pilot to pain. That’s a win-win. And, it’s also how addiction begins.

(Sidenote: I realize that I am not addressing the situation of teenagers abusing and becoming addicted to opiates. However, that is a whole other animal and, quite frankly, requires the respect its own post.)

Thankfully, in somewhat recent years, doctors are becoming more conscientious about the pain cycle and what role addiction plays. They also now are realizing that using opiates as a first-line defense is bad. More conservative, long-term pain relief options are being explored, with the addition of individual counseling to address the mental health piece.

But, for every one of those doctors, there are three that continue to prescribe opiates with abandon.

And those are the dangerous ones.

(Sidenote: there is a website that exists for the sole purpose of checking in on the rates of medications being prescribed in specific states by physicians. Keep in mind, this website is only calculating for those who are covered under Medicare Part D. It does not address those with private insurance or Medicaid. If you are wondering where our State ranks, check this out.)

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