Opinion: Why prescription drugs have little to do with the current illicit drug epidemic in the United States

The 1990s marked a time in U.S. medicine where doctors were taught to give narcotics.
(Graphic via Life and Limb blog, Edwin Leap)

Emergency physician Edwin Leap explains that U.S. doctors in training during the 1990s were instructed to treat pain with pills. He said a medical career taught him how misdirected those practices were. He adds that the nation's current addictions and overdoses aren't centered on prescription drugs anymore; they're all about super cheap, available and deadly fentanyl -- other opioids are almost an afterthought. An excerpted version of his commentary from MedPage Today is included below.

"When I was in my residency training, from 1990 to 1993. . . . We were told, over and over, that we should treat pain aggressively and should not be afraid to give narcotics to patients in pain. Who were we to judge someone's pain, after all? The young man who fell onto his knees at work, with a normal blood pressure and heart rate, looking about the room, might well categorize his pain a '10/10,' and we should honor that, respect it, and treat it."

Pain medicines such as hydrocodone and oxycodone (Oxycontin) were first marketed to doctors as a miracle for patients in pain. Given their addictive nature, it didn't take long for the drugs to take hold. Leap writes, "Much of our work as physicians was a balancing act between trying to show genuine compassion, mandated compassion, and appropriate skepticism about pain scales and the lies concocted in pursuit of drugs."

Given doctors' role as the prescription writers who "started" patients on the path to addiction, physicians are now forced to take additional narcotic treatment training. "I have to take a new 8-hour class on proper prescribing habits and pain management," Lead adds. "[But] nobody really argues with me about pain pills anymore. . . .We're only supposed to give a 3-day supply. We tell people that, and they shrug."

The likely reason a 3-day narcotic supply isn't a problem is the availability of fentanyl. "It's just so easy to get the stuff. It's inexpensive, and it's everywhere. It's in drug houses and gas station parking lots. It's in high schools and college campuses," Leap writes. "It's in prisons and homeless encampments. In fact, according to independent journalist Jonathan Choe, it can sometimes be found for 50 cents per dose in homeless camps."

U.S. physicians have little to do with fentanyl's street dominance. Leap writes, "The flood of illegal fentanyl precursors from China, which then become fentanyl and began flowing across the Southern border, continues unabated. . . . It's all rearranging the deck chairs of the Titanic until someone gets a handle on the crisis from a geopolitical standpoint. And yes, that means dealing with the border as well. . . . I'm not blaming one political side or another. I'm just saying that if it isn't taken seriously, then the deaths will keep skyrocketing."

This piece was originally published on Leap's blog, Life and Limb.