I sit in amazement as I type, that any human being can somehow muster the indifference to defend a policy that doesn’t halt the ludicrousness propagating repeated gun massacres of innocent children, young adults, and teachers in our schools.
Every day I am exhausted by the daunting cry from patients nationwide because of the politically popular trends to limit opioids, restrict doses, and mislabel legitimate chronic pain patients as addicts. I see misquoted and misleading opioid statistics that ignore real facts that the majority of opioid overdose deaths are from illegally imported fentanyl derivatives and heroin. Yet politicians and anti-opioid zealots either lack understanding of the bigger picture or choose to ignore the complexity. Meanwhile thousands of pain patients suffer, or worse yet decide that suicide is the better alternative.
Analogously many gun owners and politicians seem ambivalent to heightened gun control and limitations on assault weapons because it’s inconvenient. INCONVENIENT! Nonetheless, many innocent people are slaughtered at the hands of gunslingers that should never have access to these weapons. And I’m sorry to say that massacres have gotten worse since Dr. Fein’s Collective Bludgeoning post here in October 2015.
We know that prescription opioids have declined drastically by more than 50% since 2014 and are expected to hit a 20-year low by this year as seen in this graphic. Prescription opioid overdose data can be viewed in multiple ways at this CDC link.
Perhaps we should have the equivalent of prescription monitoring programs and urine drug screens in persons who carry guns, including a registry of where and how many ammunitions are purchased, and a continual updated database of ownership, and the equivalent of an abuse deterrent opioid – a fingerprint activated unlocking mechanism.
Gun carriers argue that their second amendment right allows “the right of the people to keep and bear Arms” and that these are invasions of privacy and INCONVENIENT.
At the same time, chronic pain patients that require long-term opioid therapy are forced by new and emerging standards of care to be monitored by state prescription databases, pee into cups, have limits on medication supplies, and limits on dosing. Are these patients being cheated from their promise of “Life, Liberty and the pursuit of Happiness” by the Declaration of Independence since they are tormented every day by pain that is being controlled by the government, politicians, and managed care executives? Do you think weekly trips to the pharmacy for subtherapeutic opioid doses might be INCONVENIENT?!
Lucky for me, a close colleague in the pain world is a responsible clinician, responsible gun owner, and has two children that she loves dearly. I asked her to make the comparison and comment herein. As you might imagine, because of the sensitive nature of both anti-opioid zealots, gun fanatics, and the overarching politics, Ophilia Pain, PharmD was a little “gun shy” at first. But, she rose to the occasion. Here’s was Dr. OP had to say…
I am writing, not as an NRA member, but as a responsible gun owner (at least I think so). My boys have always been hunters and I have a carry permit in our state. I doubt I will ever use my handgun beyond the shooting range, but I know I could protect my children if I had to. I will tell you that none of the firearms that I have used have been registered to me, and I never had to take an educational course to shoot them (I did have to take a class to get my carry permit). My dad taught me “everything I need to know” when I was about 10 years old, but I suspect I am quite ignorant. By the way, I am 5’4″ tall and would easily be overpowered by > 95% of high school boys.
That being said, before you dismiss this blog, my wish is that organizations like the NRA and supporting members are able to learn from our failures in healthcare. Let me explain – I work in a pain clinic and I have for many years. Healthcare providers, in the truest sense, exist to take care of people who suffer. According to data from the 2012 National Health Interview Survey (NHIS), 11.2 percent of American adults (25.3 million people) have experienced some form of pain every day for the past three months and more than 50 million suffer from “severe levels” of pain. The wrong answer, but the one that was pushed on providers more than 15 years ago, was to use opioids, lots of them, because they are not addictive and millions of people are suffering. Well, don’t we look foolish now?
Because we were not thoughtful we let opioid prescribing get out of hand and continuously stated that “the person who misused the medication is the one responsible, not me”. Our pain management organizations and Pharma were standing behind their pulpits demanding “more drugs, not less”, just like NRA spokespeople have done this week with “more guns, not less” to keep our children safe.
What healthcare providers really needed to do was to have heart-to-heart conversations with our patients about what is appropriate pain management (ANY medication is only expected to provide about 30% relief) as well as taking personal responsibility in improving their own health (at LEAST 70% of the load). Sometimes long-term opioids are appropriate, but most of the time, they just aren’t. We believe that a prescriber should be able to order the best medication for the patient, but because we have not been globally responsible, providers have ended up with their hands tied and patients are suffering. We left the government no choice but to step in to try to curb the rising death rates. It appears that people who have been denied prescription opioids have now turned to the black market and illegal substances, which just shifts the problem to the street and out of the office. If only we had been willing to care for patients holistically, but that takes a back seat to clinic schedules and revenue units.
The reason I bring this to you is because I ran some numbers on gun ownership and firearm related deaths, compared to opioid prescriptions and opioid-related deaths. I was rather astounded at the similarities. The association between firearm related deaths mirrors opioid deaths too closely to discount. I searched for a common denominator. The demographics of opioid use and gun ownership are very similar (rural and white). The mental illness in those who use guns and opioids inappropriately is also closely linked, and certainly the emotion attached to the government “taking away” something that provides safety, or at least comfort, is very strong.
Here are some of the numbers I found from the most objective sources I could find. I am not picking a side but simply want to see the numbers.
What I found was that gun ownership in the U.S. is approximately 300 million.
Opioid prescriptions written annually in the U.S. (2016 data) is approximately 214 million.
Annual gun-related deaths (including accidental) is ~ 31,500.
Annual opioid-prescription related deaths (including accidental) is ~ 33,000. Note if included illicit (not be prescription) opioids the number is closer to ~60,000.
Some may say that automatic weapons can kill many people in a few short seconds. I would also argue that dirty needles shared by several people in a community due to oxycodone and oxymorphone abuse, has caused a series of closely related deaths as well.
Two of the major differences are that opioids are highly regulated and guns have very little regulation. Opioids are prescribed at the discretion of a licensed medical provider and require a prescription to purchase. Guns may be purchased at any retailer (Walmart is the biggest, and, conveniently, they have pharmacies too) without consultation with an expert to help decide which weapon (or maybe no weapon) is appropriate. I’m not suggesting that there is cross over here (gun owners are also drug users), but both can be deadly. Are there more numbers we need to look at?
I believe we have gone past the polarizing “we demand that we be entitled to 2nd amendment rights at any cost”, to showing how to preserve 2nd amendment rights responsibly. An obligation to encourage the responsibility that the 2nd amendment requires. It is very easy to say “guns don’t kill people, people kill people” but the fact is, people die. I often say “drugs don’t kill people, people who take drugs inappropriately kill people”. Same concept of innate personal responsibility, and yet people die, so obviously neither of our groups is doing a very good job at PR in the form of constant and consistent messaging about safety and responsibility. I would encourage our 2nd Amendment defenders to do this before the government has no choice but to restrict those freedoms. More legislation is not going to fix inappropriate gun use, just as more legislation isn’t going to fix inappropriate drug use. I’m not aware of any “abuse deterrent guns” but they would probably be as effective as abuse deterrent opioids. Building a wall just isn’t going to fix is either. Our mental illness and irresponsibility are home-grown. We have to find better ways to help people get a handle on their personal demons and make it a deeply personal responsibility to take care of oneself and one’s safety as well as those around us. I feel deeply that if we are not part of the solution, we are part of the problem and I want us to be the leaders and the solution.
As usual, we’re happy to receive comments from zealots in either camp!