In a twisted turn of events over the last few weeks, an astute Student Pharmacist turned to me and said, “I’m surprised more people don’t die”. The sad truth is; I am too. In my previous blog entitled Collective Bludgeoning, I compared gun control to opioid control. Perhaps I should have compared knives to opioids. After all, once a bullet pierces the flesh, it can never be good. But a knife is different. It can be skillfully employed to surgically remove or repair; opioids in much the same way can be employed to improve quality of life if they enter the body slowly, skillfully, and with exceptional care. If either becomes sloppy, the result could be harm or death.
Here to tell us why he is surprised more people don’t die is Student Pharmacist Mazen Saeed…
I have always envisaged interacting with patients and providing information that may impact and improve their daily lives and overall health. I have read several online blogs and stories of prescribing errors with the wrong medication, misdiagnosis, surgeons removing the wrong knee, or pharmacists dispensing the wrong medication. As a fourth year student pharmacist, I was extremely excited to experience different settings of the pharmacy profession. In particular, my long anticipated rotation with Dr. Fudin has been an eye-opening experience to say the least. Daily activities have included pain assessments and evaluations with concentration on pharmacotherapy combination. This comes with incredibly intense relationships that we establish with our patients and their families to improve their daily activities and lifestyles.
But, I am surprised that more people don’t die!
No, it’s not because of the opioids.
It’s because of the patients themselves.
It’s because of poor decisions and flippant attitudes I have seen by some patients. These include Dr. Google, the neighborhood pain expert, or “my sister”. Recently, I read an article by the CDC entitled Understanding the Epidemic: When the Prescription Becomes the Problem. The article was well written, but the title should have been “Understanding Opioid Death: When the Patient Becomes the Problem”.
This is sort of reminiscent of NRA’s slogan, “Guns don’t kill people, people kill people” as Dr. Coleman eloquently pointed out in a previous paindr.com blog, Collective Bludgeoning. But in my mind it is nothing more than a catchy campaign phrase to minimize the 30,000 plus deaths per year that are seen from accidental or purposeful massacres, yet gun enthusiasts and sportsmen in favor of lenient gun laws continue to blindly chant “Guns don’t kill people, people kill people”. All this, to preserve Second Amendment gun rights as outlined in the United States Constitution preserving the right of the people to keep and bear arms, adopted in 1791.
How can people be so blind? As Dr. Fudin points out above, perhaps a comparison of guns to opioids was a bit overreaching and knives are more akin to what’s happening here. It doesn’t really matter if guns, knives, or opioids kill people or if people kill people – THEY ARE ALL STILL DEAD!
What about the right to bear opioids for patients who require them for adequate pain control and improved function? Perhaps we need to establish another NRA (Narcotic Reality Awareness) group. That slogan can be “Opioids don’t kill people, people kill people”. Or maybe, “Don’t panic, carry naloxone”. But seriously all of these slogans are idiotic.
In Understanding the Epidemic: When the Prescription Becomes the Problem mentioned above, statistics regarding opioid deaths from opioids are suggestive of overprescribing. Although admittedly opioid deaths have surged congruently to the number of opioids prescribed over the last 10 years, does that really mean that the prescribers are responsible?
Maybe colleges are responsible for giving inadequate attention to pain management for practicing clinicians.
Maybe regulatory agencies should require comprehensive mandatory continuing education (and not 2-4 hours that we sometimes see).
Maybe prescribers and pharmacists should be responsible for underestimating the dangers of opioids, seeking educational opportunities, and taking the proper precautions to assess for risks and reassess for those risks consistently.
Or, just maybe people kill people, and opioids don’t.
Maybe it’s not just that DEAD is DEAD!
It is true that opioids can cause opioid-induced respiratory depression (OIRD) and overdose death. On the other hand, patient conduct towards taking opioids must be considered and must be taken very seriously!
Here are some quotes from real patients over the last few weeks…
“I take 2 or 3 tablets of methadone; it depends on my pain frequency.”
“My sister gave me methadone, so I only take 1 or 2 tablets a day on the days that I feel the pain.” (This patient wasn’t prescribed methadone)
“I was in agony so I put on a second fentanyl patch.”
“I took a blue pill besides the pills you gave me. I’m not sure what it was – my friend gave it to me.” (FYI, we believe it was morphine extended release 15mg)
“My fentanyl patch doesn’t work anymore, so I took some pills my friend gave me. He said they were oxycodone”.
To truly understand the opioid epidemic, we need also to consider that just maybe the patient factor is frequently left out of the equation. In the meantime, compliant well-intentioned folks needing these medications are left in agony because of overarching fears from regulatory agencies, law suits, and their livelihood.
So for some pain sufferers, if you are not a part of the solution to advocate for opioids among your constituents, perhaps without realizing it, you are a part of the problem.
And for prescribing clinicians, the solution is a shared activity in which patients and medical providers need to be partners, to trust but also confide in one another.
The first step is establishing with your patient that you are the expert, and if you’re not, please find one for the patient – this might even be a behavior health expert working in tandem with a physician.
But the patient cannot be the expert; Google cannot be the expert; siblings cannot be the expert; neighbors and best friends cannot be the expert. And to all you pain sufferers, please feel free to bring in your documents and/or advisees so that we can have a frank discussion while you’re still alive.
Remember, chronic opioids don’t generally kill people who use them correctly and as prescribed, unless there are no new unpredicted risks such as a new medical problem, drug, or food interactions.
So to all the gun-carrying zealots, anti-gun activists, opioid advocates, and anti-opioid activists, next time you “shoot” off your mouth, remember the new NRA (Narcotic Reality Awareness) slogan…
Opioids don’t kill people;
People kill people!
As always, comments are welcome!
Mazen Saeed obtained his bachelor degree in medicinal chemistry from the University at Buffalo and subsequently pursued a Pharm D. degree. He is currently in his last year of the dual degree program at Albany College of Pharmacy and Health Sciences for his Pharm.D./MBA. Mazen plans to start a Medication Therapy Management (MTM) in a community setting with a pain management focus. He is currently under the mentorship of Dr. Jeffrey Fudin. This post was prepared on Mazen’s own time and reviewed by Dr. Fudin and not part of any government duties.
- Institute of Medicine Report from the Committee on Advancing Pain Research, Care, and Education: Relieving Pain in America, A Blueprint for Transforming Prevention, Care, Education and Research. The National Academies Press, 2011.
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- Corbett AD, Henderson G, McKnight AT, Paterson SJ (2006). “75 years of opioid research: the exciting but vain quest for the Holy Grail”. Br. J. Pharmacol. 147 Suppl 1 (Suppl 1): S153–62.doi:1038/sj.bjp.0706435. PMC1760732. PMID 16402099
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