Ohio Suing Painkiller Manufacturers for Opioid Epidemic

[Shoblongoo]

In what is shaping up to be the biggest lawsuit in America since the wave of litigation against the tobacco industry in the 1990s (and may very well play out on the same legal issues), the state of Ohio is now suing the pharmaceutical companies responsible for designing, manufacturing, and distributing opioid painkillers.   (i.e Oxycontin. Percocet. Vicodin.) 

The theory of liability is that: 

1) These drugs are defective-by-design; insofar as they are essentially low dose heroin-in-a-pill.

2) The pharmaceutical companies knew or should have known that these drugs posed a severe, unmitigatable risk of causing opioid addiction in persons who take them.

3) The pharmaceutical companies have not accurately represented the dangers of using doctor-prescribed opioids for routine pain management, and have misled the public as to the safety of prescribed use. 

4) The dramatic rise in heroin addictions, arrests, and overdoses observed over the past decade is a direct-and-proximate result of the manufacturer's misconduct in designing and marketing these products; damages for which the manufacturer should be liable.   

...Is that right?

Are the drug companies to blame? Does this lawsuit have merit? Is this like or unlike the lawsuits against the tobacco companies for misleading the public as to the dangers of cigarettes? And for what damages (if any) should the pharmaceutical companies be liable? 

Edited June 1, 2017 by Shoblongoo

[Lord Raven]

On 6/1/2017 at 9:50 AM, Shoblongoo said:

Are the drug companies to blame?

That and the doctors who prescribe them. Remember that many doctors are more or less paid under the table by pharma companies to use their drugs. It is documented, but I can't imagine as many people really know the resources in which they can track it.

On 6/1/2017 at 9:50 AM, Shoblongoo said:

Is this like or unlike the lawsuits against the tobacco companies for misleading the public as to the dangers of cigarettes?

Like, but quite a bit worse. Tobacco wasn't prescribed by professionals, it was pretty much sold over the counter as, from my understanding, more or less a leisure substance.

On 6/1/2017 at 9:50 AM, Shoblongoo said:

And for what damages (if any) should the pharmaceutical companies be liable? 

Not a lawyer, but basically ending the practice, going bankrupt, and also medical expenses (as well as payment) for those whose lives are worsened due to prescription opioids. Especially if they've taken measures to suppress information about it.

God knows that won't happen though.

Edited June 6, 2017 by Lord Raven

[Rezzy]

On 6/1/2017 at 11:50 AM, Shoblongoo said:

In what is shaping up to be the biggest lawsuit in America since the wave of litigation against the tobacco industry in the 1990s (and may very well play out on the same legal issues), the state of Ohio is now suing the pharmaceutical companies responsible for designing, manufacturing, and distributing opioid painkillers.   (i.e Oxycontin. Percocet. Vicodin.) 

The theory of liability is that: 

1) These drugs are defective-by-design; insofar as they are essentially low dose heroin-in-a-pill.

2) The pharmaceutical companies knew or should have known that these drugs posed a severe, unmitigatable risk of causing opioid addiction in persons who take them.

3) The pharmaceutical companies have not accurately represented the dangers of using doctor-prescribed opioids for routine pain management, and have misled the public as to the safety of prescribed use. 

4) The dramatic rise in heroin addictions, arrests, and overdoses observed over the past decade is a direct-and-proximate result of the manufacturer's misconduct in designing and marketing these products; damages for which the manufacturer should be liable.   

...Is that right?

Are the drug companies to blame? Does this lawsuit have merit? Is this like or unlike the lawsuits against the tobacco companies for misleading the public as to the dangers of cigarettes? And for what damages (if any) should the pharmaceutical companies be liable? 

I'm a doctor and have full prescribing privileges and prescribe narcotics when warranted.  I probably have more experience here than most.

1: Opiates do what they are supposed to.  Narcotics are often the only way to control chronic or acute severe pain.  Suing the manufacturers of opiates will only serve to drive up the cost for those who need them.  This lawsuit is frankly counterproductive.  It's not like we have a more effective analgesic and we prescribe opiates for nefarious purposes.

2: The side-effects are well-known.

3: Speaking for myself, I prescribe NSAIDs, Tylenol, or Tramadol for low grade pain.  Opiates are the higher rung.  Often, it's the patients who ask for the narcotics.  It can be tough to differentiate true pain from drug seekers.  This lawsuit would place even more undue burden on the prescribers.

4: Heroin isn't a prescribed drug, it's just in the same family.

 

For people who specialize in pain management, opiates are a necessary part of treatment for many.  This law would serve to make it harder for patients who truly need pain control to get it.  Physicians already practice defensive medicine for fear of lawsuit or getting their license suspended by the DEA.

 

Much like the tobacco lawsuit twenty years ago, everybody knew cigarettes risks by then, but unlike cigarettes, opiates are a necessary part of medicine.  Litigation will only make them more expensive and make your doctor not want to give you Percocet next time you break your ankle.

[Moblin Major General]

13 minutes ago, Rezzy said:

Much like the tobacco lawsuit twenty years ago, everybody knew cigarettes risks by then, but unlike cigarettes, opiates are a necessary part of medicine.  Litigation will only make them more expensive and make your doctor not want to give you Percocet next time you break your ankle.

If opioids are made expensive enough, cheaper (and possibly equally effective) alternatives will be sought. Cigarettes are now in competition with E-cigs (equally bad, but at least they made an attempt to fix some of the problems of cigarettes), so why can't other drugs (with proper research) fill the opioid gap? I know what you're saying, but a part of it sounds a little bit like what Big Pharma wants both us and you to think. Medicine is very good for keeping modern society alive. But that's all its doing, as if by design. Pain can hinder people for a long time, but why should the only remedy be distracting the body, either through opioids (dangerous and potentially addictive) or something else, like alcohol (very dangerous, possibly extremely addictive, and inconsistent). There are already nerve dampeners on the market, but they really only work for people with fibromyalgia because there has been no need to prescribe them over opioids for more serious pain.

[Rezzy]

30 minutes ago, Hylian Air Force said:

If opioids are made expensive enough, cheaper (and possibly equally effective) alternatives will be sought. Cigarettes are now in competition with E-cigs (equally bad, but at least they made an attempt to fix some of the problems of cigarettes), so why can't other drugs (with proper research) fill the opioid gap?

Doing that would condemn millions of patients to go without effective pain management while said alternate is sought, because currently, there is no other way to manage certain types of pain, short of putting them into a medically induced coma.

E-cigs are better than normal cigarettes.  You have the nicotine without the tar.  They have just had bad PR lately for whatever reason.  Both cigarettes and E-cigs have the same substance (nicotine), it's primarily the tar and other carcinogenic chemicals that lead to morbidity, not the nicotine itself.  Nicotine isn't exactly good for you, but isolating it is better for smokers' health than normal smoking.

Opiates are already the effective ingredient chemically isolated, so it's not a matter of finding the "good" part of the drug, and taking away the deleterious components.  What you propose would require coming up with an entirely new school of drug, which could be years away, if ever.  There's only so many pathways the body can manage pain receptors.

43 minutes ago, Hylian Air Force said:

I know what you're saying, but a part of it sounds a little bit like what Big Pharma wants both us and you to think. Medicine is very good for keeping modern society alive. But that's all its doing, as if by design. Pain can hinder people for a long time, but why should the only remedy be distracting the body, either through opioids (dangerous and potentially addictive) or something else, like alcohol (very dangerous, possibly extremely addictive, and inconsistent). There are already nerve dampeners on the market, but they really only work for people with fibromyalgia because there has been no need to prescribe them over opioids for more serious pain.

My opinion is not formed from what drug companies say, but years of experience as a physician and years of medical school.  I want my patients not to just be alive, but have a good quality of life.  Before I was a doctor, I was a pharmacy technician.  Making IVs for hospice patients, and often dispensing medications like Fentanyl.  There are pain seekers, but I don't want my genuine patients to suffer as a result of some overreaction to opiate use. 

Adults should be informed and make responsible decisions, but my profession is already over-regulated without adding more restrictions on how I can treat my patients.  There will always be drug abusers, but opiates have a bona fide medical benefit, and is one of the best tools at our disposal.

Medications like Lyrica or Gabapentin are only good for certain types of pain, like neuropathy, and won't do much for someone recovering from hip surgery or a car accident.

[Shoblongoo]

18 hours ago, Rezzy said:

I'm a doctor and have full prescribing privileges and prescribe narcotics when warranted.  I probably have more experience here than most.

...then I definitely want to get your thoughts on the allegations raised on Page #23 of the State's complaint. (By way of background--I'm an attorney. My practice areas pertinent to this line of inquiry include personal injury, criminal defense, professional liability, and consumer fraud)

A copy of the verified complaint is attached hereto, for viewing by any interested persons:
https://assets.documentcloud.org/documents/3761767/Ohio-opioid-drug-lawsuit.pdf

It is alleged by The State of Ohio that defendant drug companies have perpetrated a fraud upon the medical community by operating “front groups” purporting to be independent institutions of medical oversight and education, which are in fact staffed by and receive almost the entirety of their operating budget from the drug companies. These groups include the “American Academy of Pain Medicine (AAPM),” the “American Society of Pain Education (ASPE),” "the American Chronic Pain Association" (ACPA),” and the now-defunct  “American Pain Foundation (APF).” Doctors in leadership positions at these organizations regularly attend defendant’s corporate-sponsored events, receive instruction from the defendant’s as to what statements and guidelines they would like to see produced, and produce statements and guidelines consistent with those instructions rather than with scientific literature or independently verifiable claims.

It is further alleged that the identified “front groups” have produced the clinical guidelines for routine pain management, establishing uniform practices and industry standard-of-care for patient treatment.  That said guidelines are demonstrably false and misleading insofar as they over-emphasize the pain management benefits or prescription opiates, under-emphasize the risks of dependency and habit-forming behaviors, and unduly dismiss alternative courses of treatment as less viable. And that a doctor of ordinary skill and knowledge will in fact rely upon the clinical guidelines in setting forth course of treatment, as a basis for sound medical judgment.

So…My questions for you…

1) In making it your practice to prescribe opiates for routine management of acute and chronic pain, and in forming your medical opinion that this is good practice, to what extent did you rely upon clinical guidelines?

2) Do you believe current clinical guidelines for pain management are correct and accurate?

3) If it were to be demonstrated that defendant drug companies exercised undue influence in drafting the current clinical guidelines for pain management, and that said guidelines are NOT correct and accurate, would that change your opinion as to the appropriateness of using opiates for routine pain management?      

 

Edited June 8, 2017 by Shoblongoo

[Rezzy]

6 hours ago, Shoblongoo said:

...then I definitely want to get your thoughts on the allegations raised on Page #23 of the State's complaint. (By way of background--I'm an attorney. My practice areas pertinent to this line of inquiry include personal injury, criminal defense, professional liability, and consumer fraud)

A copy of the verified complaint is attached hereto, for viewing by any interested persons:
https://assets.documentcloud.org/documents/3761767/Ohio-opioid-drug-lawsuit.pdf

It is alleged by The State of Ohio that defendant drug companies have perpetrated a fraud upon the medical community by operating “front groups” purporting to be independent institutions of medical oversight and education, which are in fact staffed by and receive almost the entirety of their operating budget from the drug companies. These groups include the “American Academy of Pain Medicine (AAPM),” the “American Society of Pain Education (ASPE),” "the American Chronic Pain Association" (ACPA),” and the now-defunct  “American Pain Foundation (APF).” Doctors in leadership positions at these organizations regularly attend defendant’s corporate-sponsored events, receive instruction from the defendant’s as to what statements and guidelines they would like to see produced, and produce statements and guidelines consistent with those instructions rather than with scientific literature or independently verifiable claims.

It is further alleged that the identified “front groups” have produced the clinical guidelines for routine pain management, establishing uniform practices and industry standard-of-care for patient treatment.  That said guidelines are demonstrably false and misleading insofar as they over-emphasize the pain management benefits or prescription opiates, under-emphasize the risks of dependency and habit-forming behaviors, and unduly dismiss alternative courses of treatment as less viable. And that a doctor of ordinary skill and knowledge will in fact rely upon the clinical guidelines in setting forth course of treatment, as a basis for sound medical judgment.

So…My questions for you…

1) In making it your practice to prescribe opiates for routine management of acute and chronic pain, and in forming your medical opinion that this is good practice, to what extent did you rely upon clinical guidelines?

2) Do you believe current clinical guidelines for pain management are correct and accurate?

3) If it were to be demonstrated that defendant drug companies exercised undue influence in drafting the current clinical guidelines for pain management, and that said guidelines are NOT correct and accurate, would that change your opinion as to the appropriateness of using opiates for routine pain management?      

 

That link's a bit long for me to fully read right now.  Full disclosure on my end: I'm not a pain specialist.  I see patients who have pain, but for chronic pain patients or suspected CRPS (Complex Regional Pain Syndrome) cases, I refer to a pain specialist.  Part of the reason I didn't want to go into pain management is that it's such a litigious field.

1: I do not use opiates indefinitely, unless they are hospice patients.  If a patient requires ongoing pain management, I refer them to a specialist.  Anyone who enters a pain clinic, at least from me has genuine chronic uncontrolled pain, or is a drug seeker who claims to have pain.  Sadly, the latter is hard to differentiate in many cases.

2: Clinic guidelines are and have always been a vague point of contention.  You can get experts who will both support your decisions and challenge your decisions.  If a case goes to litigation, the standard is whatever the court says it is.  I cannot say one way or another as to whether they are correct and accurate, because they are not universal.

3: No, since as I said earlier, opiates are the only drug that can do what they do as effectively as they do.  They aren't the only medication, but they should not be demonized either.  There are non-traditional methods of pain control like acupuncture, meditation, and other things, but the research on them is more equivocal.

Edited June 8, 2017 by Rezzy

[Shoblongoo]

16 hours ago, Rezzy said:

That link's a bit long for me to fully read right now.  Full disclosure on my end: I'm not a pain specialist.  I see patients who have pain, but for chronic pain patients or suspected CRPS (Complex Regional Pain Syndrome) cases, I refer to a pain specialist.  Part of the reason I didn't want to go into pain management is that it's such a litigious field.

1: I do not use opiates indefinitely, unless they are hospice patients.  If a patient requires ongoing pain management, I refer them to a specialist.  Anyone who enters a pain clinic, at least from me has genuine chronic uncontrolled pain, or is a drug seeker who claims to have pain.  Sadly, the latter is hard to differentiate in many cases.

2: Clinic guidelines are and have always been a vague point of contention.  You can get experts who will both support your decisions and challenge your decisions.  If a case goes to litigation, the standard is whatever the court says it is.  I cannot say one way or another as to whether they are correct and accurate, because they are not universal.

3: No, since as I said earlier, opiates are the only drug that can do what they do as effectively as they do.  They aren't the only medication, but they should not be demonized either.  There are non-traditional methods of pain control like acupuncture, meditation, and other things, but the research on them is more equivocal.

To the bolded; whats your opinion on medical marijuana? 

My experience as a patient has been that cannabis has therapeutic pain management value, in situations where current guidelines hold that the use of cannabis is neither lawful nor medically appropriate and instead direct the use of opiate drugs.  

My understanding—and you can correct me if this is wrong—is that the barrier to broader use of THC-based drugs as a substitute for opiates in routine pain management is more of a legal one then a medical or scientific one, as the technology to make THC-based pain relievers that do not carry the same risk of chemical dependency as opiates today exists. But it is heavily frowned upon by lawmakers and policy setters; in no small part due to the influence exerted by opiate manufacturers.

Current law and guidelines are based upon the (very misguided, IMO) policy supposition that medical marijuana poses a greater threat of public nuisance and introducing patients to illicit drug use then opiates, such that opiates should be the more commonly used substance for everything from muscle cramps to toothaches and cannabis should be used only in such exceptional circumstances as a cancer patient requiring pain management during chemotherapy. I'm thinking it should be the reverse; opiates as the rare treatment for only the most extreme forms of pain, where the benefits of pain management clearly outweigh the risks of dependency, and THC-based medications as a safer remedy of common use for routine pain management.

Am I completely out of line here, or is there some sense to that?   

Edited June 9, 2017 by Shoblongoo

[Rezzy]

10 minutes ago, Shoblongoo said:

To the bolded; whats your opinion on medical marijuana? 

My experience as a patient has been that cannabis has therapeutic pain management value, in situations where current guidelines hold that the use of cannabis is neither lawful nor medically appropriate and instead direct the use of opiate drugs.  

My understanding—and you can correct me if this is wrong—is that the barrier to broader use of THC-based drugs as a substitute for opiates in routine pain management is more of a legal one then a medical or scientific one, as the technology to make THC-based pain relievers that do not carry the same risk of chemical dependency as opiates today exists. But it is heavily frowned upon by lawmakers and policy setters; in no small part due to the influence exerted by opiate manufacturers.

Current law and guidelines are based upon the (very misguided, IMO) policy supposition that medical marijuana poses a greater threat of public nuisance and introducing patients to illicit drug use then opiates, such that opiates should be the more commonly used substance for everything from muscle cramps to toothaches and cannabis should be used only in such exceptional circumstances as a cancer patient requiring pain management during chemotherapy. I'm thinking it should be the reverse; opiates as the rare treatment for only the most extreme forms of pain, where the benefits of pain management clearly outweigh the risks of dependency, and THC-based medications as a safer remedy of common use for routine pain management.

Am I completely out of line here, or is there some sense to that?   

At work, so tl;dr I am in favor of legal medical marijuana.  I'm also in favor of legal recreational marijuana, but that's a topic for another day.

I'll try to expand on this when I'm not typing on a phone.

Edited June 9, 2017 by Rezzy

[Shoblongoo]

On 6/9/2017 at 10:23 AM, Rezzy said:

 also in favor of legal recreational marijuana, but that's a topic for another day.

Anddddddd with that--a civil litigator and a physician are in complete, 100% agreement. 

[Rezzy]

For medical marijuana, it can be a supplement to opiates for pain treatment, but most evidence for its pain relief has been anecdotal and there needs to be more literature before it could be taken as a gold standard for pain treatment.  Lots of people think marijuana is a silver bullet for pain treatment, but it's effectiveness has been overstated in many cases.

[Shoblongoo]

16 hours ago, Rezzy said:

For medical marijuana, it can be a supplement to opiates for pain treatment, but most evidence for its pain relief has been anecdotal and there needs to be more literature before it could be taken as a gold standard for pain treatment.  Lots of people think marijuana is a silver bullet for pain treatment, but it's effectiveness has been overstated in many cases.

I'll throw another anecdotal account on the heap--this was my experience as a pain management patient.  

About a year back, I had a relatively minor surgical procedure. Nothing too bad. They applied a local area anesthetic during the surgery.

Afterwards the doctor comes up to me and says: “When that anesthetic wears off you’re going to be in a lot of pain. I’ll give you something for that.”

I tell him its fine. I’ll take Tylenol.

He tells me: “No you don’t understand. When that anesthetic wears off you’re going to be in a LOT of pain. You’re going to need something stronger then Tylenol.”

…he gives me a fifty (50) pill bottle of Vicodin...

I tell him I don’t feel comfortable using opiate painkillers. I’ve seen lots of people become addicted from short term use and I’d like a pain management drug that doesn’t carry a high risk of chemical dependency. I ask him if he can write me a prescription for medical marijuana.

He tells me medical marijuana is not approved for therapeutic use in acute pain management after surgery; that he’s giving me the standard treatment and everyone uses opiates after surgery, and its perfectly safe as long as I use as instructed. “Just don’t take anymore than 3 a day” he tells me. “One every 8 hours.”     

…so I go home with a fifty (50) pill bottle of Vicodin...

The anesthetic wears off. It hurts like hell. I take a Vicodin. It feels…amazing. Just great. An overwhelming sense of calm and relaxation and blissful tingly I-want-to-feel-this-way-all-the-time in every corner of the body. I take another pill 8 hours later, as instructed. I take another pill 8 hours later, as instructed.

And I didn’t even realize what I was doing…but by the 3rd Vicodin…I wasn’t taking the pill because I was in pain and needed pain relief. I felt GREAT. I was taking the pill because it felt so good that I reflexively wanted to keep having that feeling of calm and relaxation and blissful tingly I-want-to-feel-this-way-all-the-time.

On day two of my recovery from the surgical procedure, I had a moment of clarity where I realized what was happening and what I was doing. These pills weren’t just making my pain go away. They were making me never want to stop taking them.

…I was five (5) pills into a fifty (50) pill bottle…

And I have no doubt that very nasty things would have happened if I had finished that bottle.

I didn’t finish the bottle.  I drove into Philadelphia, where marijuana has basically been decrimininalized by city ordinance and carries all the penalties at law of a minor traffic ticket. I contacted an old college buddy. Procured a one week’s supply. Went home. Flushed my remaining forty-five (45) pills of Vicodin down the toilet, because I wasn’t going down that road. Spent the remainder of my recovery period self-treating with cannabis. Had some minor itching and stinging and general discomfort around the surgical site—I wasn’t all happy-tingly to the point that I couldn’t feel ANYTHING like I was on Vicodin—but nothing worse than an old scab or a mosquito bite. My pain was well-managed. And I never had that sense I had on the Vicodin of So Great. Need More. Now.

At the end of the week I had no more pain, no nasty drug habit, and I was back-to-work the following Monday without complication.

…that was my experience with opiate painkillers. And in my practice representing persons who get on these pills after a car accident or a slip-and-fall and defending criminal defendants who eventually wind up turning to heroin I see the same story playing out time after time after time.

These people go to their doctor. They’re told opiates are the standard treatment for routine pain management and loaded with opiates. They get hooked. And when the pills run out, they turn to doctor-shopping and hard drugs.

The doctors—fine—I can buy that the doctors are just following the industry standard, and doing what they do because they know that if they DON’T follow the industry standard and they get sued, failure to follow industry standard is grounds for liability. I get it. You do the best you can in a bad system.

I can’t believe that the Drug Companies didn’t know this, when they applied for FDA approval and certified that their drugs carry low risk of dependency. And marketed these drugs as the gold standard for treatment excellence. Something there doesn't smell right.

 

Edited June 20, 2017 by Shoblongoo

[Rezzy]

2 hours ago, Shoblongoo said:

I'll throw another anecdotal account on the heap--this was my experience as a pain management patient.  

About a year back, I had a relatively minor surgical procedure. Nothing too bad. They applied a local area anesthetic during the surgery.

Afterwards the doctor comes up to me and says: “When that anesthetic wears off you’re going to be in a lot of pain. I’ll give you something for that.”

I tell him its fine. I’ll take Tylenol.

He tells me: “No you don’t understand. When that anesthetic wears off you’re going to be in a LOT of pain. You’re going to need something stronger then Tylenol.”

…he gives me a fifty (50) pill bottle of Vicodin...

I tell him I don’t feel comfortable using opiate painkillers. I’ve seen lots of people become addicted from short term use and I’d like a pain management drug that doesn’t carry a high risk of chemical dependency. I ask him if he can write me a prescription for medical marijuana.

He tells me medical marijuana is not approved for therapeutic use in acute pain management after surgery; that he’s giving me the standard treatment and everyone uses opiates after surgery, and its perfectly safe as long as I use as instructed. “Just don’t take anymore than 3 a day” he tells me. “One every 8 hours.”     

…so I go home with a fifty (50) pill bottle of Vicodin...

The anesthetic wears off. It hurts like hell. I take a Vicodin. It feels…amazing. Just great. An overwhelming sense of calm and relaxation and blissful tingly I-want-to-feel-this-way-all-the-time in every corner of the body. I take another pill 8 hours later, as instructed. I take another pill 8 hours later, as instructed.

And I didn’t even realize what I was doing…but by the 3rd Vicodin…I wasn’t taking the pill because I was in pain and needed pain relief. I felt GREAT. I was taking the pill because it felt so good that I reflexively wanted to keep having that feeling of calm and relaxation and blissful tingly I-want-to-feel-this-way-all-the-time.

On day two of my recovery from the surgical procedure, I had a moment of clarity where I realized what was happening and what I was doing. These pills weren’t just making my pain go away. They were making me never want to stop taking them.

…I was five (5) pills into a fifty (50) pill bottle…

And I have no doubt that very nasty things would have happened if I had finished that bottle.

I didn’t finish the bottle.  I drove into Philadelphia, where marijuana has basically been decrimininalized by city ordinance and carries all the penalties at law of a minor traffic ticket. I contacted an old college buddy. Procured a one week’s supply. Went home. Flushed my remaining forty-five (45) pills of Vicodin down the toilet, because I wasn’t going down that road. Spent the remainder of my recovery period self-treating with cannabis. Had some minor itching and stinging and general discomfort around the surgical site—I wasn’t all happy-tingly to the point that I couldn’t feel ANYTHING like I was on Vicodin—but nothing worse than an old scab or a mosquito bite. My pain was well-managed. And I never had that sense I had on the Vicodin of So Great. Need More. Now.

At the end of the week I had no more pain, no nasty drug habit, and I was back-to-work the following Monday without complication.

…that was my experience with opiate painkillers. And in my practice representing persons who get on these pills after a car accident or a slip-and-fall and defending criminal defendants who eventually wind up turning to heroin I see the same story playing out time after time after time.

These people go to their doctor. They’re told opiates are the standard treatment for routine pain management and loaded with opiates. They get hooked. And when the pills run out, they turn to doctor-shopping and hard drugs.

The doctors—fine—I can buy that the doctors are just following the industry standard, and doing what they do because they know that if they DON’T follow the industry standard and they get sued, failure to follow industry standard is grounds for liability. I get it. You do the best you can in a bad system.

I can’t believe that the Drug Companies didn’t know this, when they applied for FDA approval and certified that their drugs carry low risk of dependency. And marketed these drugs as the gold standard for treatment excellence. Something there doesn't smell right.

 

There are people who struggle with opiate dependence, but of the thousands of cases I've seen, it's not people who take pain pills for a few days post surgery who get hooked on narcotics.  Doctors will often tell patients to take the pain medication on schedule at least for the first day post-operatively, because the pain and swelling will be greatest the first day or two afterwards, and it is easier to prevent the pain than it is to chase after the pain and have to end up taking more in the long run.

Opiates are better at acute pain than marijuana.  For severe surgery, marijuana won't be enough to handle the pain.  For every medication, there are side effects, but you have to weight to benefits versus the drawbacks.  It's not worth it to deny the best possible pain relief for post-op patients because a small percentage will develop dependency.  For every antibiotic, there are people who will present an allergic reaction, but that does not mean you don't prescribe them, it only means that you address the problem if it presents itself.

I understand the wariness about dependence, but it's a tool, and as all tools should be used wisely.  A bone I have to pick is that the DEA made it harder to give people Tramadol.  It's a non-opiate that is very good for pain relief, and a few years ago, it was a medicine that could be "called in", but now it's more strictly regulated and requires a written prescription.  If they want less people on opiates, stop making it harder to give them non-opiates.  Doctors are also hamstrung for medical marijuana, because even in places it's legal, the DEA will watch you like a hawk, and question you if that's your first course of treatment.