Based on the size of the problem we’re facing today with prescription drug abuse, it is difficult to fathom that this is really just a recent problem. Just a short decade ago, nobody was talking about it.
We’re going to take a look at the “perfect storm” that created this problem and allowed it to turn into an epidemic so quickly.
In the past, doctors used drugs like morphine to treat pain for patients who were dealing with pain from cancer or surgery. Morphine was also usually prescribed for patients dealing with various end-of-life pain issues.
There were a few drugs that contained these opioid-narcotics. However, the dose was very small and they were combined with traditional over the counter drugs.
One approach that was fairly common included a multi-disciplinary approach to treating chronic pain. This included an extended treatment plan that included reducing their dependence on narcotic painkillers in combination with physical therapy, working through behavior modification programs and some additional counseling.
At that time, doctors stayed away from using opioids for pain killers because of the risk of addiction. They felt that this addiction was such a significant concern that they wouldn’t even prescribe these drugs to patients who were nearing the end of their life and were experiencing pain.
Clearly, things changed.
There were three things that all happened at about the same time that caused this change:
Small research studies that showed the addiction risk wasn’t as large as previously thought
- Development of a time-released opioid drug
- The FDA approval that clearly looks like a mistake
There were a few medical studies that started in the mid 1980’s that began to turn the tide on prescribing opioids. These studies focused on cancer patients who were experiencing chronic pain. The study showed that these patients could use the drugs for several months and they didn’t suffer from addiction problems.
That made people in the pharmaceutical business as well as pain specialists to start thinking that these drugs could be used to help relieve pain for an even larger group of patients, without risking addiction. They joined forces to start a “War on Pain” to change the ways doctors thought about prescribing opioids.
In the 1990’s Dr. Russell Portenoy completed and published a few smaller studies that seemed to show that the risks of opioid addiction were not as bad as originally thought. However, this research likely wouldn’t have made as big a splash without the other two elements included in the perfect storm.
The development of OxyContin continued to escalate the race to our prescription drug abuse epidemic. This drug was packed in a way that allowed it to be a time-released tablet instead of one that released all its pain relieving medicine immediately.
The final part of the perfect storm came through what many people believe to be a huge mistake by the FDA when they approved this new time-released drug for use.
The pitch was that that true addicts wanted a quick fix, so the risk of becoming addicted to a time-release drug was much lower. The FDA bought into the idea, approved the drug and allowed it to be marketed by the pharmaceutical companies as “believed” to have a lower risk of addiction. Clearly when looking back, this was a huge miscalculation.
With the approvals all in place, the pharmaceutical companies then began a huge marketing push for this new group of opioid drugs for pain management. They targeted family doctors and general practitioners with their new drug and their new marketing campaign, and it was clearly very successful.
Insurance companies even bear some responsibility in the development of this epidemic. When the doctors prescribed opioids, they were much cheaper than the traditional treatment that included the multi-disciplinary approach. The insurance companies pushed doctors to just prescribe pills instead of sending them for extended treatment that cost more money.