Early Monday Morning Thoughts

Just sitting here at my desk early on a Monday morning I am thinking about friends. Without exhausting either my short or long-term memory banks and using my fingers and toes, I can count no fewer than fourteen of my friends who live day-to-day on narcotics supplied by their doctors in an entirely legal manner. I have undergone two surgeries in the past six years after which both of my surgeons, without prompting, wrote prescriptions for me for substantial amounts of narcotic pain-killers which included several refills. Sales of narcotic painkillers reached $8.5 billion last year, compared with $4.4 billion in 2001, according to the consulting firm IMS Health.

The New York times reports this morning that “a conscience-provoking article by Dr. Howard Brody, director of an institute that explores ethical issues in health care, published in The New England Journal of Medicine in early 2010. Dr. Brody criticized the performance of medical groups during the health care debates, saying they were too concerned about protecting doctors’ incomes while refusing to contemplate measures (beyond malpractice reform) to reduce health care costs. He urged each specialty society, using rigorous scientific approaches, to develop “top five” lists of tests and treatments whose elimination for major categories of patients would save the most money quickly “without depriving any patient of meaningful medical benefit.” As a result of this challenge by Dr. Brody, nine major physicians’ groups have identified 45 tests and procedures (five for each specialty) that are commonly used but have no proven benefit for many patients and sometimes cause more harm than good.”

Given the rampant legal use of narcotics in our society, one would naturally assume somewhere among these 45 tests a recommendation to limit the use of addicting opioids would be found. The staggering sales of narcotic pain killers suggest common use well beyond temporary suppression of post-operative pain. This class of medications includes many painkillers that are more commonly known as narcotics, such as morphine. Opioid medications attach to receptors found in the brain, gastrointestinal tract, and spinal cord, altering the body’s perception of pain. They may also cause sedation, euphoria, and respiratory suppression. The potential for dependence. is a major concern in the use of these drugs, and the illegal use of these drugs constitutes a huge public health problem and over-burdens our criminal justice system as well.

However, despite my assumptions, narcotic painkillers are mentioned only once among the 45 recommendations made by these various groups and, in my view, a manner that makes it more likely that legal narcotics will continue to be abused. The nephrology group, in fact, recommends the “short-term use of narcotic analgesics [which] may be safer than and as effective as NSAIDs.” NSAIDs include aspirin and ibuprofen, over-the-counter drugs which currently are used safely by millions upon millions of Americans.

Just for sake of comparison, in our deficit-concerned society, all of us taxpayers would heartily welcome a reduced expenditure that would save $4.1 billions dollars a year. Reducing the use of narcotic pain killers to 2001 levels would exactly do that. Just saying. . .