January 27, 2014

Pain killers

The CDC has decided to "crack down" on prescription drug abuse deaths, namely painkillers. By their estimates 36,000 died from drug overdoses, "mostly prescription drugs." Ok, stat rule number 1, you have to subtract out the non prescription drug deaths. Stat rule number 2, how many of these were self harm or suicides. But let's assume that 36,000 is real which is a not trivial number. But if you read further, it's not. NEARLY 3/4 are opiates. Ok, stat rule number 3, stop rounding up to prop up your case. Facts are a bitch.  So, really it's more like 27,000 opiate overdoses, again ASSUMING suicides and non prescription drugs have been subtracted out (they haven't). But let's assume it's a real number. However, let's put that in perspective. Motor vehicle crashes kill 30-39,000 annually, depending on the year. Suicide killed over 38,000 in 2010. I don't see any public outcry for increased mental health screening in the community. I don't see any clamor for decreasing vehicle fatalities. I will wage dollars to donuts that drug addiction will remain unchanged but it will become harder for people with legitimate pain to get the relief they need. I've already watched it happen in too many patients where no one wants to give opiates to patients in the hospital who have legitimate reasons to be in severe pain. They are in the hospital after all, presumably for a real reason. I just had a patient the other day with a fractured bone that required orthopedics to put in a plate with 5 screws and the family member wanted them to get tylenol because opiates are "too dangerous". So Instead they get Tylenol or ibuprofen and the patient sufferers needlessly, not that those aren't benign drugs either. And sadly, race of the doctor and patient often plays a role.

Medical schools and residency programs formally need to make pain management an actual part of their education. I can tell you first hand that it is not. CDC crackdowns are going to be as successful as the rest of the war on drugs has been.


Cary Reams said...

Stat rule 0: any quantitative assessment that starts its analysis with "most" should be sent back to the intern for a re-write.

Also - combine your post with the 60 Minutes broadcast this past Sunday on the 80% drop in psych hospital beds in the past 20 years and the question marks surrounding the numbers that aren't broken out cast even larger shadows on the subject.

Essentially, this sounds like punishing the whole class for the actions of one student. Not interested in performing the detail work to get to the root of the problem, so we're just just going to stop here, with "most" of the problem possibly addressed.

Isaac van Sligtenhorst said...

Your first sentence is spot on. The CDC has been politically driven for far too long. If it were REALLY concerned about disease control, since that's in it's name, they'd be focusing on the disturbing increasing antibiotic resistance with no companies having incentives to develop new antibiotics. Or, they could figure out a way to increase colonoscopies since colon cancer kills around 50,000 a year. That number should be MUCH lower given that it is one of the few cancers where we have an early detection system AND we can intervene to prolong and increase quality of life.