Some Things Have Changed
Some things have changed. An acquaintance recently had to undergo some minor surgery. It’s the type of surgery where the most difficult part is not having anything to eat or drink and show up at 6 AM for Prep. Although the patient received general anesthesia and was unconscious during the operation, she was ready to go home later in the morning and was resting comfortably in her own bed by lunchtime. Before leaving the outpatient surgery center, she was given a prescription for pain management medications. Her prescription was for 3 days worth of Vicodin, three pills per day, nine in total. At the bottom of the prescription was written: “No Refills”.
This prescription illuminates important changes. Just a few years before, I had a sports injury and showed up early on a Saturday morning in my local hospital Emergency Room. I was pretty sure I knew what the injury was as I had experienced something very similar a few years previous. I just wanted to make sure it wasn’t something else that could be more serious. After waiting around for a few hours I got x-rayed and then met with a doctor. He showed me the little line on the film. “You’ve got a cracked rib.” This confirmed what I thought. I thanked him and got up to leave. I was wearing a sweat shrt and old jeans, hadn’t showered or shaved yet and was feeling scruffy. I wanted to go home and clean up. The doctor held out his hand. “Hang on a second.” He turned away and wrote quickly on a small pad of paper, tore it off and handed it to me. “This is for the pain.” I looked down and was shocked. It was a prescription for a month’s worth of Vicodin, three pills a day for 30 days. 90 pills. At the bottom it noted “Three refills”. I had told the nurses and this doctor, during the examination that pain was present but not debilitating. I couldn’t lift my arm quickly and it hurt when I coughed. Aside from that it was manageable. I had already slept on it for three nights before getting checked out. I handed it back to him. “That’s OK, I don’t need this.”
He looked at me with concern. “I think you’ll need this.” No one had asked me, during any part of the examination, if I had a substance use disorder. No one seemed to listen to my explanation that the pain was not a problem for me. What was going on?
After a few more go-arounds, I re-assured the doctor and left the hospital without the prescription. I didn’t know it at the time but I had gotten caught up in the “Opioid Epidemic”. Due to a lack of training of medical personnel about how to assess and treat substance use and addictive disorders, the steady drum beat of the legal profession urging doctors to do everything they can to keep their patients happy and pain free and the pharmaceutical companies following this with the latest in “pain management pharmaceuticals” that they avowed were “non-addictive”, vast quantities of opioids were spread out across the country. This tidal wave of pills over-medicated patients seeking pain management and provided ample supplies to people with addictive disorders looking for another way to get high.
Now, about ten years later, many patients in medical settings are screened for substance use and addictive disorders and prescriptions are limited to just a brief period of time. In Massachusetts we have the Prescription Monitoring Program (PMP): a computerized system that allows a prescriber to check a data base to see if the patient sitting in their office has received similar prescriptions anywhere else. People in active addiction hate this because it has greatly decreased their ability to receive multiple drug prescriptions.
A recent study however may be illuminating a very problematic result of closing off access to prescription drugs. A person with an addiction, if unable to obtain their drug of choice through a prescription, will go out to purchase the drug on the street. Treatment professionals are threatened with this often. When we tell an person we cannot provide a prescription for a risky drug because the PMP tells us they already obtained the same prescription the day before at another clinic, they angrily tell us: “Fine, I’ll just go buy it on the street.” On the street, currently, everything white in Massachusetts is Fentanyl. While the rest of the country is experiencing a decrease in overdose deaths, in Massachusetts the number has gone up.
Some things have changed but some have not. We all keep trying but have not solved the problem yet.