Here’s why you should read this.
The United States consumes 80% of all opiods produced in the world yet we only contain 4.4% of the world population.
In the United States there were 300 million narcotic pain medicine prescriptions written in 2015.
In the United States there was 29 billion dollars spent on opiod pain killers. That’s about 55 million dollars a day.
I’m getting older, a bit fatter, a bit lazier, sometimes a bit depressed about my aches and pains. You’re thinking, Geez that sounds like 99% of anybody over fifty―and you would be correct.
So what does this have to do with anything? Humor me for a minute.
Let’s start with one simple part of every medical professionals assessment. The pain scale.
“Between 0 and 10 what is your pain level?”
If you’ve been to the doctor or in the hospital you wonder why they keep asking you this question:
I’ll tell you why. Somewhere in the mid-nineties it was incorporated into the healthcare protocol. This is now a question we healthcare providers ask every patient, every time we see them, every time they fart, pee, or step in front of us.
Pain has become the enemy, and it’s no surprise really because imagine the revenues produced if we see pain as a problem that must always be solved. Isn’t pain normal? All these wonderful hearted healthcare workers have been taught that it’s not. They are taught that their success is based on their patients not having pain. Patients are taught that they should not have pain. It’s been drilled into us to the point that it’s a part of our American psyche. This may be the real crime, and I speculate that it was pushed by the pharmaceutical companies..
Why you ask, is this a crime? If you’ve ever been in the hospital, you know that they repeatedly ask your pain levels and pump narcotics into you as part of a protocol until your pain levels is below about a 3/10.
Hmm. What’s wrong with that? I’ll tell you what’s wrong with that. Those pain medications are all narcotics. The producers of the narcotics, who seem to train our physicians, have conveniently worked this pain scale into assessments as a method of measuring outcomes of care.
A patient has arthritis, something that is not curable. He sees his doctor, he leaves with a prescription for Hydrocodone.
In fact, when I see an 85 year old arthritic, obese patient who hasn’t been out of his chair in five years and am tasked with getting him to walk, one of the measures I have to ask every visit is his pain levels. If it’s not zero by the time I discharge him, usually about six weeks, I have to report that he still has pain, and it shows up with a big negative on the outcome. It doesn’t matter that I was there to get him more active, and certainly not solve the pain he’s gotten from years of immobility and obesity, it still goes down as a negative and I have to document why I didn’t resolve his pain. Does anyone really think he wouldn’t have more pain if he’s trying to be more active and that it would go away in a few weeks. Hardly, What they want is for me to contact the doctor and suggest that his pain is limiting his mobility.
“Aha,” says the doctor, “maybe if we give him some pain meds he can get more active.”
This was also around the time when all these narcotics started getting pumped into our population to create dependent drug addicts. It was also about the time we started seeing more patient’s dying from prescription drug overdoses.
As a physical therapist I have seen countless old people who are drug addicts. I recently had a patient who got 15 mg of morphine three times a day, and oxycodone in between to take the edge off. Yes, you who know… Read that sentence again. That’s what her internal medicine specialist gives her. She’s ambulatory, talkative, eighty-six years old, and a complete drug addict. She did not become that overnight, but over time. I see this all the time.
The problem with this is that narcotics are not good for chronic type pains. Why? Because the body adapts to them and when it reaches the new normal it needs more drugs to reduce the pain. Finally, that person is completely addicted to the medicine and they begin to associate the pain with not having the medicine so they’re hurting every time their body starts anticipating it’s next fix. They’re mind is subconsciously trying to find a reason to make sure they get their next fix, and pain is the answer. I see this all the time.
So now, this poor drug addicted older person is crying in pain and non-functional if they don’t get their dose. Their mind tells them it’s because of their pain, but the fact is, it’s because they can’t live without their narcotic and they are no different than the heroin addict. They will go to great measures to get their drug, and I’ve seen it all.
The pain scale… What’s your pain level? These words should be removed from outcome reporting. Yes, they should be included in an assessment to determine if it’s non-ordinary pain signifying a medical problem. Unfortunately, pain is normal for us older folks, and patients should be educated to understand that pain is something that life deals us, and it generally doesn’t get better as we age, and stay off the narcotics because that won’t help it.
That said, my own opinion, is that other than for a couple days after a major surgery, or following trauma, narcotics should not be used except for the cases of terminal cancer pain where they definitely provide a benefit.
Let’s look at the facts.
1.) There are more people dying of prescription drugs every day than dying in car accidents and shootings.
2.) We are spending 29 billion dollars a year in this country on pain meds, and we wonder why our healthcare costs are out of control. This is certainly one of the reasons.
3.) We consume more prescription narcotics than any other country in the world, in fact. we consume most of the narcotics produced.
What does this say? It says that Big Pharma are the number one drug pushers, and in a far worse way than the street corner drug dealer. Why aren’t they going to jail? Occasionally they do, but without major changes in the current medical protocols, this problem will continue.
I say do this:
1.) TAKE THE PAIN SCALE OFF OF OUTCOME MEASURES for all cases other than immediately after trauma, surgery in the hospital, and for terminal cancer patients.
2.) CHANGE THE MINDSET OF PAIN IN OUR POPULATION. Teach people that a certain amount of pain is normal; we all have pain. For the most part, live with it. Prevent pain by staying active and producing natural endorphins. We need to make a 180 degree turn on how we treat pain in the United States Healthcare system because we are the professionals who create the public’s expectations. (Perhaps we’re just idiots brainwashed by Big Pharma). If so, we need to change that too.
Health Care in these United States 