Vox: How America became the world’s leading opioid prescriber

So how did the US become the world’s top prescriber of opioid painkillers? There are several reasons, according to Vox.

First, there were the pharmaceutical companies. Wanting to make as much money as possible, these companies marketed their drugs as safe and effective for treating pain — even though the evidence for opioids shows that, particularly for chronic pain, the risksoutweigh the benefits in most, but not all, cases. Many doctors and patients were convinced by this campaign. (Purdue Pharma, the maker of OxyContin, and some of its higher-ups later paid more than $600 million in fines for their misleading marketing claims, and opioid makers and distributors are now facing many more lawsuits on similar grounds.)

Then there were doctors. On one hand, doctors were under a lot of pressure from advocacy groups (some pharma-backed), medical associations, and government agencies to treat pain more seriously. On the other hand, doctors faced increasing pressure to see and treat patients quickly and efficiently.

The latter is a result of what Stanford addiction specialist Anna Lembke, author of Drug Dealer, MD, describes as “the Toyotazation of medicine — tremendous pressure on doctors within these large integrated health care centers to practice medicine in a certain way and get patients out in a timely fashion to be able to bill insurers at the highest possible level and to make sure that their patients were satisfied customers.”

Opioids provided an answer to these two problems. Doctors didn’t know how to deal with many of the complex pain problems their patients were dealing with, because in many cases the answers were complicated and simply required too many resources and too much time. So an easy response was to give patients some pills.

In many situations, doctors simply prescribed far too much. With acute pain patients, doctors often gave weeks- or even months-long prescriptions when only a few days’ worth was needed. It was common, for example, to give weeks-long supply for opioids after wisdom teeth removals, even though the procedure usually leads to pain for no more than a week and the pain typically can be treated with milder painkillers like ibuprofen. The prescriptions left patients with a lot of extra pills, all because a doctor wanted to play it safe — and make sure that a patient didn’t come back complaining that a provider gave too few pills the first time around.

And in other cases, the doctors involved were outright malicious — establishing “pill mills” in which they gave away opioids with little scrutiny, often for hard cash.

On the patient side, there were serious medical issues that needed to be addressed. For one, the Institute of Medicine has estimated that about 100 million US adults suffer from chronic pain. Given that the evidence shows opioids pose more risks than benefits in the majority of these cases, patients likely should obtain other treatments for chronic pain, such as non-opioid medications, special physical exercises, alternative medicine approaches (such as acupuncture and meditation), and techniques for how to self-manage and mitigate pain.

With the broader proliferation of opioids, there were so many of these pills — enough prescribed just in 2015 to medicate every American around the clock for three weeks, according to the Centers for Disease Control and Prevention (CDC) — that they were often diverted.

So America got its deadliest drug overdose crisis ever.

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