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Risk of abuse with painkillers on the rise

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I have just renewed my state pharmacy license – the one that allows me to prescribe controlled substances.

You may think that by doing so, I’m joining that small but dangerous group of physicians who can prescribe the drugs too many kids and adults are getting hooked on in quantities that can only mean that some doctors – not I! – are enriching themselves by doing so. The problem is undeniably severe.

Several years ago, a family practice resident with whom I was working told me that her continuity clinic, the place where she saw outpatients with supervision to learn more about what she would do when she went out into practice, was filled with drug seekers.

She was weary of that situation – dealing with people desperate to find relief from chronic pain or maybe just as desperate to obtain a prescription to feed their habits of taking strong pain medications. It is often difficult to tell which is the main problem.

In defense of most physicians, the prevalence of pain among patients and the availability of strong painkillers present the physicians with an impossible chore: determining who needs medication and who is seeking a drug of abuse. Almost every one of us wants to help our patients above all else. We want to believe what our patients tell us.

Our resident had both of these traits; she was definitely on the patients’ side. But she was afraid of becoming jaded by her drug-seeking patients’ clamor for opiates – for hydrocodone or oxycodone in particular.

Despite all the advances in medicine, we haven’t found a way to measure pain. We can’t do a lab test to say whether a patient is having mild, moderate or severe pain, or none at all. Each of us knows about pain that we have had, but no one else can see or feel it.

In our clinic, we ask each patient if he or she has pain, and if so, where it falls on a scale of 10. It’s not uncommon for a patient walking about happily to say that his sore throat is a “10.” Obviously, he hasn’t experienced childbirth or a kidney stone.

With small children, we ask them to look at pictures of very sad, sad, happy and very happy faces and point to the one that represents their pain. Hardly an exact science.

There’s no doubt that oxycodone and hydrocodone are very effective in treating moderate or severe pain. And there’s no doubt that they are also drugs of abuse, with effects very much like those of heroin – and that includes death from overdose.

According to Melanie Haiken, writing in Forbes Magazine, “The CDC’s data on opioid painkiller deaths speaks for itself, showing that deaths quadrupled in a 10-year period. Between 1999 to 2010, the number of U.S. drug poisoning deaths involving an opioid analgesic went from 4,030 to almost 17,000, now topping those from heroin and cocaine combined.

CDC data show that prescriptions for painkillers have nearly tripled over the past two decades, and 5 million Americans are dependent on the painkillers.”

Adults, adolescents and children are all involved and doctors are usually the source of the prescriptions that are either misused or stolen, and a very few unscrupulous doctors profit from writing for large and unjustified quantities of these drugs.

Haiken goes on to write that “The U.S., with just 5 percent of the world’s population, now accounts for 84 percent of global oxycodone (Oxycontin) consumption and more than 99 percent of hydrocodone (Vicodin, Lortab) consumption. That’s a lot of painkillers.”

In New Mexico, wrote The New York Times in 2012, the rate of prescription of these painkillers rose 131 percent from 2001 to 2010. The death rate from opioid overdose was up 60 percent over the same period.

In case you’re wondering why I’m writing about this in a column on children’s health, this has become a children’s issue, and not just because children suffer severely when a parent dies or expends all of her/his energies in finding drugs.

New Mexico’s Heroin Awareness Committee (healingaddictionnm.org) was founded by Jennifer Weiss after her son, who had become hooked on opiates after needing pain medication for wrestling, died of a heroin overdose.

In February 2012, our state Legislature passed a bill requiring, among other things, that New Mexico doctors take a course in pain management, hoping to make the provision of pain medication more rational.

I have taken that course, though fortunately I rarely encounter patients who need strong painkillers. My state-controlled substance license is necessary for treating those few patients with severe pain and in a few other occasions requiring controlled drugs.

For my readers, I recommend that if your child requires strong painkillers, you make sure that the physician is well-trained in their use and prescribes them for as short a time as possible. And if you know a child or adult who is dependent upon these medications, get help!

There is an increasing number of physicians and clinics experienced with the use of counseling and such medications as buprenorphine to treat these unfortunate sufferers.

Lance Chilton, M.D., is a pediatrician at the Young Children’s Health Center in Albuquerque, associated with the University of New Mexico. Send questions to lancekathy@gmail.com.

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