In San Francisco today, the district attorney announced charges finally on a 2017 police shooting of an unarmed black man in 2017. This coming mere DAYS before the statute of limitations would run out, according to this article on SFist. Racial justice continues to remain foremost in the minds of lawmakers and politicians and thank god–this country cannot keep going killing people. Police violence is a public health problem. I’ve said it before and I’ll keep saying it. But even more so, that leads us to a more basic point: RACISM IS A PUBLIC HEALTH PROBLEM. When black and brown people DIE merely because they are not white, this is not a coincidence. This is racism, and quite frankly, it is a national emergency.
Also in the news today, another public health problem created by white people: the opiate crisis. Purdue Pharma has finally pleaded guilty to several charges related to its role in starting–and maintaining–the opiate crisis in America. Bottom line, the company admitted to 3 basic things:
- The first relates to LIES told to the Drug Enforcement Agency (DEA). Purdue lied about having a program in place to prevent pills from getting to the black market. In fact, they really profited from oxycontin’s widespread sale by people buying it on the street. The company also lied to the DEA regarding false information provided to the agency that helped boost manufacturing
- The company paid someone to provide doctors with patient info (Hello! HIPPA?!?!) that encouraged them to write opiate prescriptions.
- Lastly, Purdue Pharma paid doctors to prescribe oxy. Boom.
Of course, there was a fancy explanation for “how” and why all these things were accomplished but the bottom line is Purdue wanted to make money. It did. The Sackler family is still filthy rich, in fact, from drug money earned by the deaths of over 200,000 Americans. The cost to the healthcare system might never be able to be estimated, as the full ramifications have not yet been felt. The East Coast still suffers from a heroin problem but has been hit hard by synthetic fentanyl in the past few years. Here on the West Coast, we’ve typically been more of a methamphetamine place, but synthetic fentanyl deaths are rising now too.
The last full book I read on the subject was Dopesick by Beth Macy. It is an incredibly detailed look at how the crisis began, details of the ways in Purdue Pharma changed not only the marketing of pain medicine but the very way we practice medicine itself. I highly recommend this book if you’d like to know more about this subject.
One of the most disturbing parts of Dopesick was reading about how during Purdue Pharma’s massive “educational” marketing seminars, it promoted PAIN IS THE FIFTH VITAL SIGN as a new concept. This really reinforced the idea that new & stronger pain medications were necessary for the average patient–medications like oxycontin. Surprise! But this mantra regarding pain became adopted by accreditation organizations such as the Joint Commission and the American Medical Association (AMA) itself. In nursing school, it was drilled into my head. Treat the pain, because your patient can’t HEAL if they are in pain.
But all of this helped contribute to our opiate problem as all doctors, including those taking care of hospital patients, felt the need to write more and more prescriptions for painkillers. Patients themselves also tended to not be satisfied that their pain was relieved no matter how much narcotic they received. I mean, we were telling them that they should have NO PAIN.
In 2016, the AMA went so far as declaring that pain is NOT the fifth vital sign, and that new non-pharmacologic measures and cooperative pain management techniques should be taken to manage patients.
As a nurse in the ICU, I have seen an attempt to reduce the use of opiate pain medication. Some of this seems silly given the circumstances–such as a patient on extracorporeal membranous oxygenation (ECMO) only getting IV acetaminophen. I mean–they do have garden hoses jabbing into each groin, plus more usually… But for surgical patients, I am fully on board. You are supposed to be able to feel your incision the day after surgery. And when you cough, it is definitely gonna hurt. While you’re coughing. And then it will stop. Magic!
My personal opinion is that the best treatment for pain and prevention of other post-operative complications is walking. Don’t take a bunch of opiates, get constipated, end up with an ileus and too weak to stand. Get out of bed, sit in a chair, take a walk. Do that over and over throughout the day. Rest in between. You’ll get better faster than your neighbor who takes oxy and complains that it hurts and refuses to get out of bed.
If you have recommendations for other articles or books on the opiate crisis, please leave a comment as I’d love to read more on this topic! Or any topic…