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America's new addiction, which
I wrote about in June in
The Huffington Post, is the epidemic of opiate painkillers, which - aptly named - in recent years
resulted in nearly
16,000 overdose deaths annually. This is not the stereotyped drug problem that can be solved by
Miami Vice style drug busts of traffickers and periodic roundups of street addicts and pushers. In this epidemic,
the traffickers are our respected pharmaceutical companies acting entirely within the law, seeking only to bring legitimate pain relief to sufferers; the addicts are, for the most part, upstanding citizens seeking a medical solution to their pain; and the "pushers" are, with few exceptions, dedicated doctors attempting to alleviate the suffering of their patients. So how can the interaction of decent people, pursuing well-intentioned and legitimate ends, result in a truly disastrous narcotics epidemic?
The answer, as counterintuitive as it may seems, is that in large part the epidemic is an unanticipated consequence of "managed care," which swept the country in the 1980s to contain rising medical costs.
Almost every week, I have received more calls from new patients searching for a pain specialist willing to take on the prescribing of their drug. In each case, the reason given for the need for a new doctor was their previous doctor's retiring or otherwise no longer being available for the task. In each case, a brief interview revealed the nature of the injury or physical problem to be either minor or, at best, partially diagnosed. Further, there is a turn of phrase, an urgency, a worn-thin quality to their stories, which informs the practiced listener that driving the call is addiction. The previous prescriber had created a demon and had withdrawn.
Comment: The TV segment can be watched by following this link (in German).