My name is Bill Prather. I am a retired Pharmacist and Physician. I received my Pharmacy and Medical degrees from the University of Missouri – Kansas City, After practicing Internal Medicine for several years, I completed a Fellowship in Geriatrics from Harvard University. My specific focus in Geriatrics is drug use in the elderly.
Now that I am retired, I feel the need to offer patients medical and pharmacy information, opinions, and advice. I am selfish. I am doing this for my own feelings of worth and I hope this blog helps patients as much as it helps me.
I will start this blog with my opinions on the use of opioids for chronic pain relief. I want to emphasize that these are my opinions only:
No Narcotics for You!
The word narcotic comes from the ancient Greek, which translates into the word “numbing”. In the United States the word has since become associated with opioids, commonly morphine and heroin, as well as derivatives of compounds found within the raw opium gum. Subsequently, the US Government has classified other drugs as narcotics, such as amphetamines and cocaine.
The use of opioids has been documented for decades as an effective therapy for pain relief. However, for years physicians over-prescribed narcotics. I believe the vast majority of these physicians were simply trying to obtain pain relief for their patients, During WWII, thousands of soldiers on both sides of the campaign were prescribed narcotics to enhance performance and increase attention span. This, in turn, created thousands of addicts and began the era of what I term as the “narcotics taboo”.
During the period after the war, US Government began to redefine a narcotic as a drug that is totally prohibited and used in violation of legal regulations. Unfortunately, the government painted these drugs as causing tremendous harm to the US population in the form of overdoses, addiction and death. I believe this attitude forced the narcotic pendulum too far the wrong way, The government has now instituted so many regulations, time consuming documentation and potential penalties to legally prescribe narcotics. I have found, as a result, the great majority of physicians will not longer prescribe narcotics at all in their practice. I believe physician employers are concerned about the federal oversight currently in use to prescribe narcotics and noting the activity if far from profitable.
Let me give you an example. I have a relative who has suffered for many years in pain from severe cervical osteoarthritis. His name is Joe and is on a daily dose of anti-inflammatory and over-the-counter analgesics but requires more potent prescription pain medication. Joe lives in rural Colorado and was been unable to find a physician who would consent to prescribe opioids in the entire county! Joe finally found someone to help him in Denver, some 150 miles from his home. Joe has been thinking about moving to St. Louis, Missouri to be with relatives. He called Washington University and was told their pain clinic refuses to prescribe any form of pain medication. So he found a prominent pain clinic that is not really a pain clinic.
I believe institutions like Washington University have abandoned an important, time honored, part of the armamentarium known to help patients…narcotics.
On further investigation, we found out that, although treatment with narcotics is not used in their clinic, Washington University would be happy to consider conducting procedures on Joe. This includes such things as paravertebral muscle injections and intrathecal spinal injections under MRI.
My assessment is that institutions such as Washington University have seen the government’s stance towards narcotics harm their business model and realize more money can be made by doing procedures. Procedures that result in higher reimbursement amounts from insurance companies while essentially no reimbursement is seen for an office visit to prescribe narcotics.
I believe Washington University is only one example of how the majority of our health care systems have responded to our government-induced “narcotics taboo”. A taboo that exists today to the detriment of patients.
Additionally, I believe this taboo can be corrected. Unfortunately it takes physicians and their organizations to form a back bone. Physicians coming to the realization that narcotics can be very helpful in controlling pain and stand up and do something about it. Physicians can form pain clinics that will prescribe narcotics while precisely following the government’s regulations. If they plug in a 20% net margin into their business and don’t take insurance, they could insure profitability. The refusal to take insurance and the resultant price to the patient may be considered expensive, however I predict these clinics will be very, very, busy. The era “narcotics taboo” has been going on far too long and patients will give a lot to obtain proper pain relief. Complaints concerning the potential expense of these clinics should be directed to our US Government, the one propagating the “narcotics taboo”.
Look forward to comments to this opinion, but really ready to hear about healthcare situations where you need my advice/opinions
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