The U.S. death rate for 2015 went up for the first time in a decade, according to new data released by the Centers for Disease Control and Prevention. Although it remains too soon to know exactly what caused this uptick in mortality, many researchers believe that the opioid epidemic is to blame. Opioid overdose deaths continue to rise at a rapid rate, with opioid-related mortalities increasing 2.8-fold from 2001 to 2014. With millions of dollars and thousands of lives at stake, many are eager to point fingers. So who is to blame for this exploding epidemic of opioid addiction in the United States?
One Side of the Argument Blames Patients for the Opioid Epidemic
According to Dr. Joel Zinberg, surgeon and associate clinical professor at Mount Sinai Hospital in New York, patients are to blame. Dr. Zinberg believes that efforts to educate physicians about the potential for opioid abuse and the need to change prescribing practices are misdirected. Rather, he holds, the change must come from patients.
Dr. Zinberg argues that the current opioid epidemic is driven by patients who knowingly or unwittingly obtain opioid medications from legitimate sources, only to use them to fuel their drug addiction. He believes that most opioid abusers obtain the drugs from friends or relatives, purchase drugs on the black market, or get prescriptions from multiple providers.
Furthermore, Dr. Zinberg argues that asking about patient’s experience of pain should not be a routine part of an examination or patient satisfaction questionnaire. He believes that the “pain as a fifth vital sign” movement — which added questions about patients’ subjective experiences of pain to the traditional vital signs of temperature, pulse, blood pressure, and respiration — has created more problems than it has solved. By asking about a patient’s subjective experiences of pain, Dr. Zinberg argues, physicians are placed in a role in which they must prescribe opioids to alleviate any pain, no matter how minor or transient.
Patients Are Not to Blame for Their Drug Addiction
Sadly, the argument by a prominent physician that patients are to blame for the opioid epidemic shows only too clearly that the stigma associated with addiction lives on. Opioid dependence and drug addiction are not signs of weakness. They are indications that our current healthcare system is failing to help the people who are most vulnerable and need it most.
The #PatientsNotAddicts movement has been gaining steam to highlight the differences between patients who use opioid medications versus individuals who are addicted to opioids. Patients with chronic pain may take opioids over relatively long periods of time without ever becoming addicted. These patients have come to depend on painkillers to achieve relief from chronic pain, but they are not addicted. They may develop some level of opioid dependence, the physiological response to long-term use of opioid painkillers. However, addiction refers to a psychological and behavioral pattern of drug-seeking behavior that is not characteristic of all — or even most — opioid users.
In contrast, people addicted to opioids engage in compulsive drug-seeking behavior, experience intense cravings for the drug, and often fracture relationships with loved ones because of their behavior. Addicted individuals often use the drugs to mask painful psychological or emotional issues that have gone untreated. Too often, individuals with mental health problems have inadequate resources to combat depression, anxiety, mania, trauma, or other psychological problems. This causes them to turn to opioids and other drugs to numb the pain, contributing to the virulence of the opioid epidemic.
Importantly, this perspective does not place the blame on patients. It places blame on a system that allows people with mental health issues to fall through the cracks, self medicating to alleviate their problems. Patients are simply bystanders who are doing their best to get by with too few resources, extremely limited access to effective treatment options, and too little compassion from the healthcare system.
Opioid Epidemic Rages On
The opioid epidemic rages on, and it is clear that no one group holds the sole blame for the problem. The epidemic is part of a complex web of global policy decisions, patient factors, physician prescribing practices, failure of the mental health system, and other factors. Disentangling these complicated parts to find a solution will remain a challenge that we need to face in coming years.
What do you think? Who is to blame for the opioid epidemic?
The US Death Rate Went Up For The First Time in a Decade, Vice News. Retrieved on 06/06/2016.
Overdose Death Rates, National Institute on Drug Abuse. Retrieved on 06/06/2016.
Where Doesn’t It Hurt?, City Journal. Retrieved on 06/06/2016.