Prescribed Opiate Misuse Kills More than H1N1 Flu
By Barbara Lock, MDDecember 21, 2009
About a year ago, a young man came in to the Emergency Department at 4 in the morning complaining of severe back pain, so bad that he couldn't sleep, asking for pain control. I am very sympathetic to people with severe pain and readily order opiate pain medication if it is indicated, but this patient set alarm bells ringing in my head. Was it because it was the middle of the night? Was it because he strode into the emergency room without any of the hesitancy that usually accompanies severe pain? Was it is his perfect white-blond hair and his assertion that he was a Hollywood actor? He raised my hackles for a hundred nebulous reasons, none of which would stand in a court of law or a medical review, but which in aggregate summarized this patient in my mind as: Arrogant Liar.
I took care of him as best I could, resorting to opiates because he asserted that he was allergic to everything else (a common ruse), and let him go with prescriptions for ten pills, the "ten" spelled out so that it couldn't be adulterated by a patient with hankering for an extra zero on the end of a "10", and sent him on his way. He was furious.
Several months later, I got a call from a D.A.'s office saying that this self-same patient had feigned pain for a different doctor and had come away with a prescription for 120 tablets of some narcotic, which he had given or sold to an unlucky third person, who was now dead.
Last weekend, I took care of a man who, feeling stressed about end-of-year graduate school exams, had taken one (just one) of his mother's prescribed narcotic pills, and had passed out in a restaurant. He improved, and we made a plan for him to have further testing and treatment at his doctor's office, but it made me think: if misuse of prescribed opiates spans the social gamut from criminals to graduate students, perhaps we have a bigger medico-social problem on our hands than we all realize.
Canadian Researchers reported in the Canadian Medical Association Journal that deaths associated with prescribed narcotics far outstrip those associated with illicit heroin use, and are also higher than those associated with HIV/AIDS and H1N1 influenza.
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