Shortcuts to Addiction Big Pharma, the author argues, has inflated the number of Americans with chronic pain to 100 million when 25 million would be more realistic. Sally Satel reviews “Drug Dealer, MD” by Anna Lembke. By Sally Satel
http://www.wsj.com/articles/shortcuts-to-addiction-1481153114
Psychiatrist Anna Lembke, chief of addiction medicine at Stanford University’s medical school, has spent her career helping patients battle their addiction to opioid drugs, from Vicodin to heroin. Out of this experience comes “Drug Dealer, MD,” a short and feisty book in which, among much else, she calls out practitioners for overprescribing painkillers and censures a scamming subculture in which patients abet their own addiction and suffering.
The “prescription drug epidemic,” as Dr. Lembke calls it, encompasses several trends, the most dramatic being a spike in overdose deaths. Prescription-drug abuse, she explains, began to be a problem in the 1990s, when campaigns for improved pain treatment gained ground. In 2001 the powerful Joint Commission on Accreditation of Healthcare Organizations established standards for pain management in response to the widespread problem of under-treating pain.
Few experts would deny that the inadequate treatment of pain had long been a challenge for American medicine, and the new standards were not in themselves misguided. But the pendulum has since swung in the other direction. Too many well-meaning doctors use long-acting, high-dose narcotics to treat nasty toothaches and minor injuries when such drugs are really meant to relieve the agony of cancer and other severe, unremitting conditions. The more opiate medications in circulation, the more opportunities for patients—and non-patients—to abuse them.
Part of the blame for the epidemic, Dr. Lembke says, rests with the pharmaceutical companies, which have been heavy-handed in their promotion of narcotics to doctors. Meanwhile, she argues, Big Pharma has exaggerated the number of Americans with chronic pain, inflating the figure to 100 million when 25 million would be more realistic.
Users themselves, of course, must assume some responsibility too, and one can only applaud Dr. Lembke for wading into these politically incorrect waters, given that any discussion of the role of the user is construed as blaming the victim. There are patients, Dr. Lembke writes, who “visit a doctor’s office not to recover from illness but to be validated in their identity as a person with an illness.” She describes how patients finagle pills out of doctors and, in an amusing riff, labels their strategies by user type. “Senators” will “filibuster” the doctor with unrelated problems until the final few minutes of a visit and then make a plea for narcotics; the doctor is now so short on time that he relents. “Exhibitionists” writhe in fake pain. The “Dynamic Duo”—a patient and his crying mother (“the commonest co-dependent”)—present a team too pitiful to refuse. CONTINUE AT SITE
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