I also would like a unicorn that craps rainbows.
Between 2013 and 2014, the age-adjusted rate of death involving methadone remained unchanged; however, the age-adjusted rate of death involving natural and semisynthetic opioid pain relievers, heroin, and synthetic opioids, other than methadone (e.g., fentanyl) increased 9%, 26%, and 80%, respectively. The sharp increase in deaths involving synthetic opioids, other than methadone, in 2014 coincided with law enforcement reports of increased availability of illicitly manufactured fentanyl, a synthetic opioid; however, illicitly manufactured fentanyl cannot be distinguished from prescription fentanyl in death certificate data. These findings indicate that the opioid overdose epidemic is worsening. There is a need for continued action to prevent opioid abuse, dependence, and death, improve treatment capacity for opioid use disorders, and reduce the supply of illicit opioids, particularly heroin and illicit fentanyl.
(The CDC includes suicide and adverse effects in its overdose counts. An adverse effect means the patient took the drug as prescribed, and something bad happened. E.g. patient croaked.)
This is the opposite of surprising. The people who became hooked on opioids in the form of a prescription pain medication did not stop being addicts when the local pill mill was shut down or their doctor got cold feet and changed or cut their prescription without accounting for the fact that they were now dependent on the drug. Withdrawal without treatment goes something like this. So naturally people sought replacement drugs.
I checked out the latest guidelines on prescribing opioids (it seems the CDC has been dropping these things monthly), and one of the problems is right up at the top:
primary care providers say they receive insufficient training in prescribing opioid pain relievers.
Right. So two possible solutions that could make life a little better for providers and patients and keep a bunch of besuited morons who just see DRUG ADDICTS USING DRUGS SKREEEE! from passing some disaster of a law that takes the War on Drugs 2.0 to the national level and pleases no one save the United
Cocaine Heroin Producers, Smugglers, Pushers, and Affiliated Scum:
1. Before a doctor (or nurse practitioner or physician assistant) puts his patients and his DEA license at risk, get some training. I know providers are very busy people, but continuing education is part of the job. And it beats what happens when the local DEA agent gets bored and starts sniffing around the practice.
2. If training isn’t an option, the PCP sends the patient to a pain management specialist. Getting a consultation could be easiest for the patient. But referring the patient to another provider: “Here, you take care of this one, I can’t,” is sometimes the best option. Perhaps the patient needs a treatment that doesn’t involve opioids, and the PCP sure won’t want to stick needles into a patient’s spine. And if there are no PMs close enough, the friendly state or national pain management society is a phone call or email away.
But it’s probably way too late for that and we’re going to get some nightmare of a federal law because DRUG ADDICTS, SKREEE!