The Daily Herald's recent stories on heroin use in the suburbs have been informative with many demonstrating the devastating impact of the drug on the lives of not only the user but also on family, friends and neighbors. But a person does not wake up and suddenly decide to start using heroin. Most, if not all, started off taking prescription pain medications, occasionally prescribed to that person legitimately for a painful condition, but more often taken recreationally to get high. Some then quickly developed dependence to opiates, causing a very uncomfortable withdrawal syndrome if the medication is stopped, and eventually develop an addiction through with the repeated use has adverse effects on their life.
Pain pills seem to be in endless supply; the U.S. has less than 5 percent of the world's population but consumes over 80 percent of the world's opiates. But price can be a barrier. OxyContin is often the drug of choice for pain, most commonly prescribed in 20, 40 and 80 mg tablets. With the average street price for an OxyContin at $1 per mg, that means a single dose would cost $20 to $80. But heroin, which seems to be as readily available, costs about $10 a bag. So when money gets tight and a person with dependence starts to develop withdrawal, the stigma and danger of heroin starts to look less daunting and another heroin addiction is created.
So while fighting the gangs and busting up drug cartels will certainly help, more progress could be made if we worked on limiting the availability of prescription opiates for recreational use. The state of Illinois has developed the Illinois Prescription Monitoring Program (www.ilpmp.org), an online system that allows prescribers and pharmacists to quickly and easily look up a patient's controlled substance prescription history and avoid prescribing or dispensing to a patient who may be providing false information to obtain a prescription. Unfortunately only a small number of prescribers actually use it. I used that database quite often, and I once discovered a person was using 31 different aliases to obtain opiate prescriptions all over the Chicago area. In addition, many patients regularly got multiple prescriptions from the multiple physicians month after month.
Second, physicians have to stop prescribing so many opiates. Pain is a natural physiological response to injury; it is not a disease. Pain is also not a vital sign; it is a purely subjective measure, determined by the patient. Equating it with pulse and blood pressure is fraught with danger. There are very few situations that warrant the use of opiates in the outpatient setting; most acutely painful conditions can be treated with an anti-inflammatory medication, and chronic pain is best treated by pain management specialists without opiates, which do nothing to address the cause of the pain.
Hospitals are also pressuring doctors to provide "an excellent patient experience" and aggressively treat pain, resulting in physicians feeling compelled to prescribe opiates to avoid receiving a poor patient satisfaction score. Drug seekers have learned to use this to their advantage, threatening doctors with a poor score if they don't prescribe them their opiate of choice.
Second, patients need to promptly dispose of any remaining pain medications they may have left over from a prescription. Doctors commonly prescribe in multiples of 30 as a habit, yet patients rarely need more than a few days of medication for most conditions. They should never keep that bottle sitting in the medicine cabinet "just in case." It provides a source of opiates for anyone who visits the house and peeks in the cabinet. Also, if a painful condition develops that is severe enough to require an opiate, the person should probably seek medical attention.
Finally, safe and effective opiate addiction treatment should be made available. The success rate of multidisciplinary addiction programs is quite high; unfortunately, so is the cost, making these programs out of reach for those who need it the most. It is shortsighted for the state to claim there is no funding for such programs as they will be paying for it later in crime and prison costs, and unfunded health care costs.
While we all may not be directly affected by opiate abuse, we all pay the price in increased taxes and decreased safety. Next time your physician offers you an opiate, just say "no thank you, I'll try some Tylenol."
• Dr. Hirsch is a board certified internist and HIV specialist who is vice president of Regulations and Education at Accretive Health. He practiced medicine in the Elgin area from 1991 to 2012.