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Deaths from prescription drug overdoses have tripled since the late 1990s, recently prompting the Drug Enforcement Administration to tighten the rules around prescribing drugs like Vicodin, which contain the opiate hydrocodone. We’ll discuss recent developments in what many are calling an epidemic of prescription drug abuse.

Guests:
Erin Marie Daly, journalist and author of "Generation Rx: A Story of Dope, Death, and America's Opiate Crisis"
Anna Lembke, assistant professor of psychiatry and behavioral sciences at the Stanford University medical center
Hallam Gugelmann, clinical fellow at the UCSF School of Medicine

  • Casey Talk

    Any discussion of this topic should mention the recent study that shows legalisation of marijuana appears to lower the incidence of accidental overdose of other prescription drugs. http://www.usatoday.com/story/news/nation/2014/08/25/medical-marijuana-prescription-drugs-study/14572193/

  • Beth Grant DeRoos

    Makes me so mad that my late husband suffered badly from constant pain after being left 100% disabled by a drunk driver. Had his physican taken his 24/7 pain that resulted in depression and even caused stress which resulted in damage to his internal organs, more seriously, he probably would be alive today!! Instead my husband was given the least amount of pain medication, which didn’t even dent the pain.

    • Martin

      That’s the result of physicians not having the courage to advocate for their patients instead of capitulating to a reactive system.

    • Mrs. Eccentric

      Beth i am so very very sorry. I suffer from chronic, iatrogenic neuropathy. If i had not found something which helped with the pain, i would have found a way to die ‘accidentally’ in my early 40’s (straight out suicide would have been too awful as both my parent are still alive, and i had also recently married for the first time).

      I know that if, theoretically, i had experience benefit from opiods i would be very reluctant to speak publicly and not anonymously about it. First, there is a huge stigma. Secondly, sadly many people with addictions are on the lookout for sources and stealing from a legitimately prescribed source is one option. I personally feel that these two factors tend to skew discussions about this topic.I know i would be frightened to death to disclose my own, theoretical, opiod use, no matter how beneficial or contrary to the picture being painted by the guests it may have been.

      Again, Beth, you make a very good point. It’s beyond horrible that young people die of ODs, i feel so bad Ms. Daly and her family. At the same time, a life can be ruined by chronic pain and we don’t have much to offer there, either. I hope this program and the new legislation helps one way or the other. steph

    • thucy

      Beth,
      So sorry to learn of your husband suffering needlessly. Really makes me think that the solution has to involve better screening. People with legitimate chronic pain like you husband suffered should not pay the price for the current crisis.

  • Whamadoodle

    I’m terrified for people who are clean and sober, and who have kicked addictions. It’s hard for me to imagine that proper care is being taken when doctors then prescribe them addictive painkillers. Are such patients left to fend for themselves in looking out for that danger (of becoming addicted again)?

    • Leon Foonman

      People have to take responsibility for their own treatment, it is not the doctor’s fault if they become an addict. Ridiculous!

      • Whamadoodle

        Hoo boy… uh… sorry to doubt you, but I do NOT believe that you’re actually an MD. “First do no harm” ring any bells?

        What a thoughtless response. If you were an MD, then God help anyone who comes to you for care.

  • Leon Foonman

    Once again, it’s time to punish responsible non addicted pain medication patients because someone’s little brother snorted 50 oxycontin tablets and died. The discussion on the air right now is dominated by people who who are not experts, they are partisan crusaders. Shame on NPR for encouraging this antiquated view of pain meds.

    • Whamadoodle

      Yet addictions are going up by leaps and bounds, as opioids are prescribed more and more; view the rise in heroin deaths, most famously in New England for example, due to such addictions. Surely you don’t deny that this has increased dramatically?

      Also, you’re incorrect–the doctor mentioning that pain hasn’t increased, whereas prescriptions HAVE increased dramatically, IS an expert. He’s a doctor.

      • Leon Foonman

        Being an MD, which I am doesn’t make him an expert on pain or pain treatment, it only gives him the right to put “M.D.” in his title.
        I have been practicing since 1958, and have watched the pendulum swing back and forth for years. People can be treated with opioid meds without being turned in to “addicts”. The guests are barbarians!@

        • Mrs. Eccentric

          Thanks doc 🙂

        • Whamadoodle

          SOME people can, sure–many people. Many people can’t. Yelling “the guests are barbarians” is empty name-calling, without presenting any data.

          You failed to address: “Yet addictions are going up by leaps and bounds, as opioids are prescribed more and more; view the rise in heroin deaths, most famously in New England for example, due to such addictions. Surely you don’t deny that this has increased dramatically?”

      • Mrs. Eccentric

        well, doctor visits due to pain have not increased. The Dr. hasn’t cited a study looking at actual pain, as a person with chronic pain i can tell you i’ve had many pain visits where the pain was not dealt with, and after a certain amount of time i would just stop going – sitting, driving, walking are all affected by my neuropathy and going to doc appts. just aggravated the pain.

        We need to address the addiction part of the equation as well as the chronic paint issue. When people get addicted to opiates they start ODing and ending up in the ER and in the morgue. It’s a very visible problem. When people have chronic pain, they just drop out of society. My neighbors all know when i’m having trouble, they just never see me out of the house. Then there’s the degradation of being treated by nurses, docs, receptionists, pharmacists like you’re just some doctor hopping pill popper – there are good docs out there, but imagine dealing with Hallam Guggelman. No offense to the good doctor, but it’s difficult to defend yourself to a stranger with very strong preconceptions.

        You have to go looking and digging around to find the heartache caused by chronic pain, and the people affected by it as a rule have so much trouble with daily life it’s hard to go around being activists. Notice that it was the bereaved families who sued for lack of pain control after their loved ones died from cancer, not the people dying from cancer.

        If all this gets the medical profession and society in general to view addiction as a disease and find some decent treatments, that would be a great thing. Here’s hoping.

        • Whamadoodle

          Hm… I’m sorry you’re going through pain, but to be honest, I don’t think any of that addresses my reply to Leon Foonman.

          • Mrs. Eccentric

            hi W. I do not dispute that we are seeing bad effects from Rx med abuse. My point is that is only part of the overall problem, and that finding 1) benefits from opiate medication of chronic pain and 2) bad effect of untreated chronic pain should be part of a balanced, honest discussion. IMO the difficulty of gathering this info (which i went into in my post above) is part of why this part of the discussion receives short shrift.

            HTH, if not that’s all i got, don’t take it personal. Best, steph

          • Whamadoodle

            Heh… aw. Thanks Steph! Well (to quote Michael Krasny again) I will let that stand as an editorial comment. I hope that your situation gets better and your pain goes away soon!

          • Mrs. Eccentric

            Thank you for the kind thoughts Whamadoodle. But that’s part of the problem – i have iatrogenic chronic neuropathy. It resulted from massive prescribed use of steroids to tamp down what is most likely some undiscovered autoimmune disease which looks a lot like lupus but only attacking the lungs/bronchii. I would have died without the steroids, there were no good treatments for what ails me (tho it is in remission and medical advances have been/are being made so that’s good).

            But my nerves are damaged. Before guess what medicine i tried which actually makes a difference (after trying PT, tests up the wazoo, and some real brain-scrambling anticonvulsants/antiseizure meds and nerve pain specific drugs) i was seriously planning how to make my death look like an accident – i couldn’t even go grocery shopping without horrible pain, i’d end up in tears. I found out you literally do go blind with pain. I was in my early 40’s, just married to a great guy but my condition was that bad.

            Even with treatment it’s still not great. I can’t take a bath or shower (don’t worry, i do a sponge bath sitting on the side of the tub thing), any type of travel is too hard on my leg to make it worth it (over 1.5 hours in the car). I am able to walk for exercise every day, very important for anyone with lung issues. Med sci doesn’t know how to fix nerves yet. If they find out, yay for me! But if they don’t, i’m looking at 25+ more years of this grinding pain, I am very glad i have drugs that work so i can live closer to normal – tho i can’t work because of the nerve damage.

            I appreciate your conversation on this and you do seem very interested in learning more about these issues. I tell my (frankly kind of boring) story so that maybe some people will realize that there is another side to use of these drugs – not everyone wants to get hopped up on pills to mask the back pain they have cause they are lazy and can’t put the junk food down. I didn’t ask for this condition, i got it trying to not croak by age 40 from my lung disease, i would have been *thrilled* if ‘normal’ drugs would have done the trick, but they didn’t. I don’t want anyone to die because of heroin or pill addiction; i don’t want anyone to die or live a death in life because of something we can help out with. I think the journalist hit the nail on the head in that we desperately need more good information out there on these topics – it’s not simple.

            thank you and happy weekend! steph

          • Whamadoodle

            Thanks again Steph–and of course, I should say that if someone really has chronic pain like that, then I don’t mean that anyone should stand between them and their doctor’s prescription for painkillers. No time to keep commenting at the moment, but again, I wish you the best in getting better or at least managing the pain. Be well.

    • DopelessHopefiend

      Newsflash Leon: you are addicted. Take opiates regularly? Over 3 weeks? Yup, Physically addicted. Dont agree? stop taking ’em for 5 days. Lemme knowhow that goes for ya

    • jaxjaguars1993

      Exactly Leon, this (shaming and then criminalizing people w/ severe chronic pain and/or disabilities) is precisely what the system does to people each and every day, who suffer with severe chronic pain, and/or other conditions similar in nature. The pill mill stuff was bad and out of control no doubt, but yet again, the people struggling every day to live with crippling disabilities suffer the repercussions of these “crack downs.” I’m in my late 20’s -suffered serious injuries stemming from football and the weight room- and after seeing some of the best doc’s in the country, plus having a series of failed surgeries/operations too long/complicated to list, have been forced (extremely reluctantly mind you, b/c of knowing well the dangers of pain killers, from knowing cautionary tales you hear as a D1 college athlete) to get to know just how insane the process is for all folks dealing with severe chronic pain/disabilities. For those older than me, especially the elderly, this system is particularly onerous to traverse (for multiple days a month). Between Doc. visits to get script(s), then actually finding a pharmacy able (or willing) to fill your script; a process that can take at least 1, and often 2-3 full days of each month of your life, simply to be able to procure the meds. you’re prescribed to keep your pain level at a manageable level. Pain meds should not be an excuse not to exercise, stretch, treat, and/or whatever needs to be done to best help yourself manage your pain naturally (letting your body heal, plus, natural supplements if possible or practical in a person’s given situation), and hopefully (like I always do) get to a point in the not so distant future, where I will no longer need pain meds. just to live any kind of a basic quality of life? Given the nature of my debilitating low back, discogenic @ L-45 and L5-S1/nerve root damage induced pain.

  • Mrs. Eccentric

    Did i hear correctly that an ER doc is spending hours on his own time trying to diagnose people who came into the ER with acute conditions? Do those people not have Primary Care docs they can see, who can coordinate follow-up? That speaks to something wrong with the system which goes WAAAAAAY beyond use of opiods, in my humble opinion. steph

  • Kimball

    I became familiar with Pain creams after having a surgery and didn’t want to ingest drugs. They are non-addictive, and go directly to the site of the pain without going through kidneys and liver. Recently I got one for my migraines and it is incredible–all to say that there are alternative ways now to manage pain without all the the negative side effects.

  • Tamara

    As a former worker’s compensation insurance adjuster, I frequently saw instances in which opiates were overprescribed by doctors who were paid on a fee for service basis and I saw many claimants who became dependent on these medications and were not necessarily addressing the root causes of their pain, such as obesity or inactivity. Obviously, not everyone who suffers from chronic pain is going to be addicted but we need to recognize that there is a significant incentive built-in to the system that leads doctors to promote medications over other potentially effective therapies and treatments.

  • ES Trader

    the caller regarding the restless leg syndrome and Kaiser is more relavent than the example of Kaiser as more responsible for alternative therapy for pain vs. pain killers.

    Kaiser doctors, in my experience, are not governed by their medical training and the treatment of their patients but by a “higher authority”, which is Kaiser’s policy for the bottom line and the compensation for their CEO.

    Kaiser doctors are more compliant and are simply factory workers on a production line.

    “Thrive” their marketing motto, should include very fine print that it is meant for the institution of Kaiser

    • Claudia in San Jose

      My 14 year experience with Kaiser is that my doctors work for me. They are dedicated, highly skilled and compassionate. They even initiate contact when it’s time for an exam. No system is perfect. Resources are not infinite. But my confidence in my healthcare at Kaiser is 100% positive.

      • ES Trader

        i’m happy you are satisfied, but I was too until…

        Speaking from personal experience, I hope that you are never in a position that requires more than routine care and re-assurance. That was my mistake, to not do some research into what my primary doc told me.

        I assumed that everything was just fine and that issues I had were under the recommended levels.

        It turned out that they were not, that I required a high dose ( 4x original Rx ) and consequently suffered a stroke that after 3 years still living with its effects.

        While in rehab, I heard similar stories by other patients of the re-assurance that everything was ok until their stroke occurred. One patient required partial removal of her skull to accommodate the swelling following a rupture that might have been prevented.

        Kaiser is fine for routine care but if your illness. like high blood pressure, is not obvious without obvious symptoms, then caveat emptor and monitor your condition yourself.

        Kaiser is interested in collecting premiums, like all insurance companies, and minimizing expenses, thus their RECORD profits in recent years.

        As Warren Buffet is fond of saying, “insurance is the best business; it’s the only business that receives revenue w/out immediate services required”.

        Kaiser MD’s therefore are managed to see their quota of patients, but dig a little below the surface and they do not turn out to be Marcus Welby,M.D. !

  • Sriram

    I had my first root canal operation last year. That night I was up all night in excruciating pain, the worst pain I’ve ever experienced, popping Advil’s like there’s no tomorrow which had no effect. I called my dentist the next morning who promptly prescribed me Vicodin. I slept like a baby after that. I’ll be eternally grateful for this miracle drug.

  • Claudia in San Jose

    Non-Drug Treatment for Restless Leg Syndrome: I discovered that using a closed cell foam roller is the best treatment …. I have to get out of bed every night to roll my quads and sometimes I take 2 Advil…but after rolling fronts/sides/backs of my legs the discomfort is totally gone. Any personal trainer at a gym can guide you on the technique.

  • Werner Adam

    Opiates, who, by the way, are going to be way more potent pretty soon, as genetically manipulatred poppy is now grown on mainland Australia (other than on Tasmania) are not the only iatrogenic addiction substances.

    Between 2000 and 2007 prescription of Ritalin to ‘cure’ ADHS has multiplied by the factor of 70 (yes sevsty times more Ritalin prescribed!!).

    The pahrmaceutical lobby is still by far too unlimited on their free rough rides along the shores of the health of all of us..

    werner adam

  • Carole

    Not all patients are predisposed to addiction to pain medication. I was prescribed Vicodin for chronic pain and took it for a number of years. I was relieved when I no longer needed to take the drug, as I did not like the principle side effect of constipation. I took the drug when I needed to, for pain. It is very difficult for me to relate to the notion of using it to get “high”.

    • Whamadoodle

      It’s odd for me to try to take an implication from your post. Does it mean that because there is no problem for you, there is no problem? If not, then what are you implying should or shouldn’t be done about the problem of increases in prescription and addiction to these things?

      • Carole

        Thanks — good questions. I did not really make a clear point with my comment. First, of course I would not deny what is evidently a serious issue of addiction to prescription medications for some people. It is also the case that not all patients become addicted to pain killers. (My own limited experience was with the Vicodin I took for pain.) My comment was somewhat reactive, in remembering that I could not find a doctor who would prescribe strong enough pain medication (fear of my becoming addicted) until I went to a pain clinic where my situation was taken seriously. I do not know how I would have gotten through that period of my life without my physical pain being diminished by the Vicodin, so I cannot help but feel concern for others who may be in a situation in which they cannot manage their pain and are not receiving the relief they need. (I also received hypnotherapy for pain management, and was dealing with my situation in other ways than through drugs.) Serious pain medication should, of course, be prescribed and dealt with responsibly. I do not know how the situation is best dealt with overall, but I do think patients ought to be considered on a case-by-case basis. (Also, I did not listen to the entire Forum program, but came in towards the end, so I missed some of the discussion which may have informed my comment more.)

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