The media was obsessed when famous actor, Phillip Seymour Hoffman, apparently died of a heroin overdose last month. I was saddened last week when I worked a shift at Thomas Jefferson University Hospital nursery when a new baby was born having lost the father to an opiate overdose before the birth, and an acquaintance’s young adult son recently died of overdose.
So I was frightened when the Federal Drug Administration approved a new very potent pain killer named Zohydro. The hydrocodone medication is five times more potent than what is on the market at present. Legal prescription opiates are a gateway into addiction for millions of Americans. These drugs directly led to 16,000 deaths in users in 2012 – whether legally prescribed and used for good reasons such as chronic severe pain (often in Sickle Cell Disease for a pediatrician), or illegally diverted into a street drug for widespread use in the United States. This is up from about 4,000 deaths in 1999. Many users after addiction start heroin by injection because it is markedly cheaper than diverted pills, and another 4000, at least, died from heroin last year.
As a pediatrician who works in well baby nurseries, I am even more directly involved in the over 20,000 babies born to opiate and methadone using mothers last year in the U.S., half of whom will have drug withdrawal and have extended stays in the hospital. In 1999, about one in a 1,000 babies in the U.S. was born in danger of withdrawal (officially Neonatal Abstinence Syndrome or NAS), but now almost six in 1000 have a mother on opiates or opiate substitutes such as methadone. In less than 15 years, the number of NAS babies has gone up more than fivefold and many are being born in very poor rural areas such as inland Maine or Appalachian Tennessee and Kentucky where there are limited resources to take care of these babies in small rural hospitals .
Even more remarkably, the FDA is taking all of the hydrocodone products and other opioid analgesics and moving them to a much more restrictive category (Schedule II from Schedule III) to minimize the careless writing of unnecessary prescriptions by practitioners.
Why do we need these dangerous medicines? We need them because sometimes people are really in intense pain. Children and adults with Sickle Cell Disease are often in horrible pain especially during sickle cell crises. Yes, almost all severe Sickle Cell patients are physically addicted to opiates, but in many cases, they would not be able to work or take care of their families without the medication. Unfortunately, the combination of careless physicians prescribing unneeded or excessive amounts of legal narcotics with venal physicians giving out unnecessary narcotics to simply make money leads to the prescription of five times more legal opioid pain medicine than is needed to fight pain. The excess quickly is diverted to the dealers on the street.
I think physicians should treat pain. When a child with ear pain comes in with a middle ear infection, if the resident just tells them to just take an antibiotic, I stop the resident and say: “The presenting complaint is ear pain, give some medication for ear PAIN, the amoxicillin does not work until two to three days at least.” I give out appropriate amounts of acetaminophen (Tylenol), non-steroidal anti-inflammatories (Ibuprofen) or topical ear pain drops (Lidocaine). Even those over the counter medicines are dangerous in excess amounts. But what we have to stop is the massive addiction of our U.S. population and the deaths and misery that tends to follow.
Here’s what we can advocate for to address this issue:
- Limiting legal production of opioid pain medicines to a lower amount closer to the actual legal market
- Putting physicians who prescribe abnormal amounts of pain medicine under intense scrutiny and if they are running a scam prosecute them
- Restricting the marketing Zohydra or similar super opiates