Agents of the Drug Enforcement Administration have been visiting Myrtle Beach for more than a tan. Their suspicions were raised when observation of distribution patterns revealed that from 1997 to 2005, sales of oxycodone, the pain reliever in OxyContin, soared 800%. The prosecution of the "Myrtle Beach Eight", who ran a clinic particularly liberal about dispensing pain medication, sent a warning to doctors around the country that they would be held accountable if their patients abused medication.
There are many who see painkiller prescribers as drug dealers, and many who view them as life-savers. Two widely divergent views can exist because, as we discussed earlier, pain is so difficult to gauge. A patient with chronic back problems could need high doses of opioids just to get out of bed in the morning, or they could be playing up the problem to feed an addiction. Even stepping back from the fuzzy personal view to the more abstract statistical picture, it is difficult to tell whether rising use signifies abuse or merely rising need.
The Associated Press performed its own analysis this week to try and illuminate the statistics. Using the same prescription and sale data that the DEA relied upon to find the Myrtle Beach trend, the AP reports that national sales of the five main painkillers rose 90% in those 8 years. The AP investigation went past the addiction epidemic explanation to suggest three alternative reasons for the rise in painkiller use: economic, demographic, and ideological.
Ten years ago, the legislative floodgates blocking drug companies from reaching the public were opened. A report in the current issue of the New England Journal of Medicine reviews the results of the loosening of FDA rules for television advertising. From 1996-2005, direct-to-consumer advertising grew from $11.4 billion to $29.9 billion. That money is not being spent in vain; many viewers are convinced of the need for and the effectiveness of specific drugs that they see on TV.
The desire for painkillers may be artificially inflated by advertising, but it may also be rising naturally as our population grows older. The percentage of the population over 65 is rising, and with this booming elderly population comes a slew of painful afflictions like arthritis.
Another alternative explanation for rising prescriptions is that the ideology of pain control is shifting. The AP explains that while two decades ago doctors saw pain as a necessary part of the healing process, they now more commonly view it as something that can and should be managed. Patients too are changing their view of pain. An article this year in Anesthesia & Analgesia argues that pain management has become a fundamental human right:
We conclude that, because pain management is the subject of many initiatives within the disciplines of medicine, ethics and law, we are at an "inflection point" in which unreasonable failure to treat pain is viewed worldwide as poor medicine, unethical practice, and an abrogation of a fundamental human right.
The sentiment that patients are entitled to treat their pain, and that laws hindering them are illegitimate, undoubtedly contributes to the rise in painkiller usage.
Another possibility that the AP does not consider is that medical procedures, not just medical ideology, have changed. Perhaps the trend towards letting patients out of the hospital more quickly after surgery necessitates a rise in prescriptions so that patients can recover at home instead of hooked up to an IV.
It is possible that painkiller abuse is rising out of control, but this AP article suggests that there are many other plausible causes for the growing number of prescriptions. While future evidence might reveal a need for further regulation in the future, throwing doctors in prison will achieve nothing if there is a legitimate need for more painkillers.
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