Excellent article that describes the swing from overprescribing narcotics to the under- prescribing we have now. The under-prescribing is driven to by attitudinal changes, as the article points out, and is coupled with the regulatory burden that providers now must bear in order to prescribe narcotics for deserving patients. The result leads to a bias toward inadequate treatment of pain. This article brought to mind a personal experience. To wit, when Mary had her last hip surgery she was given a woefully inadequate oral dose of narcotic in the first few hours after her operation. The was, of course, the politically correct thing and, as a bonus, required the least amount of paperwork. Unfortunately, Mary suffered greatly until her “need” for the proper dose and route( think intravenous not oral) of narcotic could be ” proven”.
At a deeper level, the story of the patient in this article, I believe, speaks to the power of politically correct simplistic narratives to drive people, even the educated and sophisticated , to irrational extremes.In the case of opiates , the narratives were
” opiates are good” and now are “opiates are bad”. The nurse in the article is illustrative. There was a time when this nurse was driven by the narrative, ” opiates are good”. In that instance, the nurse would have been critical of the doctor if he did not prescribe large amounts of narcotic for the patient. The nurse now confidently takes the opposite view. Neither narrative takes into account the complexity inherent in the task of appropriately prescribing pain medication.
The above dynamic, fueled by the advertising power of the pharmaceutical industry, created the ” opioid epidemic” and its aftermath.
About the NEJM:
The New England Journal of Medicine (NEJM) is a weekly medical journal published by the Massachusetts Medical Society. It is among the most prestigious peer-reviewed
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