Opioid Prescriptions Down: Good? Bad? Misguided?

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King of pain Photo credit: www.45cat.com

On the surface, this would seem to be a no-brainer. As recently reported in the New York Times, there has been a drop in the number of narcotic prescriptions for each of the past three years. Win-win, right?

Don't be so sure. To make this call, we also have to examine what harm has accompanied the good. Have we traded one problem for another? The jury is still out, but some of the evidence so far is disturbing.

Make no mistake. The days of physicians prescribing a 30-day supply of Vicodin following oral surgery are pretty much over, as they should be. But, some doctors (and I agree wholeheartedly) say that, in many cases, overreaction has replaced sensible moderation.

It would be hard to find a better example of overreaction than what Massachusetts Governor Charlie Baker tried to pull off in October 2015. Baker wanted to pass a law limiting the first prescription of narcotics to three days. Is he kidding??

Typical stupid overreaction by a politician. Try telling someone who has just undergone an autologous spinal fusion (the bone is often taken from the patient's pelvis, and this hurts worse than the fusion itself) that three days of Vicodin is a good idea. It would be unwise to get between the patient and the emergency room on Day 4.

Fortunately, the Massachusetts Medical Society lobbied for a much more reasonable seven-day supply, which is a rational plan that addresses both addiction and unnecessary suffering.

Perhaps worse, the Times article features Dr. Mitchell Stark, an oral surgeon in Maryland, who wants patients to try ibuprofen (Advil) first. Fine, except, as Dr. Stark surely knows, oral surgery can be extraordinarily painful, especially for procedures such as bone grafts, and removal of impacted wisdom teeth. In cases like these, the only thing that high doses of Advil will do for most people is to screw up their stomachs, so instead of one type of pain, there will be two. If I'm in Maryland, I'm not going to try Advil first. I'm going to try a different oral surgeon.

To follow: Part 2 — When medical issues get into the hands of politicians, look out.