Feb
01
2020

About the Opioid Epidemic

Dr. Anna Lembke gave a talk about the opioid epidemic on Dec. 13, 2019. This was at the 27th Annual World Congress on Anti-Aging Medicine in Las Vegas from Dec. 13 to 15th, 2019. The full title of her presentation was “From Freud to Fentanyl: Update on the Opioid Epidemic.” Dr. Lembke is an associate professor at the Stanford University School of Medicine. From 1999 to 2010 opioid sales went up 6-fold. Opioid treatment admissions and opioid deaths have risen 5-fold in the same time period. Physicians prescribe too many opioid pills. One slide summarized how patients got opioid pills. 53% had pain pills given by friends for free or bought opioids from them. 37.5% received pain pills from a doctor by prescription. 6% bought pain pills from a drug dealer or a stranger. In about 3.4% it was not traceable how the persons using drugs obtained them.

Compassionate doctor and drug-seeking patient

The doctor went through medical school wanting to care about patients. Compassion to help is a powerful motivating force. On the other hand, most patients are glad that the physician wants to help and they do their part to contribute to healing. Except, there is a small percentage of patients who take advantage of a soft-hearted physician. They will demand prescriptions, even if they are not in pain. They may do this to sell the drugs to get some extra income. Others take more pills than what the doctor  prescribed, because they want to get high on the drugs. Patients who have an addiction to pain pills, have a process in their brain, called neuroadaptation. Whenever the dosage in the blood goes down, they are now adapted to taking more pills.

About the opioid epidemic and the role of Big Pharma

Pharmaceutical marketing spent more than 26 billion USD in 2012. This consisted of drug representatives visiting doctor’s offices and giving hand-outs of free samples to physicians. There were promotional mailings, advertisements, direct-to-consumer advertising and educational and promotional meetings. In addition, pharmaceutical marketing included sponsoring clinical trials. In 1980 there was still an opinion that pain drugs would be harmless and in the majority of cases would not be the cause for abuse.

Purdue Pharma, the producer of the pain pill OxyContin, was caught in secretly pushing the sales of OxyContin in order to sell more of their drug suboxone, which helps with drug withdrawal.

A law suit against Purdue Pharma brought the  “project Tango” to light.

Three myths about drug addiction

Myth #1: Opioids work for chronic pain

The pain pill producers have been pushing for the concept that pain pills would work for chronic pain. However, clinical studies showed that pain pills will only work for acute pain and when it becomes chronic pain, pills against pain become less reliable. People who take pain pills for chronic pain enter into a vicious cycle. They need to take more pain pills to experience relief from pain. But they often do not realize that the drug withdrawal pain is what gets them into seeking more drugs.

Purdue stated this:“We now know that many patients with chronic, non-malignant pain respond very well to opioids. The barriers to vastly improved treatment for hundreds of thousands of people in pain, are simply the misinformation and prejudice of doctors, pharmacists and regulatory bodies.” Purdue Physicians’ Pain Management Speaker Training Program, April 1997

Myth #2: When it comes to opioids, no dose is too high and no duration is too long

This reflects what Purdue says to increase its pain medication sales.“Opioids are effective, easily titrated, and have a favorable benefit-to-risk ratio. Large doses of opioids may be necessary to control pain if it is severe, and extended courses may be necessary if the pain is chronic.” Purdue Physicians’ Pain Management Speaker Training Program, April 1997

Evidence from unbiased researchers show that opioids taken in high doses and taken over long periods of time harm patients.

Patients develop cardiac arrhythmias, depression and may commit suicide. Other symptoms are  constipation, addiction, cognitive impairment, hormonal imbalances and  death. In addition, opioids can cause an annoying skin hypersensitivity.

Research further showed that gradual opioid withdrawal improves chronic pain (2017 study by Frank et al.)

Myth # 3: Less than 1% will get addicted to pain pills

Purdue stated:
“Contrary to our teaching, addiction is very rare and possibly nonexistent as a result of treating such patients with opioids.” Purdue Physicians’ Pain Management Speaker Training Program, April 1997

Here is the truth: A meta-analysis of 38 studies showed that people abused pain pills on average between 21 and 29%. Addiction rates were between 8% and 12%. These figures likely are under estimates. The authors said that the real figure of opioid abuse is likely about 40%.

Poor people treated differently

Poor people on Medicaid in the US receive twice the rate of opioids as do non-Medicaid patients. But Medicaid patients die at 6-times the rate from prescription overdoses. Often patients receive a prescription for pain pills and also a prescription for benzodiazepines. The doctor prescribes benzodiazepines for sleep problems or anxiety. Drug interactions of two potentially addicting drugs likely are more detrimental on the long-term.

Examples of a doctor’s visit (YouTube display)

Dr. Lembke played a YouTube video where she was role-playing her previous behavior as a supportive physician who prescribed opioids to patients (drug-seeking patient and supportive physician).

However, she said that she learnt from experience. In the meantime, when she finds out from a computer program that a patient is deceiving her, she behaves differently (doctor non-supportive towards a doctor-shopping drug addict).

About the Opioid Epidemic

About the Opioid Epidemic

Conclusion about the opioid epidemic 

The topic of opioid addiction is multifaceted. I summarized a lecture presented at the 27th Annual World Congress on Anti-Aging Medicine in Las Vegas from Dec. 13 to 15th, 2019 by Dr. Lembke. She talked about the opioid epidemic and the difficulties keeping the science of opioids separated from the marketing by Big Pharma. Three myths of Big Pharma were analyzed and on every occasion the truth was the opposite of the myth. Chronic pain does not respond to opioids, yet many physicians keep on prescribing these drugs. Medicaid does not help poor patients. They get twice the opioid prescriptions as non-Medicaid patients get. But Medicaid patients die at 6-times the rate from prescription overdoses. There are many unanswered questions regarding opioids. Hopefully, more judicious prescribing by physicians and alternative ways of treating pain by chiropractors, physiotherapist and acupuncturists will gradually improve the situation.

Incoming search terms:

About Ray Schilling

Dr. Ray Schilling born in Tübingen, Germany and Graduated from Eberhard-Karls-University Medical School, Tuebingen in 1971. Once Post-doctoral cancer research position holder at the Ontario Cancer Institute in Toronto, is now a member of the American Academy of Anti-Aging Medicine (A4M).