Head of FDA Calls on Doctors, Internet-Service Providers To Join Opioid Fight
Painkillers Prescribed Haphazardly While Online Sales Soar
One of the reasons the nation’s opioid crisis has spun out of control could be the fact that doctors are not trained universally in the field of pain management. So said Dr. Scott Gottlieb, commissioner of the U.S. Food and Drug Administration, in an interview with Dr. Sanjay Gupta, CNN’s chief medical correspondent.
“I think doctors were trained…that pain is the fifth vital sign, so there was more liberal prescribing of these medications,” Gottlieb said in an article titled “FDA head calls for mandatory education, internet policing to fight opioid crisis.” “We now recognize that wasn’t appropriate, so I think that there needs to be some effort to try and re-educate a generation of physicians.”
The National Center for Biotechnology Information said pain officially was declared the fifth vital sign because of how many it affects. More than 80 percent of Americans who visit the doctor complain of pain, and more than 76 million Americans live with pain. The article since has been retracted.
“…the evaluation of pain became a requirement of proper patient care as important and basic as the assessment and management of temperature, blood pressure, respiratory rate, and heart rate,” it reads. “The numeric pain scale certainly has a place in care and in pain management; however, it is important to assess the patient’s communication and self-management style and to recognize that patients, like pain, are on a continuum with varied styles of communication and adaptation. It is easy to get lost in the process, even when the process is initiated with the best of intentions. In the quest for individualized medicine, it might be best to keep pain assessment in the individualization arena.”
Gottlieb disagrees and instead wants doctors to undergo mandatory opioid training as soon as they receive their license from the Drug Enforcement Agency to prescribe narcotics.
“So at the very time you’re educating them about the appropriate prescribing of opioids, you’re also educating them about how to spot signs of abuse and treat it if they do have a patient who becomes addicted to opioids,” Gottlieb told Gupta.
Patients who become addicted to opioids have no set stereotype, no perfect profile. They range from professionals who make millions of dollars to middle-class mothers and fathers raising families in the suburbs to the poor and the hungry who get the illegal types of such drugs on the street. The epidemic knows no bounds.
“Perfectly sane people become addicted to these medications and end up dead,” wrote Flea, the Red Hot Chili Peppers’ bass player and former addict, in an editorial published in Time magazine. “Lawyers, plumbers, philosophers, celebrities – addiction doesn’t care who you are. There is obviously a time when painkillers should be prescribed, but medical professions should be more discerning. It’s also equally obvious that part of any opioid prescription should include follow-up, monitoring and a clear solution and path to rehabilitation if anyone becomes addicted. Big pharma could pay for this with a percentage of their huge profits.”
Flea continues, “Addiction is a cruel disease, and the medical community, together with the government, should offer help to all of those who need it.”
The 55-year-old husband and father who started using at age 11 has been clean for 25 years, but he almost succumbed to temptation after a snowboarding accident that resulted in major surgery.
“My doctor put me back together perfectly, and thanks to him I can still play bass with all my heart,” Flea wrote. “But he also gave me two-month supply of OxyContin. The bottle said to take four each day. I was high as hell when I took those things. It not only quelled my physical pain, but all my emotions as well. I only took one a day, but I was not present for my kids, my creative spirit went into decline and I became depressed. I stopped taking them after a month, but I could have easily gotten another refill.”
The proliferation of opioids exists not only in doctors’ offices but also on Web sites. A 2018 congressional study found that online sales of fentanyl, a powerfully dangerous substance, topped 500 in three months across 43 states – $230,000 worth of financial transactions.
“The Subcommittee’s investigation confirmed that many Americans are purchasing fentanyl and other illicit opioids online and having them shipped here through the international mail system,” states the report, by the Senate Permanent Subcommittee on Investigations, titled “Combatting the Opioid Crisis: Exploiting Vulnerabilities in International Mail.” “This review led to several alarming findings. Most troubling, the Subcommittee identified seven individuals who died from fentanyl-related overdoses after sending money and receiving packages from one of the online sellers. The Subcommittee further identified 18 individuals who were arrested for drug-related offenses and also made purchases and received packages from the online sellers.
Gottlieb told Gupta that internet-service providers have a duty, now more than ever, to police their Web sites and look for rogue operators pushing pills.
“Internet firms simply aren’t taking practical steps to find and remove these illegal opioid listings,” Gottlieb said. “I think we can work with them to do much more to address this public health danger.”