The very first challenges President Obama raised in the his final State of the Union address last night were criminal justice reform, and helping people who are battling prescription drug abuse.
It’s well known by now that in the last 15 years or so, sales of prescription opioids – painkillers – have risen by more than 300 percent. And the number of people dying from overdoses of prescription opioids or heroin has also shot up, by 200 percent.
But recently, a group of researchers wondered what happened to people who survive an overdose. Their findings, published recently in the Annals of Internal Medicine, were stunning: 91 percent of those who overdose on prescription painkillers are able to get another prescription -most from the same doctors they’d been going to before the overdose.
Here & Now‘s Robin Young talks with Dr. Marc LaRochelle, the lead author of the study and a doctor at Boston Medical Center, about why that happens and what can be done to change it.
Interview Highlights: Dr. Marc LaRochelle
What was the reaction you and your colleagues had when the answer started taking shape?
“We were shocked and stunned by the level of prescribing after overdose. We weren’t sure what to expect, but this level of continued prescribing was shocking. You’d hope that after a near-fatal event such as this that someone would change course and do something different to try and get these people help.”
How can a person overdose on prescribed painkillers (opioids), and not have their doctors or other medical staff know that the overdose occurred?
“That’s one of the things we couldn’t tell from the study; whether the prescribers who had continued prescribing were aware the overdose had occurred. We speculate that this is a symptom of the fragmented healthcare system. If someone went to my emergency room at Boston Medical Center, I would probably be made aware that the event had happened, that they had an overdose. I’m a doctor there and we share electronic medical records. However, we have multiple emergency rooms in this city and if someone goes into another emergency room, there’s no clear mechanism for that information to get back to me as a provider.”
To be clear, these were not individuals who were ‘shopping around’ to get drugs. These were patients who had a relationship with a doctor, presumably, and had ongoing pain.
“Exactly. These are people with chronic pain that are receiving treatment with opioids. Best estimates are that one in three Americans experience chronic pain, and anywhere between 5 and 8 million Americans are prescribed these medicines on a long-term basis.”
How do we know whether the doctors giving the prescriptions are aware the overdose occurred or not?
“We don’t know. We need more research to understand whether it was because the doctors didn’t know, or because they felt trapped in a system in which they felt they had no better alternatives. Or whether they felt that the pain was so severe that, even given the risks, continued prescribing was better than going cold turkey.”
Then unless there is a system in place, like the one at your hospital, there is no way for a doctor to know if an overdose occurred or not. It seems the only other way a doctor would know is if the patient told them.
“That’s correct, and there’s really no good reason to believe the patients are going to volunteer this information if they have an addiction or if they have a problem with this medication and their source of getting this medication was this doctor. If they’re worrying about continuing that source, they may move on to another doctor.”
What has been the response to this finding?
“We’ve been shocked at the level of response. We thought it would be met with some interest, but we’ve been overwhelmed with responses from media but also from policymakers on state and national levels who are interested in seeing what we can do to fix this.”
- Marc LaRochelle, M.D., physician at Boston Medical Center and assistant professor of medicine at Boston University School of Medicine.