A Provider’s View of the Synthetic Fentanyl Epidemic in the US

This is a thread that Stu in South Dakota authored and I added provider information for.  You can find the entire article here:

https://threadreaderapp.com/thread/1109843643022614533.html

1. In a recent thread, Mexico’s complicity in trafficking synthetic fentanyl was discussed. The thread also included some horrifying statistics on opioid deaths in the US.

https://twitter.com/STUinSD/status/1106560260800761857

2. That thread only examined the trafficking part of the fentanyl story. There is another aspect that needs to be covered, and an orthopedic surgeon pal kindly provided the following requisite information.
3. I really like the theory of Jeffrey Singer MD who writes for the Cato Institute. He has written at least two articles about the prohibition effect on opioid availability and how that drives the public to use illegal drugs and inadvertently get involved ….

3A. … in the illegal fentanyl trafficking from Mexican and Chinese sources.

4. He believes that opioids are less prescribed now, and this control by state medical boards has driven people to get their pain-killing meds on the street, which makes the public more vulnerable to drugs laced with fentanyl.
5. Here are some excerpts from the first Dr. Singer article:

Policymakers in Washington and in state capitals are misdiagnosing the opioid crisis as a doctor-patient problem.

6. Their policies are coming between doctors and patients. They are preventing doctors from using their judgment and expertise to ease pain and suffering. They are making many patients suffer needlessly, with some turning in desperation to the black market.
7. While raids on black market drug dealers continue to net hauls from a seemingly endless sea of diverted, smuggled or counterfeit prescription opioids and heroin, ….

7A. … policymakers can’t shake free of the myth that the opioid crisis is caused by doctors prescribing opioids to their patients in pain.

8. The numbers show that isn’t the case. The Centers for Disease Control and Prevention reported in July that prescriptions of opioids by health care practitioners have continued their steady decline since 2010.
9. The Drug Enforcement Administration has ordered cutbacks in the production of opioids by pharmaceutical companies — 25 percent last year and an additional 20 percent this year, for example.
10. Since the late 1990s states have established prescription drug monitoring boards that maintain surveillance on providers and patients and have a chilling effect on prescribers.
11. All 50 states have them today, and recent studies have shown they have had no effect on the overdose rate but may be driving desperate pain patients to the black market in search of relief.

<unquote>

https://www.cato.org/publications/commentary/misdiagnosing-opioid-crisis

12. It should also be pointed out that providers have really cutdown on narcotic scripts (prescriptions) since 2010 according to this article:
13. [Because of the] spiraling public health disaster, [a] growing coalition of activists and health experts is pushing for an alternative strategy, broadly dubbed “harm reduction,” to minimize the health risks associated with drug use.
14. In essence, harm reductionists argue for making drug use saferin order to reduce the dangers of overdose, disease, and addiction, rather than simply discouraging it entirely.
15. They say that stopping drug use altogether is an unrealistic and ineffective approach that can even make things worse.
16. In 2010, responding to mounting concerns about painkiller addiction, health authorities began to crack downon prescription pills. According to the CDC, opioid prescriptions are down 28% since 2010, and high-dose prescriptions have fallen by 56%.
17. Besides cutting down on high-dosage scripts, doctors also scaled back the number of small prescriptions they write. Prescriptions for less than a 30-day supply—what you might get for a root canal or another minor, one-off procedure—have declined by nearly 40% since 2010.

What is so difficult is the Insurance companies and pharmacies are ignoring post-operative pain by allowing very little narcotic pain medication after surgery denying anything more than short duration scripts  with low number of pills such as  for one week at a time without automatic refills. You may not know that all prescriptions are by diagnosis not by procedure so surgical procedures may be ignored.