As opioid addiction and deadly overdoses escalated into an epidemic across the U.S., thousands of surgeons continued to hand out far more pills than needed for postoperative pain relief, according to a KHN-Johns Hopkins analysis of Medicare data.
Many doctors wrote prescriptions for dozens of opioid tablets after surgeries — even for operations that cause most patients relatively little pain, according to the analysis, done in collaboration with researchers at Johns Hopkins School of Public Health. It examined almost 350,000 prescriptions written for patients operated on by nearly 20,000 surgeons from 2011 to 2016 — the latest year for which data are available.
Some surgeons wrote prescriptions for more than 100 opioid pills in the week following the surgery, often with instructions to take one to two pills every four to six hours, as needed. The total amounts frequently exceeded current guidelines from several academic medical centers, which call for zero to 10 pills for many of the procedures in the analysis, and up to 30 for cardiac bypass surgery.
While hundreds of state and local lawsuits have been filed against opioid manufacturers, claiming they engaged in aggressive and misleading marketing of these addictive drugs, the role of physicians in contributing to a national tragedy has received less scrutiny. Research shows that a significant portion of people who become addicted to opioids started with a prescription after surgery.
In sheer numbers, opioid prescribing in the U.S. peaked in 2010, but it remains among the highest in the world, according to studies and other data.
In 2016, opioids of all kinds were linked to 42,249 deaths, up from the 33,091 reported in 2015. The opioid-related death rate jumped nearly 28% from the year before, according to the CDC, and the rate of deaths involving prescription opioids increased 11%.
Yet long-ingrained and freewheeling prescribing patterns changed little over the six years analyzed. KHN and Johns Hopkins examined the prescribing habits of all U.S. surgeons who frequently perform seven common surgical procedures and found that in the first week after surgery:
- Coronary artery bypass patients operated on by the highest-prescribing 1% of surgeons filled prescriptions in 2016 that exceeded an average of 105 opioid pills.
- Patients undergoing a far less painful procedure — a lumpectomy to remove a breast tumor — were given an average of 26 pills in 2016, with little variance from year to year. The highest-prescribing 5% of surgeons prescribed 40 to 70 pills on average.
- Some knee surgery patients took home more than 100 pills.
Those amounts — each “pill” in the analysis was the equivalent of 5 milligrams of oxycodone — are many times what is currently recommended by some physician groups to relieve acute pain, which occurs as a result of surgery, accident or injury. The analysis included only patients not prescribed opioids in the year before their operation.
“Prescribers should have known better” based on studies and other information available at the time, said Dr. Andrew Kolodny, co-director of opioid policy research at Brandeis University and director of the advocacy group Physicians for Responsible Opioid Prescribing.
While the dataset included only prescriptions written for patients on Medicare, the findings may well understate the depth of the problem, since doctors are more hesitant to give older patients the powerful painkillers because of their sedating side effects.
Surgeons’ prescribing habits are significant because studies show that 6% of patients who are prescribed opioids after surgery will still be taking them three to six months later, having become dependent. The likelihood of persistent use rises with the number of pills and the length of time opioids are taken during recuperation.
Also, unused pills in medicine cabinets can make their way onto the street.
Dr. Marty Makary, a surgical oncologist at Johns Hopkins, admits that he too once handed out opioids liberally. Now he is marshaling a campaign to get surgeons to use these powerful painkillers more consciously and sparingly. “I think there’s an ‘aha’ moment that many of us in medicine have had or need to have,” he said.
But old habits are hard to kick.
Interactive: Look up surgeons’ opioid prescribing records
KHN contacted dozens of the surgeons who topped the ranks of opioid prescribers in the 2016 database. They hailed from small, community hospitals as well as major academic medical centers. The majority declined to comment, some bristling when questioned.
Some of those surgeons were critical of the analysis, saying it didn’t take into account certain essential factors. For example, it was not possible to determine whether patients had complications or needed higher amounts of pain medication for another reason. And some surgeons had only a handful of patients who filled prescriptions, making for a small sample size.
But surgeons also indicated that the way they prescribe pain pills was less than intentional. It was sometimes an outgrowth of computer programs that default to preset amounts following procedures, or practice habits developed before the opioid crisis. Additionally, they blame efforts in the late 1990s and early 2000s that encouraged doctors and hospitals to consider pain as “the fifth vital sign.” A major hospital accrediting group required providers to ask patients how well their pain was treated. Pharmaceutical companies used the fifth vital sign campaign as a way to promote their opioid treatments.
Makary, who oversaw the analysis of the Medicare dataset, said that, while opioid prescribing is slowly dropping, to date many surgeons have not paid enough attention to the problem or responded with sufficient urgency.
Indeed, Dr. Audrey Garrett, an oncologic surgeon in Oregon, said she was “surprised” to hear that she was among the top tier of prescribers. She said she planned to reevaluate her clinic’s automated prescribing program, which is set to order specific amounts of opioids.
KHN will analyze data for 2017 and subsequent years when it becomes available to follow how prescribing is changing.
Prescribing patterns highlight what’s at stake
The analysis examined prescribing habits after seven common procedures: coronary artery bypass, minimally invasive gallbladder removal, lumpectomy, meniscectomy (which removes part of a torn meniscus in the knee), minimally invasive hysterectomy, open colectomy, and prostatectomy.
Across the board, the analysis showed that physicians gave a large number of narcotics when fewer pills or alternative medications, including over-the-counter pain relief tablets, could be equally effective, according to recent guidelines from Makary and other academic researchers.
On average, from 2011 to 2016, Medicare patients in the analysis took home 48 pills in the week following coronary artery bypass; 31 following laparoscopic gallbladder removal; 28 after a lumpectomy; 41 after meniscectomy; 34 after minimally invasive hysterectomy; 34 after open colon surgery; and 33 after prostatectomy.
According to post-surgical guidelines spearheaded by Makary for his hospital last year, those surgeries should require at most 30 pills for bypass; 10 pills for minimally invasive gallbladder removal, lumpectomy, minimally invasive hysterectomy and prostatectomy; and eight pills for knee surgery. It has not yet published a guideline for open colon surgery.
The Hopkins doctors developed their own standards because of a dearth of national guidelines for post-surgical opioids. They arrived at those figures after reaching a consensus among surgeons, nurses, patients and other medical staff on how many pills were needed after particular surgeries.
Hoping to reduce overprescribing, Makary is preparing to send letters next month to surgeons around the country who are among the highest opioid prescribers under a grant he received from the Arnold Foundation, a nonprofit group whose focus includes drug price issues. (Kaiser Health News also received funding from the Arnold Foundation.)
Even if the prescription numbers have fallen since 2016, the amounts given today are likely still excessive.
“When prescribing may have been five to 20 times too high, even a reduction that is quite meaningful still likely reflects overprescribing,” said Dr. Chad Brummett, an anesthesiologist and associate professor at the University of Michigan.
Brummett is also co-director of the Michigan Opioid Prescribing Engagement Network, a collaboration of physicians that makes surgery-specific recommendations, many of them in the 10- to 20-pill range.
“Reducing unnecessary exposure is key to reducing the risk of new addiction,” said former Food and Drug Administration commissioner Scott Gottlieb. In August 2018, when he was at the agency’s helm, it commissioned a report from the National Academy of Sciences on how best to set opioid prescribing guidelines for acute pain from specific conditions or surgical procedures. Its findings are expected later this year.
“There are still too many 30-tablet prescriptions being written,” said Gottlieb.
Healers sowing disease?
Naturally, surgeons rankle at the idea that they played a role in the opioid epidemic. But studies raise serious concerns.
Transplant surgeon Dr. Michael Engelsbe, director of the Michigan Surgical Quality Collaborative, points to the study showing 6% of post-op patients who get opioids for pain develop long-term dependence. That means a surgeon who does 300 operations a year paves the way for 18 newly dependent people, he said.
Many patients do not need the amounts prescribed.
Intermountain Healthcare, a not-for-profit system of hospitals, clinics, and doctors in Utah, began surveying patients two years ago to find out how much of their prescribed supply of opioids they actually took following surgery.
“Globally, we were overprescribing by 50%,” said Dr. David Hasleton, senior medical director.
But Intermountain approached individual doctors carefully. “If you go to a prescriber to say, ‘You are overprescribing,’ it never goes well. A common reaction is, ‘Your data is wrong’ or ‘My patients are different than his,’” said Hasleton.
For the new analysis, KHN attempted to contact more than 50 surgeons whose 2016 numbers ranked them among the top 10 prescribers in each surgical category.
One who did agree to speak was Dr. Daniel J. Waters, who 13 years ago had his chest cut open to remove a tumor, an operation technically similar to what he does for a living: coronary artery bypass.
“So I have both the doctor perspective and the patient perspective,” said Waters, who practices in Mason City, Iowa.
In 2016, Waters’ Medicare bypass patients who filled their prescriptions took home an average of nearly 157 pills each, according to the KHN-Johns Hopkins analysis.
“When I went home from the hospital, 30 would not have been enough,” said Waters of the number recommended by the Hopkins team for that surgery.
But he said he has recently curbed his prescribing to 84 pills in the week after a heart bypass.
Nationally, the average prescription filled for a coronary artery bypass was 49 pills in 2016 and had changed little since 2011, the analysis shows.
Others who spoke with KHN said they had developed the habit of prescribing copiously — sometimes giving out multiple opioid prescriptions — because they didn’t want patients to get stuck far from the office or over a weekend with pain or because they were trying to avoid calls from dissatisfied, hurting patients.
In the KHN-Johns Hopkins data, the seven patients of Dr. Antonio Santillan-Gomez who filled opioid prescriptions after minimally invasive hysterectomies in 2016 received an average of 77 pills each.
A gynecologic oncologist, Santillan-Gomez said: “I’m in San Antonio, and some of my patients come from Laredo or Corpus Christi, so they would have to drive two to three hours for a prescription.”
Still, he said, since e-prescribing of opioids became more widespread in the past few years, he and other surgeons in his group have limited prescriptions to 20 to 30 pills and encouraged patients to take Tylenol or other over-the-counter medications if they run out. E-prescribing can not only help track patients getting opioids but also reduce the problem of patients having to drive back to the office to get a written prescription.
Dr. Janet Grange, a breast surgeon in Omaha, Neb., said that in her experience, opioid dependence had not been a problem.
“I can absolutely tell you I don’t have even 1% who become long-term opioid users,” said Grange.
The analysis showed that Grange had 12 opioid-naïve Medicare patients who had a lumpectomy in 2016. Eight of them filled prescriptions for an average of 47 pills per patient.
She called Johns Hopkins’ zero-to-10-pill pain-control recommendation following that procedure “miserly.”
The pendulum swings
Some of the higher-prescribing surgeons in the KHN-Johns Hopkins analysis reflected on their potential contribution to a national catastrophe and are changing their practice.
“That is a shocking number,” said oncologist Garrett, speaking of the finding that 6% of patients who go home with opioids will become dependent. “If it’s true, it’s something we need to educate physicians on much earlier in their medical careers.”
Garrett, in Eugene, Ore., said she has cut back on the number of pills she gives patients since 2016, when the KHN-Johns Hopkins analysis showed that seven of her 13 opioid-naïve Medicare patients undergoing minimally invasive hysterectomies filled a prescription for opioids. Those patients took home an average of 76 pills each.
Johns Hopkins guidelines call for no more than 10 opioid pills following this procedure, while Brummett’s Michigan network recommends no more than 15.
Surgeon and researcher Dr. Richard Barth, once a heavy prescriber himself, said that his own experience convinced him that physicians’ preconceptions about how much pain relief is needed are often way off.
The analysis showed his lumpectomy patients in 2013 filled an average of 33 pills in the week after surgery. By 2016, that average had dropped to seven pills. Many patients, he said, can do just fine after lumpectomy with over-the-counter medications — and often no opioids at all.
The key, he said, is to set patients’ expectations upfront.
“I tell them it’s OK to have a little discomfort, that we’re not trying to get to zero pain,” said Barth, who is chief of general surgery at Dartmouth-Hitchcock Medical Center and has published extensively on opioid prescribing.
After lumpectomy, “what I recommend is Tylenol and ibuprofen for at least a few days and to use the opioids only if the discomfort isn’t relieved by those.”
Indeed, the data analysis showed that a significant number of patients given prescriptions for opioids never filled them because they don’t need that level of pain relief.
Between 2011 and 2016, for example, only 62% of lumpectomy patients in the analysis filled prescriptions, similar to hysterectomy patients.
In 2016, patients of Dr. Kimberli Cox, a surgeon in Peoria, Ariz., were prescribed about 59 pills in the week following lumpectomy, well above the recommendations from both Johns Hopkins and others.
But the KHN-Johns Hopkins analysis of that year’s data shows that half of her patients never filled a painkiller prescription — a fact she acknowledges and that has changed her thinking.
“I am now starting to prescribe less because many patients say, ‘You gave me too many’ or ‘I didn’t fill it,’” she said.
Kaiser Health News (KHN) is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation that is not affiliated with Kaiser Permanente. Julie Appleby can be reached at [email protected] and Elizabeth Lucas can be reached at [email protected]. On Twitter, they’re at @Julie_appleby and @eklucas.
It’s not prescription opioids that kill, it’s “lifestyle” + addiction + ILLEGAL drug use. The CDC doesn’t even differentiate between licit and illicit prescription opioid users in their overdose data– we don’t know how many pain patients overdose on their prescription opioids only. Puja Seth, (CDC, 2018), has TOTAL prescription opioid overdose deaths at just 17,000/year. Other researchers peg this number at 13,000, WITHOUT differentiating between legal and illegal users. Prescriptions for opioids have come down since 2012, but overdose deaths from ALL drugs keeps going up. The CATO INSTITUTE (Singer) states drug overdoses have been rising exponentially since the 70s with no meaningful deline in sight. CATO recommends ending drug prohibition and providing harm reduction for illegal drug users.
MILLIONS of Americans have safely and responsibly taken prescription opioids for years and decades without ever overdosing or becoming addicted. This is PROOF the authors basic premise is WRONG- prescription opioids have NOT caused the opioid overdose epidemic.
“[R]esponsible” opioid patients (CDC, Apr 2019), intuitively or by design develop “overdose risk reduction” strategies that have worked 100% for most legal users of this class of miraculous drugs that increase Quality of Life by attenuating pain signals that provide relief from “the worst human experience ever”- physical pain. Even moderate length physical pain can kill a person through health degradation and deprivation– starvation and lack of fluids, or suicide. You may just lie in one place, not moving or eating and drinking until your organs give out or you take your own life (see FOXNews, Elizabeth Llorente’s 5 part series on pain patient suicides).
It’s lifestyle and lack of risk reduction safety training that has caused the illegal drug overdose epidemic (are medical error deaths the greater epidemic- 44,000-400,000 deaths a year?). Illegality of drugs and drug abuse contribute to the illegal drug overdose epidemic. Portugal has seen a decrease in overdose deaths since de-stigmatizing illegal drug use.
A variation at gene A118G predisposes 0.5% of the population to addiction. The other 99.5% of people are not thus predisposed. As the CDC and FDA stated this year, “responsible pain patients are being harmed” by “misapplication and misinterpretation” of the CDC Opioid Prescribing Guideline.
I surmise people who want to harm innocent and responsible pain patients to save the lives of drugs addicts and abusers are seeking public notoriety and have chosen to do so by rejecting good science and humane medicine.
I thank God we chose Jackson Memorial Hospital to preform my liver donor surgery with my Aunt. The doctors where in the room several times a day and always concerned about our level of pain as well as how well we were doing.
I don’t know about other people but I come from a large family, some 9 of us grandchildren and our spouses and children, Many of us have had serious issues and surgeries and I am the only one taking opioids. But I also have had over 20 surgeries since the age of 11, that’s eleven. BUT yes I am now on Medicare.
WHY NOT TELL THE TRUTH! YOU CAN’T PAY PEOPLE WHAT THEY WORKED FOR AND JUST WANT US DEAD!
STOP THE DAMN SUFFERING.
Pain clinic doing cool sculpturing, even they see what’s happening .
Let us go back to our real physicians, who give us more than 5 minutes and the minimum the CDC allows, not what we need.
One day we will look back on this time in our history with shame.
Julie Appleby and Elizabeth Lucas
I read this article in disgust and let me state why I have used such a harsh word.
I have been a long-term chronic intractable pain patient for over two decades, and it has been necessary to use narcotic medications during this entire time. Why, because I have had had four failed cervical surgeries leaving me in severe pain. Did I try other drugs, the answer is yes, and to this day, continue to use various modalities with medications?
• The figure of 350,000 scripts seems very high, and when I go to your #2 Link, I do not see that figure of 350,000 listed. 2011 – 2016, I believe it would be a five-year study.
• The CDC released their initial report in March 2016. Yes, they did say that 42,249 deaths did occur from prescriptions of opioids. Not so. They came back in 2018 and admitted they made a mistake. The number was lower and was not from pain medications as the CDC, and your report wants us to believe. Prescriptions for opioid pain medications did not kill 42,249 people.
• How does one judge by numbers alone what a surgical patient will need post-op when every one of us has a different metabolism rate. What you might need for knee surgery will be different than someone else.
• I shall say with respect, any time that a report has the name of Andrew Kolodny, M.D. in it, I know from a lot of different materials, articles, and speaking to people that he cannot speak for patients with pain. He is not in and has never treated people in pain. This man has helped to get legitimate pain patients further away from treatments that work and has created a tremendous amount of suffering to patients.
• “Look-up the opioid prescribing records of physicians.” What do you or anyone else know about the patients who have been cut open for a medical procedure? What specific clinical information for a given patient do you have to see why a surgeon prescribed the amount of opioid they did?
• Purdue Pharma introduced Oxycontin in a terrible and unethical manner. They should never have done what they did and tell their detail people to lie.at the same time; the medication of Oxycontin can be the right product for long-term chronic, Intractable Pain Patients.
Each of you should look in the mirror tonight, and ask yourselves is this type of article beneficial to the public? One day, you might be the ones needing these medications. I hope not.
For Mary W and others: I am working to contradict the distortions, mistakes, and occasional outright lies being told by fringe-element anti-opioid nut cases — and by badly misinformed government officials at all levels. One part of this effort is radio and media interviews. On Sunday 23 January I was on-air with award winning Canadian radio journalist Roy Green, for 20 minutes. Green’s show is syndicated to multiple radio stations across Canada.
Those interested in hearing the 20 minutes (with commercials edited out) may find it in the “stack” at his web page, under my name. See https://globalnews.ca/national/program/the-roy-green-show
In this interview, I review the broad outlines of CDC data which reveal beyond any rational contradiction that doctors prescribing to their patients did not create and are not sustaining the so-called “opioid epidemic”. Prescribing is unrelated to opioid overdose related deaths. The whole silly idea of “over-prescribing” is deeply contradicted by both prescribing data and demographics. The CDC should have known from THEIR OWN data that there was no relationship, long before they published the 2016 guidelines on opioid prescribing. They either failed to exercise due diligence and analytic oversight, or deliberately ran away from the implications. Solving the real opioid crisis will be much more difficult than turning the US DEA loose to persecute pain doctors and drive them out of practice. What must happen instead is that America must invest in repairing its infrastructure and reducing income inequality and poverty that are hollowing out communities across our Nation; Economic stagnation is far more the creator of vulnerability to drug abuse, than any short term exposure to medical opioids.
The entire policy narrative which is said to support restrictions on opioid prescribing to legitimate patients is wrong. Just flat out wrong, in the most fundamental ways. And legislation may be required to tell the DEA to stand down from its unjustified interference in medicine.
Well, another shady article with zero facts that still got published. The authors don’t do the tiniest bit of research but are happy to present a completely one-sided view-again. Way to go, statnews.
Surgeons who push Kolodny’s agenda without bothering to look into his background are as lazy as the journalists who do the same. He’s no ‘expert ‘ on pain! You know who is? Me, and tens of thousands of others just like me who are not addicts but who are responsible adults who have chronic intractable pain. Nothing in medicine should be one-size-fits-all because no human body is exactly the same as another. Why do SURGEONS not understand this? People heal at different rates. People feel pain at different levels. Speaking for myself only, I have never expected NO PAIN. I will always have quite a bit. But being able to function is very important. Being denied the medication that allowed me to function successfully for decades because AMERICA HAS AN ADDICTION EPIDEMIC and pain patients are lumped in with junkies is next-level inhumane.
Docs already have a national problem with lack of trust. This sure won’t help.How many thousands of patients who need surgery are not getting it because they know they’ll be told to take some Tylenol? Do y’all not see the absurdity in this?
Amen,,Mr.Lawhern ,,this lie,,”the one size fits all,” or ,” the lie of a opiate epidemic,” caused by doctors,,,has killed more in America’s history in suicides,,then ever in this countries existence..There are more dead now,,since the Kolodny Agenda,back-up via corrupt politicians,thus our government,both EITHER BOUGHT OFF w/$$ or who’s soul goal is $$$$$$… As one 1 Andrew Kolodny stated himself,”until thee entire generation dies,” unquote,,we will continue to literally torture to death the medically ill in physical pain due to there medical illness,,and they know this is happening,,See the less of us chronic-pre-existing medically ill,,,the more money the insurance companies save,,medicare,medicaid save,,and the more money the ,”addiction the-rapist,” make…that’s the truth!The new definition of addiction now will guarantee every NORMAL person who takes the MEDICINE opiates legally will be falsely deemed an addict..Very convenient for the likes of kolodny and all addiction shrinks.Guaranteed income for life!This whole mess was never ever about our welfare,,it was never ever going to be about truth,,or truthful data..Again all these b.s,. research studies/data claiming some b.s. epidemics,,or b.s. higher addiction rates,,,WHERE ARE THE VIDEOS OF THIS RESEARCH/DATA,,,????!!!In this day and age,,there s no reason why every single data/research claiming higher addiction crap,,should be video’s instead of just relying on anti-opiate phob PERSONAL opinions,,,but again,,this was never ever about truth,,,it is about propaganda and spreading it wide and far,,,and as 1 Andrew kolodny stated,,,”opiates will not be gone until thee entire generation dies off,”Thank Mr Lawhern sir,,for trying/continuing so hard to keep putten the truth out here,,,With the invention of the new area of medicine call Pain management, of course the number of scripts for the medicine opiates will go up,,,Of course w/the invention of data survelience,,we will now be able to see exactly how many medicines are prescribed,,,but to automatically just deem thee amount and medicine bad,,bad opiates,,when not 1 person has ever died or .00000000000001 % became addicted from taking there medicine as prescribed by their doctors,,,,,,was proof,,,it never was about truth,,,it is about propaganda to spread their agenda..Kill off all baby boomers ,chronic medically ill and pre-existing medical condition to save a buck for the likes of kolondny,,ceo of insurance companies thus the insurance industries,,,it was alllll about $$$$$$,,,Which is why ,no-one ever calls out thee addiction industries for how much more money have they made on this one?,,yet they’ll bash the doctors/purdue/jj,,,but never ever see how much MORE MONIES thee addiction side has made thru this propaganda surge,,,notice that?!!Or never ever do they show data on how many people have had to use death as their only means of stopping their physical pain since kolodnys agenda..Or how many actual opiates alone have killed people,,but AGAIN,,IF YOUR NOT TAKING THEM AS PRESCRIBED,, your breaking the law,,not your doctor..There are sooo many area’s they refuse to look at,,that would prove the medicine opiates,prescribed legally,taking as doctors prescribe had NOTHING to do w/ a so-called epedimic,,but they don’t want those truth ,,it doesn’t fit their agenda,, ,JMO,,MARYW
I suspect PROP is behind this. Anyone with Twitter or any other social media venue tag Kaiser, ask how were they privy to Nationwide Medicare data? I was not aware our medical records, what we are or are not prescribed was available for analysis and surveys. Link this article, and in case they don’t read it, Kaiser Drs feel pain medication after surgery, you’re not supposed to be comfortable and apparently they don’t care about patient input at all because they weren’t included in this “analysis”
Kaiser patients if they were aware that Kaiser Drs used the recommendations of an anti-opioid Psychiatrist who after basically calling our esteemed Medical community paid “Big Pharma” shills. After the FDA studied his groups claims, they dismissed them as a “fringe” group. It was so far off the mark of what the studies found the ex FDA official he used another word to describe them along with fringe but it isn’t nice so I won’t repeat it.
In the meantime even though you’re supposed to disclose your conflicts of interest, he felt he was above all that until he testified against J & J and got partially exposed for$500,000 that the law firm paid him. 8.5 million dollar contract apparently wasn’t mentioned but he did finally disclose it like all the rest of the medial community is supposed to do.
There is another Kaiser doctor the belongs to this fine group who has a 1.3 million contract, he too did not feel it was important to disclose it but look other Doctors know how to dig around too.
I guess advocating to make people suffer is lucrative.
I was wondering how a Psychiatrist that made some pretty outlandish claims about opioids inserted himself in influencing policy. It turns out as a Psychiatrist he probably knew this, exploited it and has caused the suffering of millions of people, this isn’t going to age well. Yes we prescribe more opioids than other countries, why? it is the same reason that the global elites travel here for surgery. Being kept comfortable after surgery is a stated reason within these circles and we do quite a bit more surgeries too. 11 million in the UK but in the USA we do 48 million and another 69 million eye surgeries. Quick Google search will tell you that, so of course we prescribe twice the amount of opioid pain meds. Look I just used the same methodology the authors of this article did. But in all seriousness, if we prescribe twice the amount of meds we must have twice the addiction rates? No we actually don’t. They’re the same because an addict will be addicted on their first couple of exposures. If PROP really cared about stopping addiction, the focus would be on educating young people who’ve yet to be exposed. If they feel a magic carpet ride when they take an opioid, tell someone right away, they have the gene. They’re addicted. I guess Suboxone stocks and kickbacks along with “addiction” clinics are far too lucrative to really help It is better that those CPP lose their careers, homes, their lives, not to mention the millions in government contracts and grants. ( Isn’t this why he said officials from the FDA , American Academy of Pain Management, American Cancer Society and the American Medical Association weren’t credible?)
How can this be, how can all of these young medical professionals not understand addiction. How can they conflate physical dependence which you see them use over and over again. Addiction isn’t dependence or is it? It turns out in 1987 a group of addiction specialists were organized by the American Psychiatric Association along with the WHO to revise the DSM. It was an international community. This was no small feat.
They changed the word addiction to dependence
Some felt it would be better to use the word dependence so addicts didn’t feel stigmatized. Others felt that it would confuse the medical community and lead to the confusion we are seeing today. It passed by a single vote. (See link below) It turns out in study after study after study that is is extremely RARE for treatment of pain to cause addiction, it is closer to 1% than 6%.
Ideologues usually don’t care about the pain and suffering they’ve caused others, it is apparent because of what he and this PROP group keep pumping out. You either believe the BS or you believe in weeding out the old and weak, and would torture them to do it. Just in our Twitter community we have 60 suicides due to forced tapering and unbearable pain. Despite the CDC, FDA, AMA warnings not to force taper and that those draconian guidelines were voluntary, yet 42 states, insurance companies and Pharmacies have used those guidelines, they were not to be applied to surgery patients , cancer patients or those stable on their meds. September has been interesting, lets “analyze” what has come to light.
The CDC admitted that NEARLY ALL deaths were do to illicit fentanyl, they had been counting any fentanyl death with prescription drugs of any kind as a separate prescription drug death.
Reputable medical professionals, medical schools and associations across the country warned the CDC what would happen if they published those guidelines, despite the suicides, and untold suffering PROP continues to pump out PROPaganda like this while the CDC keeps back pedaling with each story that comes out. The Media is picking it up as amputees don’t get their pain meds after they cut off his leg, CPP dying in pain akin to medieval torture. .
Isn’t a Psychiatrist supposed to keep up with his industry? Especially regarding addiction, since he has been touted as an “expert” ? He is an expert alright, he knew the difference, you can tell by the verbiage in his articles. He purposely conflated dependence and addiction, to enrich himself and his group. A CPP dependent on opioids is no different than patients dependent on other medications, like a diabetic being insulin dependent. The force tapering is continuing to kill people. Some not even by their own hands, a heart attack or stroke. People noticing that their loved ones have opiate related death on their death certificate when that wasn’t the cause at all. They’re all contacting the CDC, FDA , anyone who will listen. It is coming to the surface. I find it rich that one of our larger insurers is doing data analysis with Medicare records, I’m not so sure Medicare patients know is being used, those government records are released yet the VA won’t release theirs, but just from the deaths we do know about, it is obvious. Since these draconian guidelines were introduced suicide and OD deaths are up significantly despite opioid prescriptions being in decline for over 7 years. The FDA warned them this would happen too.
The first class action suit will be filed against the big chain Pharmacies CVS RiteAid Target Wal-Mart and Kaiser for not filling legitimate prescriptions, even for stage 4 cancer patients, surgical patients even a 5 year old that had an emergency appendicitis. ( 5 year olds was finally filled but it was a ridiculous amount of time leaving the baby in agony, he was traumatized)
More and more of these stories are hitting the media, the deaths and untold suffering. 7 Million people being forced off their needed medications. There are 50 million CPP 11.4 million who needed opioid medications to participate in life. The pill mills are long gone but the DEA continues to raid and target Doctors, I know of two cases where they raided they both had 8 clinics, lost everything but were never charged. The compassionate Doctors out there treating the hardest cases, the old and weak, when no one else will. They are Hardly getting rich off of thing Medicare & Medicaid patients ,of course there are more prescriptions, no one else will treat people especially those who are poor, they get thanks by being raided. You can hardly blame the DEA, they see the ugliest side of this on the streets, someone is “educating” them. Misinforming them is more like it. After the government carves out it’s pound of flesh from the pharmaceutical industry and deaths keep going up… Doctors who did nothing but try to help people who really need it, others afraid and doing medically dangerous things because ether afraid of raids. The government overreached and over reacted, they were exploited too. Dr Kolodny got the ear of grieving horrified people who didn’t really know anything about opioid medications. Someone, a group gave them skewed stats, used a term for CPP he knew had been conflated with addiction, millions of peoples lives ruined, careers, homes families and lives lost. Little old ladies & men stable for years, now immobile and incontinent because they can’t make it to the bathroom. Their little bodies so contorted with arthritis they lay in be 23 hours a day when they may not have been what I would call mobile but with a walker got around and didn’t grimace and groan every time they move. My little 87 year old Mom.
Law enforcement, politicians and the general public were looking to someone to FIX it, not make it worse, or be exploited. The entire medical community is angry and frustrated. As this is coming to a head, and more and more people become aware, they are going to need someone to blame. It won’t be the CDC, they’ve may have been the ones that let the genie out of the bottle, but they’ve back pedaled. Dr Tom Friedman is gone, the FDA warned and warned them about these “fringe” opinions and what they would do. I see karma coming, and no one will deserve it like this group that enjoys seeing people suffer. Even people from the addiction medical community, the American Psychiatric Association were sounding the alarm. Someone from HHS gave this too me, It explains a lot…
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3812919/
So does this.
I earlier posted a referenced extract from a published paper which I co-authored with Dr Andrea Trescot (former President of the US Association of Interventional Pain Physicians) and Dr Stephen E Nadeau, (professor of neurology and clinical and health psychology at the University of Florida College of Medicine in Gainesville). For whatever reason, the comment never got out of moderation, so I’ll repeat the highlights if I may.
Two very large scale American papers have recently been published on the incidence of diagnoses for substance abuse disorder, and the incidence of protracted opioid prescribing following surgery. In each case, over 640,000 opioid-naive surgical patient records were followed for a year to an average of 2.5 years. Incidence of substance abuse disorder diagnoses was a maximum of 0.6% in these groups. Incidence of long term prescription renewal varied between surgical procedures though fewer than 1% renewed their prescriptions longer than 13 weeks. In four of the 11 studied procedures, no change in prescribing rates occurred at all, when compared to non-surgical patients. In the remaining 7 procedures, rates of long term prescription renewals varied, but plausibly reflected the incidence of surgical failure and emergence of chronic pain in the aftermath of surgery — not any traceable effect of opioid exposure under medical management.
To put the case (again) bluntly: there is no real relationship between rates of opioid prescribing for post surgical patients versus the emergence of either opioid abuse or overdose related mortality. NONE. This article has deliberately cherry picked from biased sources to support a political agenda.
Reading comments such as yours with all the solid facts and figures you and others present just makes me always draw one conclusion…we middle aged and senior adult pain patients are victims of an ongoing conspiracy against us. Lets all be brutally honest folks, we are in a war here against people like dr. kolodny who are trying to tear us down and deprive us of our right to pain medicines.
More precisely, AN EXTREMELY CORRUPT POKITICAL AGANDA!
This article is really deceptive, and this kind of misinformation is doing a lot of damage. Of course not one industry funded study was ever done on that alleged 6% of post surgical patients. No one ever asked why some people are left with intractable chronic pain after some surgeries. Surgeons should not have to write a prescription for 30 days, but they often don’t do any follow up.
In ,any cases the patients won’t see their doctor for weeks, and no evaluation of their pain is ever done. The industry chose to ignroe levels of post surgical pain, becasue it could make them look bad. It is also illegal to fill a prescription for just a few pills, the pharma industry made sure of that. in some states is is illegal to fill 2 scripts in 30 days, or have another person pick it up. The big box pharmacies force people to wait for 2 or 3 hours to fill a script, difficult for someone trying to recover from surgery.
People are being misled by these articles targeting doctors and patients, to take attention away from the real failures of our healthcare system. Patients need to be concerned that their pain won’t be controlled after or during surgery. Patients who develop chronic pain are being demonized and stigmatized by deceptive reporting like this.
I have had several surgeries (bone, abdominal, hard and soft tissue), and was never prescribed the loads of opioids that the US surgeons apparently do. I did not need them (there are over the counter alternatives). I have also had dental work done without local anesthetic or drugs – it simply is not necessary for all procedures. But I do not live in the US, maybe that means I have a different level of pain tolerance?
I do not want to generalize, but the over-subscribing of opioids is very obvious, no matter who wrote this article, or whoever thought I have had no surgeries or no pain.
Mr.Chris M,,,the fact/truth is,,I cannot possible physically feel your physical pain from what-ever surgeries u have had,,,it is literally impossible..That very very basic truth stands true for all living mammals,,no-one can physical feel the physical pain of another.With this truth in mind,,your body is obviously different then others,,yours may, as u stated, have a different chemical structure w/a higher level of natural morphine receptors in your own body then thee average guy,,thus why u maybe able to tolerate more pain then others..The fact is,by a ,”generalized,” statement,or the cookie cutter approach to medical treatment,it is not in the realm of reality,thus not a effective methodology to effectively treating the physical pain of another..Furthermore by setting this precedence that tommy only needs 1,,, 5 mg of oxy,,,sooo EVERYONE in the world should only need 5 mg,,will cause those of higher weight,,higher hieght,different painful medical condition to FORCIBLE SUFFER,,BY forcing them to endure physical pain,,thats the definition of torture…For me,,I would never-ever ,”generalized,” thee amount of physical pain someone is endureing,for in doing so,,you are responsible then,for forcing another human being to forcible endure that physical pain that can be effectively lessen by the medicine opiates..Why,,why torture another person,,to prove a lie,,??That lie being,the one size fits all approach is not a humane,nor a realistic approach to effectively lessening physical pain from a medical condition..It will cause someone,,somewhere to forcible endure their physical pain,and for me,,,THATS NOT MY CHOICE,NOR MY DECISION TO MAKE,,, ie how much forced physical pain should a humanbeing forcible endure until they get a effective dose medicine to lessen their now forced physical pain?/That is no-one choice,but,,the persons enduring that physical pain,for reality is,,they are thee only ones who can physically feel ,,their physical pain,,no-one else can,,Anyone who thinks they have that right,that right to decide for all of humanity,,how much forced physical pain another human should forcible endure,,is practicing torture,,and torture should NEVER EVER BE ACCEPTABLE IN A SO-CALLED HUMANE SOCIETY,,,, As far as doctors over-prescribing,i disagree,,Did a new field of medicine arise in the last 20 years called Pain management as a step moving forward towards A MORE CIVIL HUMAN SOCIETY,, yes,,a new field of medicine has arisen..Thus natural the number of opiate medicine would natural be higher then decades earlier..If u notice,,no-one has stated ever,what is thee acceptable level of opiate medicine to be used in the field of painmanagement?All they have to say,,”bad opiate bad opiate,,w/no intelligent structure in place to say,,what is the acceptable amount..??It maybe it is literally impossible to put a ### on it,,for all of us,,are different,,thank god,,thus no number would ever be a humane approach to effectively lessening physical pain from a medical condition,,,jmo,,maryw
This kind of anecdotal and misinformed content does not help. Lots of procedures can be done with a topical anesthetic, and don’t require opioids. However there are people with chronic pain, pain that never goes away, and limits their lives. Many turn to suicide due to articles, attitudes and comments like this. Of course living in a country with real healthcare makes a big difference. Here in US people go for years without a diagnosis, or with until a condition festers and gets worse over time, before seeking treatment. In more sensible countries people can take a day or week off of work, in the US most people can’t. They have to continue to work while injured, work 2 or 3 jobs in the Gig Economy, and postpone medical care. No research has been done on any of that, it would be bad for the corporations that are profiting from this mess. Many American postpone dental care, if they can get it, until the pain is unbearable and they are infected, of course they might need an opioid, but these biased researchers never researched those kinds of factual issues.
I have been a RN for 25+ years, many of them on the med-surg & ortho-neuro floors and while each person responds differently to pain AND to opioids, there is an overall “average” we see. Your comment above implies that you are just fine with OTC pain medications for post-op pain (i.e. bone pain since I don’t know how minor the other surgeries were), which is very odd considering not only my experience with this, but also it has been proven in large studies by REPUTABLE researchers, hospitals & universities, that Tylenol does nothing for surgical pain! It helps “some” headaches & is a fever reducer but that’s the extent of the benefits. NSAIDS such as Ibuprofen are very effective for surgical pain IF the patient is able to tolerate them, BUT, opioids are still need to be taken WITH the NSAIDS for the majority of surgeries. Many people can’t take NSAIDS due to GI issues, liver & kidney problems – usually caused by taking NSAIDS long-term prior to having their surgery (even taking them for 1 week, if taken around the clock, can cause a GI bleed and more prolonged use results in liver and kidney damage and these are FACTS). Back to your surgeries and pain: ANYONE having bone surgery requires a significant amount of opioids and that’s pretty much all patients! The new recommendations for post-op surgery opioid prescribing from anti-opioid groups, call for 0-20 opioid pills that are only 5mg each (most surgery patients WERE/ARE getting 7.5 or 10 mg pills). A recent change is now allowing up to 30 for knee & hip replacements and 50 for open heart surgery. Since almost all patients take 2 tablets every 4 hours (4-6 but usually 4) for at least the first 3 days after a major surgery, you can see how the new guidelines are just not reasonable! Let’s assume a patient CAN take a NSAID to supplement, and let’s just look at the first 2 days of post-op pain where the patient takes 2 opioid pills every 4 hrs (plus a NSAID), that is 24 opioid pills in the first 2 days and believe me, for any major surgery, they need at least 3 days at the higher dose with or without NSAIDS (again, most patients really can’t take them and Tylenol is worthless for post-op pain – especially for major surgery). PLUS, the guidelines call for 5mg tablets and for major surgery, even 2 tablets is just not going to provide enough pain relief to get the patient up walking, tolerating dressing changes, or participating in physical therapy which is required for most of these major surgeries! As a result, healing time is prolonged, hospital stays are longer & complications are up. For example, someone having major abdominal surgery must get moving that day and keep moving or they can get an ileus (paralysis of the bowel) which can be life-threatening. They need a NG tube hooked up to suction until the bowel “wakes up” which takes several days. All patients having major surgery are also at a much higher risk of blood clots & embolism if they can’t get up and walk like they need to due to inadequate pain relief! There are many other complications from under-treated post-op pain too, plus the additional pain they cause! So essentially my message to you, is that I don’t believe you didn’t require opioids for the more major surgeries (and any bone surgery), even if you do have a high pain tolerance. These anti-opioid zealots have created ridiculous “guidelines” & they are responsible for the propaganda that’s being spread and added to the REAL CRISIS that has led to the under-treatment of pain in surgical, acute/accident pain, cancer patients – including those on hospice very close to the end of their lives, and chronic pain patients (many have pain as severe or more severe than advanced cancer pain)! Most doctors have either cut their pain patients off of their opioids or force tapered them to a level used for a brand new chronic pain patient when these legacy patients had been taking opioids for their painful conditions for 10, 20 or 30 years and even longer! Being cut off cold turkey can and has caused the death of so many people in withdrawal and that’s malpractice! Unfortunately, the DOJ, AG’s & DEA has put the fear of God into all doctors, so they are now afraid to prescribe, even to patients they KNOW really do need higher doses! In addition, medical boards (most of them) have been corrupt in their discipline of doctor’s arrested! There is no oversight for any of these agencies/organizations and there needs to be! The real cause of this crisis needs to be the focus (which are illicit street drugs and illegally manufactured Fentanyl coming in from China & Mexico, causing the skyrocket in the number of OD’s AND the street drug addicts who OD & toxicology finds at least 6 different illicit drugs plus alcohol in their systems). Instead of using the funding to focus on the real problems, they are targeting innocent doctors and punishing legitimate pain patients, which isn’t going to change the number of OD’s in the least – nor has it, even after the past 2 years or more, with a documented significant decrease in the number of Rx opioids filled, the number of OD’s has skyrocketed! This is proof that what they are doing is a huge waste of time & resources – all at the expense of human suffering, of all pain patients and doctor’s who have had their lives totally destroyed even when their charges are dismissed! Yes, there were some doctors over-prescribing and breaking other laws, but they were the minority, not the majority but most of that has been stopped now. Punishing pain patients & doctor’s, isn’t going to stop the street drug addicts from chasing a high and overdosing!
Dear Chris,
Well.
I have not had ” several” surgeries.
I know precisely how many surgeries I’ve had.
I also know I have not ever been prescribed “loads of opioids” here in the US.
My surgeries also include “bone, abdominal, hard and soft tissue”, as did yours.
I do not believe pain tolerance is a matter of geography.
Your attitude is not helpful and is, in fact, ignorant of the many differences in experience – – in pain and everything else in life!
You may believe “the over-subscribing of opioids is very obvious” but exposure to opioids does not cause addiction.
Addiction is far more complex which shows why restricting prescribed narcotics has shown no reduction in addiction and overdose!
It has escalated and continues to escalate.
Please, open your eyes. The data tell a different story!
This article has so much misinformation that it is beyond reproach. This “phobia” of opioids that is being propagated by PROP and Kolodny has made American doctors so afraid to prescribe opiates to treat not only acute surgical pain, but for people who have intractable pain like trigeminal neuralgia. This has led to the torture of patients who really need these medications in order to function in society. I know personally of thousands who have lost their livelihoods, jobs, homes, spouses because of their uncontrolled intractable, chronic pain. This was due to doctors and pharmacists refusing to give them the opiates needed to give them some sort of function to do their jobs, make love with their spouses, enjoy things with their children and family, etc. This needs to stop and doctors and pharmacists need to show at least some compassion.
Another thing I want to address is the fact that Dr. Andrew Kolodny has never, ever treated pain patients. He is a psychiatrist, not a pain doctor. How he can be proclaimed to be an expert on opioids and their effects on patients is ludacris, at best. He and PROP, have addiction centers that are making a fistful of dollars from patients that are being referred to them. There have been many reports that their centers and others that have them, have poorly trained personnel, not enough personnel, are filthy, have poor results, and have many people that are forced to return to these facilities because they were not “cured” of their addiction. I have read many articles and saw video reports on how people got even more addicted or if they were not addicted when they came to the centers they became addicted. This is because drugs were freely entering the facilities. There are many horror stories regarding drug use or physical abuse by employees of these places. These places hire agents to go around the country preying on purported drug addicts to come to their places for “help”. They provide free airfare and hotel accomodations to lure them in. These centers get quite a bit of money from insurance companies and the government so they are able to this. It is a multi billion dollar business. Kolodny is getting paid around $500,000 from Oklahoma as a “witness” in this trial going on against Johnson and Johnson. This as a “witness” who has no clue as to what actual pain is.
The CDC itself has said that less than 1% of opioid naive intractable pain patients will ever get addicted to opioids. Less than 1%!! Many other surveys on average have said that less than 5% might get addicted. Why should 95% – 99% have to suffer in severe acute and in many cases, lifelong severe chronic pain? I do agree that there should be limits on surgical pain. In my opinion no more than 3 – 7 days depending upon the procedure performed with exceptions for heart related and a few other ones. We need common sense prescribing, not severe restrictions.
It is interesting that this survey was with only 50 doctors. Why such a small number?
I also wonder why this article makes no mention of intractable pain or many types of back surgeries? Very limited in scope indeed. I also wonder why pain who have severe pain were not included? These are questions that need to be answered by the authors. Stop being so one sided. Stop making pain patients out to be drug addicts, we are not. Why was illicit drug use not mentioned? This is what is driving people to addiction. Another thing is if you look at drug addiction rates from the 1960s to the present, you will find that there is relatively no change. Sure, we have more drug addicts today, but that is because of population increases, something that is not mentioned in these numbers. Look at the percentages.
This report is for idiots. How dare these ‘numbers’ pertain to so many patients, when everyone is different. People will be buying, and using illegal drugs since the government has classified doctors as ‘dealers’. This report is dangerous, and millions of patients will be dead, or wish they were, if these kind of articles go public,without any concern for pain, or truth, in general. I can not believe STAT would quote these kind of numbers. The agenda is clear. The government no longer cares about the very people who vote them into office, or the hard working, dedicated, and knowledgable doctors who work so hard to treat patients with respect, caring, and ongoing empathy. Soon, doctors will be quitting thieir careers due to the disrespect, and reporting of how little they know. Doctors went to medical school, not politicians. WHAT HAPPENED TO ANDREW KOLODNY’S ADMISSION THAT THE OPIOID GUIDELINES WERE NOT MEANT FOR PAIN PATIENTS? This can become very dangerous. We know how dangerous it is to approach an injured animal. People are not animals, but pain is pain. What makes it even worst is people are told we have a right not to be in pain,yet here we are, and it is not getting better, it is getting worst. How dare the government tell educated doctors how they are allowed to treat pain.Yes, there are limits, but let the doctors decide, based on individual knowledge. The pain community better stand-up sooner, and stronger, before America loses the very rights so many have fought, and (increasingly) die for. What about your forgiving statement about heroin and fentanyl being the targeted culprits, not people in pain? Enough is enough. I believe we know why-nothing has been accomplished in gaining control of illegal drug trafficking, so instead, the CDC, etc. has to report something-they need to make the public think we are winning the war on drugs, but it is only getting stronger. Instead we are suffering from debiliating pain, and doctors, and patients are being held hostage. I still say ‘stop classifying pain medications as opioids, to help the public understand where the truth stands. How much of the billions of dollars being spent demonizing the sick, the weak, and those still able to work to support themselves, and their families, with the very much needed pain medications, could be used to control illegal issues? I still can’t believe I read this article in STAT. The sick, the injured, the veterans, and the doctors, are not the problem. Mr. Kolodny alreadt admitted that, yet look where we are. In a war against people in pain, and in a country our veterans fought and died for. America. Do the jerks who have decided that doctors do not know medicine, and reports like this one stand out, mainly because those not suffering, or not watching people they love suffer, probably do not know the whole truth? Who would have ever even imagined that these crimes against humanity could happen right here in America? There should be public apologies to the veterans, and families of veterans, who became disabled, physically, and mentally, fighting for freedom, and the right not to suffer in pain-the very rights being stripped away as we speak. I honestly hope there are some politicians out there that will speak against this brutality, and ensure it will be addressed IMMEDIATELY. They are the ones that will get elected. Just because many people in pain cannot get around easily, or not at all, does not mean they cannot vote. We live in a digital world. We can earn college degrees online, we can work from home online, and we can vote online. It is sad that pain and suffering is being lumped, basically into one criteria. No two people are the same, and it is the doctors that have earned the right to treat their patients with dignity, and the necessary treatment for the individual. It is said ‘be careful for what you wish for,you may just get it’. Well, Mr. Kolodny, and the others causing death and sufferage to pain patients, we will not allow your disrespect, and lack of empathy destroy America. Treat those who need rehab, get rehab, and let doctors treat pain patients, treat them. Both areas deserve care and empathy. Stop the public propoganda, and have some respect for all. Don’t forget your family members who lived and died for freedom, and the right not to suffer in pain. Americans-do not be fooled by false claims. This was never meant to harm pain patients. Remember Mr. Kolodny? Pay attention to the damage done by alcohol, tobacco, and gambling. Stop the torture, and clarify the difference between pain meds, and opiods. Please, respected officials, stop the torture-speak up now!