2 Responses so far.

1. I also work in addiction…..pediatricians need to check OARRS and perform UDS on the children to confirm the child is actually taking the prescribed amphetamines for ADHD and to ensure the parents are not taking the child to multiple providers. I also work in pain management, opioids are the last resort and should be used at the smallest amount possible to keep the patient moving without hypnotics and/or benzos. Pain management is a combination of treatment modalities; not just opioids. Pain management must be highly regulated with random drug screens and pill counts and state reporting records. I see people who have had horrific traumas; falling off of buildings, injured in war, ejected from cars, assaulted by prisoners…etc, and opioids due improved their adls and quality of life. However, 30% of my new patients are addicts trying to hose me, so we must always be on our game and use out tools to assess EVERY time.

2. Great topic Jeff! Here are my 2 thoughts. The crisis is multi-layered and in my opinion, created the perfect storm. There were 3 things that occurred in a relatively short time, first was the push from big pharma in the 1990’s that as you mentioned was sold as non-addictive (which hid the research on addiction, and is now being sued by several states including Ohio) the second was pain as the 5th vital sign which not only forced providers to give this out for minor reasons, but more importantly has implied to the public that they could always live in a pain free state even after surgeries. The 3rd was the war in Afganistan. It had been a long US policy to buy and destroy drugs prior to entering the country. The Bush administration stopped this practice to protect our soldiers and the Obama administration continued this, thus the flood of product into the country. I agree with you that the bleeding has to stop, and it starts with us. My hope is that the babies today will not have access to opioids and don’t learn the misconception that life will always be pain-free