Wednesday, February 22, 2012

The Problem with OxyContin Addiction is the Prescribing

My grandfather was a lawyer, yet somehow was involved in helping opium addicts through withdrawal in pre-WWII Burma. Opium addiction ravaged young men back then, and withdrawal was a terrible affair, like it will be for thousands in Ontario pretty soon. Responsible, upright citizens like my grandfather sought solutions. I’m not sure how they came up with the idea but they discovered that a shot of ovo-lecithin followed by a run did the trick. Ovo-lecithin is thick and requires a large needle to inject it. To say it hurts is a bit of an understatement. The sheer shock probably had them clinging to the ceiling, their body ringing with pain. Then my grandfather sent them out to run. After a week of daily injections and runs, as far as what my father remembers his Dad telling him, they went Cold Turkey. They quit the opium and kept on running. And amazingly, the withdrawal symptoms were manageable, and they slept it off.**

This is all by way of saying that before twenty-first-century-advanced medicine, people (in some countries) cared for addicts and used their little grey cells to help them through withdrawal. They knew addiction; they understood the awfulness of withdrawal. In our enlightened era, on the heels of changing its narcotics strategy*, the Ontario government has changed the rules of the prescribing of OxyContin and cares so little about the mass withdrawal about to happen that it has not planned for it – at all. And the doctors who caused this massive OxyContin addiction in Canada aren’t taking responsibility for it either. It isn’t surprising because the very reason I believe this problem came to be – doctors not wanting to spend time on their hurting patients – is the same reason why they won’t help now. And the worst affected will be the terminally ill outside of the big city (where the registered palliative care physicians practice) who will have to go through the shakes, sweats, nausea, panic while dying because their unregistered-for-palliative-care GPs will be wading through the futility of applying for Exceptional Access instead of treating them.

The solution to Canada’s addiction problem isn’t going after the poor and elderly patients covered by the Ontario government’s drug plan and more big brother but to go after the doctors who created the problem.

Let me illustrate.

There was a young man who went to his doctor for stomach pain. The doctor ordered X-rays. He diagnosed constipation. He prescribed Tylenol 3s.

Pause.

Any Faculty of Arts and Sciences student who has taken pharmacology or physiology like me knows that morphine (or codeine) bungs you up. If a lowly FAS student knows this, don’t you think a graduate of any Faculty of Medicine would? Well, aside from the fact Canada is producing dangerous idiots for doctors who think constipating more a constipated patient is a great way to get rid of his pain, this terrible story highlights why Canada has the highest rate of OxyContin use in the world: doctors would rather throw pills at pain than listen, think about, discover, and treat the cause of the pain.

Twenty-first century-high-tech medicine gives the illusion that tests and pills are enough to treat any ailment. But pain is tricky. We don’t fully understand it, and we are only beginning to understand how pain relievers like morphine actually work. I wonder how long it took my grandfather’s peers to figure out the ovo-lecithin withdrawal treatment? And I wonder who had the courage to try it on an addict for the first time?! They took the time because they didn’t have the plethora of remedies and high-tech equipment and tests we have now. Medicine needed to be hands on and thought out pre-WWII.

It still does.

Government and the public need to remind doctors of that.

Government needs to pay doctors to spend time with their patients, not in the current way that encourages widget assembly line care and the mindless pain-relieving methods of pill throwing. Government also must start paying for pill alternatives. By cancelling physiotherapy, for example, they took a step back in that and only ensured the rich could get help for the cause of their pain while pushing the rest into taking pills and being disabled for life. But the public also need to stop demanding easy treatments for symptoms, aka pills, and instead demand longer-to-take-effect but permanent treatments for the cause of the pain. There are many, many effective and scientifically-proven alternatives to opioids, which don’t have addiction risks and side effects and may work like them, like acupuncture. But the ultimate treatment is healing the cause. The second ultimate is if the cause can’t be treated, to be willing to learn how to think differently about pain so as to manage it and live well.

Unless all that happens, we’ll have massive untreated withdrawal, especially on remote Ontario reserves and go right back to our current situation when doctors begin prescribing oxycodone (the faster acting original version of OxyContin) and patients with their fat prescriptions begin to sell that instead.

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**I found a 1957 paper describing lecithin and glucose treatment in India. Search for lecithin on the linked page. I bet today’s physicians could benefit from reading this paper.

*BTW did you take a look at the list of drugs the Ontario government is monitoring? They include drugs for anxiety and ADD that have been prescribed for decades. They’re not suddenly a problem now because of their pharmacology but because the medical profession has begun to prescribe them indiscriminately. The pill culture brings on big brother oversight. Another reason to re-educate doctors and patients.

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