I perceive a lot of cultural differences when it comes to dealing with pain in the US and in Germany, and as in so many ways, I am split in the middle. I don’t believe in sticking out pain. When I don’t feel well, I take something. I also like being in full possession of my mental faculties though.
With the regularity of a Swiss clockwork, NPR and other reputable news sources cover stories about pain killer abuse, and attempts to crack down on these abuses. As somebody who has been on both sides of the issue, i.e. the recipient of (strong) pain killers and as someone who has seen people get addicted to them, I am also torn here.
Let me give you an example: All four of my wisdom teeth needed to come out. I had one side done in the US and one side in Germany. The left side in the US was first. After the procedure, I was given 40 Vicodin (Hydrocodone and paracetamol) and a patch to put behind my ear against sickness. I was twenty-nine, and that was the first time I had been given Vicodin. I barfed like nobody’s business, was awake for 24 hours straight, and scratched my scalp. Then it got better, but the damn tooth took about two months to fully heal. Half a year later, I have the same procedure done in Germany. Afterward I was handed a three day supply extra strong ibuprofen (1200mg). Oddly enough, this side was perfectly healed in a week. (I am not saying that it was the ibuprofen, we all know healing is more complicated than that.) But why no Vicodin?
It turns out, in Germany, hydrocodone is on the market, but as a medication to suppress very strong, life threatening coughing, and is mostly used if you are already in the hospital for that cough. So in a very controlled environment. Indeed, growing up with Crohn’s in Germany, I was never prescribed any narcotic painkillers. I wasn’t told to bite on a stick either, but stomach cramps, Crohn’s or not, were treated with hot water bottles, fennel and mint tea, Buscopan and metamizole (a medication not allowed on the US market). Obviously, at some point, this was not enough to treat severe Crohn’s disease, and when I hesitantly asked for Tramadol drops for the first time, I got them without a lecture on the dangers of addiction. But I also only got 50ml. As opposed to 40 pills of Vicodin for two wisdom teeth. Cognitive dissonance anyone?
And that’s where I get upset. All of a sudden (not that sudden, when you think of the fact that NPR has been saying it for about five years), it dawns on us that we have a prescription drug problem. Did we need the incredibly talented Hugh Laurie aka House, M.D. to shove it into our faces?
Doctors prescribe narcotics way too freely, some say. I tend to agree- see the 40 Vicodin in the above example, and I could give you several more of the like- but I only agree to a point. As a doctor, especially in the ER, you have a waiting room of 20 patients on any given night, double that on weekends. The person in front of you is in obvious pain, and you have all these people waiting for you outside. You have only so many options. Obviously, you want to help as many people as possible. Still, most people that I know have leftovers of narcotics at home from when they were in the ER, because they were prescribed way too much. So why not give me ten Vicodin, and if I am done and still need them, I can go to my regular doctor?
In the US, it’s ultimately insurances that reign supreme.
And insurances want: cheaply produced generic painkillers such as Vicodin, or Oxycontin. Ultimately, as a doctor, your hands are more or less tied. You have a patient in visible pain, and you have a palette of things to prescribe, all of them can be addictive. You also know that the patient’s insurance will go up if they go to their regular doctor too often (if they have insurance at all). And often enough you know you have an addict in front of you, but what are you going to do? Addiction programs are expensive as well, and letting them go cold turkey can be dangerous too.
The solution, the states of Texas, New Mexico and Wyoming believe, is data collection. Essentially, every time you go to an ER, they will put you in a system, and if you have gone a certain amount within a month, a panel consisting of “experts” will decide whether you are considered an abuser.
“Under the new system, the difficult decision of whether to withhold drugs won’t be made by the doctor on duty, Garcia says. Instead, a hospital panel made up of doctors and administrators will meet once a month to decide whether patients flagged for unhealthy behavior should officially be labeled abusers. The panel will be watching for signs — like more than a few visits to the ER in a given month.”
At first, I started laughing. I am within Portland, Oregon, and my hospital (OHSU) can’t communicate my blood tests to my GI doctor at the Oregon Clinic (I have them on my app, print them out, and personally deliver them to him, because they just won’t get it done), but they want to be able to track if I go to different ER’s? If the hospital system in New Mexico, Texas and Wyoming is anything like OHSU, then good luck with that. But then, how many ER’s are there in Wyoming ? (ok, that was a cheap shot).
Then I got angry. First of all- people in chronic pain- from whatever condition they may be suffering- on occasion have several trips to the ER in one month. Heck, with my surgery and the post-surgery complication, I was in the ER so many times that the surgery department knew me and my family by name. Would that panel label me as an abuser?
Secondly, the moral judgement behind it all really, really bothers me. Do people addicted to painkillers not have a right to treatment? If all you do is send them away from your door and not giving them means and ways to get out of the addiction, then you are sending them into criminality (according to “Better call Saul,” illegal Vicodin is pretty expensive), because they won’t stop being addicted because you turn them away.
We have pills and meds for EVERYTHING, how hard can it be to develop non-addicting pain-meds?