No wonder there is an opioid epidemic in this country.
Recently, we learned that average life expectancy in the U.S. decreased for the second year in a row — something we have not seen since the early 1960s. Experts attribute this disturbing finding to the increase in drug-related deaths caused by opioid overdoses. After my family's recent experience, I am not surprised.
At 2 a.m. on a Thursday, my husband, Sam, awoke with belly pain. We went to the emergency room, and 12 hours later we came home with one fewer appendix and a bottle of pills.
My husband received excellent medical care and a stellar outcome. I could not be happier with the experience, except for one thing:
At every turn, Sam's clinicians pushed opioid-based narcotics without a second thought.
The first time a clinician attempted to give my husband opioids was when we arrived at the ER. Before the appendicitis diagnosis, we asked the ER nurse what my husband's options were for managing his pain. The nurse said they would be happy to give Sam the opioid-based narcotic Dilaudid.
Because I happen to have a family member who is a doctor, I knew to ask for a specific drug (Toradol) that is a nonopiate painkiller (basically intravenous ibuprofen). The nurse seemed confused when we asked for this alternative. He offered to give Sam Toradol and Dilaudid. We clarified again: "Could we try Toradol first to see if that works before taking narcotics?" Yes, we could.
Toradol worked great for Sam; the nonnarcotic managed his pain well.
After we got the news that Sam needed to have his appendix out, it was time to meet with the surgeon. We asked again: "What are Sam's options for pain management?" The surgeon said, "Your options are Norco, or no Norco." Norco is — you guessed it — an opioid-based narcotic.
Overprescription of opioids is a serious issue in this country. According to the Centers for Disease Control and Prevention, "We now know that overdoses from prescription opioids are a driving factor in the 15-year increase in opioid overdose deaths." Sales of prescription opioids nearly quadrupled in the U.S. from 1999 to 2014, without an increase in reported levels of pain. Prescription opioid overdose deaths also nearly quadrupled during this time.
Ninety-one Americans now die each day from an opioid overdose (see: www.cdc.gov/drugoverdose).
Back in the pre-operating room, my husband's surgeon added that Sam should need the Norco only for a day or two after surgery. Imagine my surprise when we received a bottle of 20 pills on our way out.
As it turned out, Sam didn't need the Norco at all. He easily managed his pain with over-the-counter acetaminophen and ibuprofen.
Not a single doctor or nurse suggested a nonnarcotic option to manage Sam's pain; opioid-based narcotics were literally the only option presented to us.
In addition to not providing Sam with pain-management options, none of Sam's clinicians mentioned risks — or even side effects — associated with narcotics. Aside from the very real risk of addiction, there are less dramatic, but still real, side effects to consider: constipation, nausea/vomiting and depression, to name a few.
Why didn't anyone even mention these factors before offering Sam opioids?
I am sure there are many cases where narcotic painkillers are worth the risks. But it couldn't be clearer to me that there are many, many situations in which they are not. Given the havoc that opioid abuse is wreaking on American families and communities — jobs lost, children abandoned, lives ruined — we need to make clear that there are options to managing pain.
Why not inform patients and then let us decide?
Jennifer Rosenbaum lives in Minneapolis.
