Jennifer Caudle: Prince's overdose reopens issue of opioid problem, in part spurred by overprescribing
Caudle: U.S. doctors need to take a step back and re-evaluate prescribing practice
Editor’s Note: Jennifer Caudle is a board-certified family medicine physician and assistant professor of family medicine at the Rowan University School of Osteopathic Medicine in New Jersey. Follow her on Twitter @DrJenCaudle. The opinions expressed in this commentary are solely those of the author.
CNN
—
It breaks my heart, as a family physician, to see patients struggle with addiction to prescription painkillers. As a medical student, I was taught that pain was the “fifth vital sign” – on hospital rounds with my team of fellow medical students, residents and senior physicians, we learned the importance of assessing and managing patients’ pain.
But somehow things have gotten out of hand. My profession is supposed to heal people, but when it comes to opioid abuse, it seems we are part of the problem.
Jennifer Caudle
In 2013 alone, health care providers wrote nearly a quarter of a billion opioid prescriptions – enough for every American adult to have “their own bottle of pills,” says the Centers for Disease Control and Prevention. Some of these very prescriptions caused harm. I can say this because we know at least half of all opioid overdose deaths involve a prescription opioid.
From 2000 to 2014, nearly 500,000 people died from drug overdoses. Even more staggering is that the number of opioid overdose deaths in America, if averaged over a year, would be 78 per day. The crisis cuts across all our society, and even the rich and famous are vulnerable.
Photos: Prince: The artist
Richard E. Aaron/Redferns/getty images
Singer and songwriter Prince performs onstage during his Purple Rain Tour in 1984. The artist, who pioneered "the Minneapolis sound" and took on the music industry in his fight for creative freedom, died in April 2016 at age 57.
Photos: Prince: The artist
Waring Abbott/Michael Ochs Archives/Getty Images
Prince performs in New York in 1980. Prince won seven Grammy Awards, and earned 30 nominations. Five of his singles topped the charts and 14 other songs hit the Top 10.
Photos: Prince: The artist
Waring Abbott/Getty Images
He performs at the Palladium in New York in 1981.
Photos: Prince: The artist
Andre Csillag/REX/Shutterstock
Prince at the Lyceum in London in 1981.
Photos: Prince: The artist
Michael Ochs Archives/Getty Images
Prince and Apollonia Kotero in a scene from the movie "Purple Rain," which was released in 1984.
Photos: Prince: The artist
Warner Bros/Everett Collection
Prince, seen here on set, won an Oscar for the original song score for the classic film.
Photos: Prince: The artist
Richard E. Aaron/Redferns/getty images
Prince performs in New York in 1984. Controversy followed the singer and that, in part, made his fans adore him more. His 1984 song, "Darling Nikki," details a one-night stand and prompted the formation of the Parents Music Resource Center. Led by Al Gore's then-wife, Tipper Gore, the group encouraged record companies to place advisory labels on albums with explicit lyrics.
Photos: Prince: The artist
Mirrorpix/Courtesy Everett Collection
Prince performs at the Joe Louis Arena in Detroit in 1984.
Photos: Prince: The artist
Michael Ochs Archives/Getty Images
Prince performs live at the Fabulous Forum in 1985, in Inglewood, California.
Photos: Prince: The artist
The LIFE Picture Collection/Getty Images
Prince in 1985.
Photos: Prince: The artist
The LIFE Picture Collection/Getty Images
Prince, circa 1985.
Photos: Prince: The artist
Michael Ochs Archives/Getty Images
Prince performs live at the 1985 Fabulous Forum in Inglewood, California. He created what became known as the Minneapolis sound, which was a funky blend of pop, synth and new wave.
Photos: Prince: The artist
Michael Putland/Hulton Archive/Getty Images
Prince in the United Kingdom in the 1980s.
Photos: Prince: The artist
The LIFE Picture Collection/Getty Images
Prince, circa 1985.
Photos: Prince: The artist
Warner Bros/Courtesy Everett Collection
Prince in a scene from the 1986 film "Under the Cherry Moon."
Photos: Prince: The artist
Michael Putland/Hulton Archive/Getty Images
Prince performs in London in 1986.
Photos: Prince: The artist
ERMA/CAMERA PRESS/redux
Prince performs in London in 1986.
Photos: Prince: The artist
David Corio/Michael Ochs Archives/Getty Images
Prince performs at London's Wembley Arena in 1986.
Photos: Prince: The artist
CROLLALANZA/REX/Shutterstock/Rex Features
Prince in 1987.
Photos: Prince: The artist
NILS JORGENSEN/REX/Shutterstock
Prince performs at Wembley Arena in London in 1988.
Photos: Prince: The artist
Graham Wiltshire/Hulton Archive/Getty Images
The singer's predilection for lavishly kinky story-songs earned him the nickname "His Royal Badness." He is also known as the "Purple One" because of his colorful fashions. He is seen here in 1990.
Photos: Prince: The artist
picture-alliance/Newscom
Prince performs in 1990.
Photos: Prince: The artist
Rico D'Rozario/Redferns/getty images
Prince, 1990.
Photos: Prince: The artist
Mirrorpix/Everett Collection
Prince performs during "The Nude Tour" in Birmingham, United Kingdom, in 1990.
Photos: Prince: The artist
Frank Micelotta/Getty Images
Prince listens to the crowd during a 1991 concert.
Photos: Prince: The artist
Frank Micelotta/Getty Images
Prince performs at the MTV Video Music Awards in Los Angeles in 1991.
Photos: Prince: The artist
Scanpix Sweden/SIPA USA
Prince performs at the Globe Arena in Stockholm in 1993.
Photos: Prince: The artist
Jacques Brinon/AP
Prince arrives at the Ritz Hotel in Paris in 1994.
Photos: Prince: The artist
Tim Rooke/REX/Shutterstock
A disguised Prince appears at a Virgin Records in London in 1995.
Photos: Prince: The artist
Reed Saxon/AP
As dozens of singers perform "We Are The World" on the 10th anniversary of the African famine relief anthem, the artist formerly known as Prince stands sucking on a lollipop next to Quincy Jones at the American Music Awards in Los Angeles in 1995.
Photos: Prince: The artist
Chris Wahl/iPhoto.ca/Newscom
Prince poses for a photo in Toronto in 1996.
Photos: Prince: The artist
KARIN COOPER/ROGERS & COWAN/AP
Muhammad Ali pats Prince's head prior to a news conference where they were to announce plans for a benefit concert in 1997.
Photos: Prince: The artist
Wattie Cheung/Camera Press/Redux
Prince performs in 1998.
Photos: Prince: The artist
MITCH JACOBSON/Associated Press
A disguised Prince speaks at GQ magazine's third annual Men of the Year Awards in 1998.
Photos: Prince: The artist
WIREPIX/FPS/Newscom
Prince, circa 1999.
Photos: Prince: The artist
ANAT GIVON/AP
Prince performs in Hong Kong on October 17, 2003. Prince's concert was the the opening act in a four-week government-sponsored music festival titled "Hong Kong Harbor Fest," aimed at boosting the image of SARS-battered Hong Kong.
Photos: Prince: The artist
KEVORK DJANSEZIAN/AP
Prince arrives with his then-wife, Manuela Testolini, for the 77th Academy Awards on February 27, 2005, in Los Angeles.
Photos: Prince: The artist
Kevin Winter/Getty Images
Prince at the 2005 NAACP Image Awards in Los Angeles.
Photos: Prince: The artist
Terry Gilliam/MCT/Sipa USA
Prince performs during a news conference for Super Bowl XLI in 2007.
Photos: Prince: The artist
Jonathan Daniel/Getty Images
He left his imprint on many aspects of popular culture, from film to movies to sports to politics. As the Minnesota Vikings prepped to take on the New Orleans Saints in the 2010 NFC championship game, Prince wrote a fight song entitled "Purple and Gold" to inspire his home team. The Vikings lost. He was the half-time performer at the Super Bowl in 2007 in Miami Gardens, Florida, seen here.
Photos: Prince: The artist
Vince Bucci/Getty Images
Prince performs onstage during the 2007 NCLR ALMA Awards.
Photos: Prince: The artist
Solo/ZUMA PRESS
Prince performs on the runway at the spring/summer 2008 collection fashion show by Matthew Williamson during London Fashion Week in September 2007.
Photos: Prince: The artist
Kevin Mazur/WireImage/getty images
Prince performs during his Welcome 2 America tour at Madison Square Garden in 2011 in New York.
Photos: Prince: The artist
Simon Earl/Splash News/newscom
American pop legend Prince is pictured performing on the final night of the Hop Farm Music Festival in Kent, United Kingdom, in 2011.
Photos: Prince: The artist
Jakob Jorgensen/Polfoto/ZUMA PRESS
Prince performing at the Femoren on August 6, 2011, in Copenhagen, Denmark.
Photos: Prince: The artist
Christopher Polk/Getty Images for Clear Channel
Prince on stage with singer Mary J. Blige during the 2012 iHeartRadio Music Festival in Las Vegas.
Photos: Prince: The artist
JOE KLAMAR/AFP/Getty Images
Prince presents the winner for Record of the Year to Gotye and Kimbra during the 55th Grammy Awards in 2013.
Photos: Prince: The artist
Ethan Miller/Getty Images
A year later, Prince performs during the 2013 Billboard Music Awards in Las Vegas.
Photos: Prince: The artist
Christian Hjo/REX/Shutterstock
Prince performs at the 2013 Skanderborg Festival in Denmark.
Photos: Prince: The artist
Photo via Newscom
Prince is seen in the stands during the 2014 French Open in Paris.
Photos: Prince: The artist
Fox/courtesy Everett Collection
Left to right: Zooey Deschanel, Prince, and Jake Johnson in a scene from the TV show "New Girl" which aired in 2014.
Photos: Prince: The artist
Kevork Djansezian/Getty Images
Prince speaks at the 2015 Grammy Awards in Los Angeles. Additionally, last year, Prince released the song "Baltimore," addressing the unrest after the death of Freddie Gray while in police custody. He performed at a benefit concert in the city and gave a portion of the proceeds to youth groups in Baltimore.
Since 1999, the amount of prescription opioids sold in the United States has nearly quadrupled, but there hasn’t been a major change in the amount of pain that Americans report. The “amount” of pain is important because historically opioids have been reserved for those with moderate to severe pain resulting from circumstances such as surgery, injury/accident or cancer.
Every day I see patients who have been prescribed these medications – but not for these (or similar) medical reasons. So why are health care providers writing so many opioid prescriptions? Have we overestimated the pain scales we were taught as medical students? Are we caving to pressures placed on us by drug-seeking patients to prescribe these medications? Are we simply not paying attention?
To answer these questions – to solve this urgent problem – we need to stop overestimating our patient’s pain. We should be treating and assessing pain appropriately, in the way our medical training dictates.
We must be immune to pressures from patients who have been led on by the ubiquitous pharmaceutical ads in magazines, on the Internet and TV: Our first job as health care providers is to “do no harm.”
I have been yelled and cursed at (even walked out on) by patients who become angry with me because I would not prescribe opioids when not appropriate. We cannot ignore that up to 1 in 4 patients on opioid therapy struggles with opioid addiction. Not paying attention to this simply isn’t an option.
As an osteopathic family physician in an academic medical practice, my colleagues and I, like many other physicians, have taken a judicious approach to prescribing opioids.
My office has “controlled-substance agreements,” for example, that a patient receiving opioids or other controlled substances must sign. These contracts require, among other things, that patients get their medications from only one pharmacy (pharmacy-hopping is not allowed), take their meds only as prescribed, return to the office for refills (meds cannot be refilled over the phone) and be subject to random drug screening. In addition, we also use the national Prescription Drug Monitoring Program, which allows providers to see which controlled medications patients have been prescribed by others.
We also regularly attend lectures and training on how to prescribe opioids and other controlled substances properly.
Thankfully, many providers throughout the country are using these resources regularly to curb the inappropriate prescribing of opioid medications as well.
To be sure, the issue of opioid abuse and overdose is a complex, multifaceted issue, and the prescribing of opioids is just one aspect of this problem. Many doctors are prescribing these medications appropriately and many patients are taking these medications the right way. In fact, I often remind patients that opioid prescription medications are not bad – they are quite useful in treating pain when used and prescribed appropriately.
And as a physician, my intention here is not to place the blame of opioid overdoses solely on health care providers. Rather, it’s a wake-up call for us to take a step back and re-evaluate our prescribing practices. Not only is this appropriate, but it’s simply “good medicine.”
Jennifer Caudle is a board-certified family medicine physician and assistant professor of family medicine at the Rowan University School of Osteopathic Medicine in New Jersey. Follow her on Twitter @DrJenCaudle. The opinions expressed in this commentary are solely those of the author.
