There are many causes cited for the opioid crisis – false advertising and the pressuring of doctors by pharmaceutical companies, doctors looking for new ways to treat pain, the economy – but one addiction expert says those are just superficial explanations. According to Anna Lembke, a Stanford psychiatrist focused on addiction care, the real problem is what she calls the “Toyotazation” of the health care system — a sort of assembly line approach to medicine that encourages doctors to move a patient in and out of their clinic or hospital so that they can get paid as quickly as possible. Doctors have also been guilty, Lembke says, of looking for quick, one size fits all solutions, such as a single opioid medication, that can satisfy patients without the need for much follow through.
Part of the problem here is that not all medications work for all conditions or all people, and some people simply can’t be cured. There’s evidence that opioid painkillers aren’t really effective for chronic pain, and several studies have shown that use of opioids for that purpose may actually worsen pain. In one study of patients undergoing orthopedic surgery, patients who received long-term opioid therapy reported higher pain levels – 7.6 vs. 5.5 out of 10 – than those who had not, those individuals who have suffered with it for years are desperate for relief and will grab onto any ray of hope.
Even if opioids do relieve some of the pain, patients may still need physical therapy and other treatments, and even then, they can’t always expect a recovery. Patients may just need to learn to cope with the pain, according to Lembke. Methods like exercise, meditation, biofeedback, acupuncture, and chiropractic care could be beneficial.
It’s true that some doctors are guiltier of doling out opioids than others – the so-called pill mill doctors – either out of a desire for efficiency or because they were being wooed by pharmaceutical companies. However, the evidence shows that all doctors are guilty of overprescribing them. According to a study authored by Lembke and published in JAMA Internal Medicine, it’s family care practitioners who wrote the most opioid prescriptions, at least among Medicare prescribers. In 2013, there were more than 1.1 billion claims for nearly $81 billion in opioid medications, and while there were large numbers concentrated in pain management specialists and anesthesiologists, family practice (15.3 million), internal medicine (12.8 million), nurse practitioners (4.1 million), and physician assistants (3.1 million) were at the top.
The solution, Lembke says, is nothing short of a total overhaul of our healthcare system. Doctors need to look at individual problems and come up with individual solutions, while lessening the number of opioid prescriptions they write and monitoring the people already taking them.
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