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Letters: Opioids in the U.S.

October 17, 2016 I am an oral and maxillofacial surgeon and am keenly aware of the abuse of narcotic medications in our country having lost friends and patients to overdoses. Other than short-term use, I have never met anyone where narcotic use has worked out well. Our literature is replete with articles on this topic, yet the solutions offered are, I believe, not going to affect any change in the current crisis. Professionally, we are being called upon to check pharmacy records prior to prescribing any narcotic pain medication. This new policy places a burden of regulation upon us as practitioners without any power of enforcement. It also does not provide a solution to the narcotic issue since the abuse of prescription narcotics is down, with heroin and its additives on the rise. Which raises another issue: how would one know if the patient is using illegally obtained narcotics? Fundamentally, as a condition of licensure, we are being asked to check if patients are lying to us and then confront them. I do not believe that a patient will become imbued to enroll in a rehab program if I review the evidence with them. I do believe most certainly that same patient will just seek narcotics from other sources.

In regards to the federal and state government record in this area, for over 40 years the war on drugs has been a total failure. Recently, the head of the Centers for Disease Control sent all practitioners a letter about how all of us are responsible for the problem. But when I saw him in an interview, he was vehement that we are all part of the problem and cited the rubbish we were fed in the 1990s; that we must relieve patients' pain, the addiction issue should not be a big concern and we were victims for having received this advice. I never bought into that line of reasoning, since it made no sense having seen friends from high school succumb to narcotic addiction. I continued to do what was logical, give patients no more than a three-day supply of pain medication, which is now the current guidelines: three to five days for post-surgical pain management.

The federal programs have been an abject failure as there has been no coherent focus on demand, only on interdiction. One of those programs was in allowing drug dealers in Mexico to obtain weapons, with the belief that the weapons could be tracked. That program was poorly thought out by the attorney general's office and only resulted in more deaths.

We, as practitioners of health care, must take a longer view of this problem and propose solutions that can affect a positive change on the addiction issue in the United States. What are those solutions? First, they must be aimed at demand; for without that, there is no solution to this problem.

As realists, we must look at history and know that this is an age-old problem, which goes back to the dawn of civilization, where it has waxed and waned. The most successful removal of narcotics from society was by the Chinese when opium became endemic in their society; from which the British received tremendous profits. The solution that the Chinese enacted were draconian and would never be legal in the United States. Popular culture needs to re-evaluate its stance on the issue, and we need to engage it to act more responsibly and not provide glamour to this problem.

This argument should be well-received, since on a percentage basis that subculture in society has had more than its fair share of drug abuse issues.

We need to be engaged in the discussion as to what works and what doesn't work, and not be delegated a responsibility that will not effect a change and places us in jeopardy.

Kenneth G. Miller, D.D.S.
Clarks Summit, Pennsylvania