As justice closes in on Dr. Conrad Murray, and the final determinations are made about which drugs were administered to pop star Michael Jackson, when, and by whom and with what intent, a larger social question emerges. Was Jackson’s problem isolated? Is the excess prescribing of various narcotics and sedatives a pervasive one among doctors and their patients, or is Dr. Murray a lone wolf? Is there a culture of misuse and enabling which enriches corrupt physicians even as it addicts patients?
The answer is an unfortunate...yes.
At a time of terrible drug shortages of lifesaving medication in the U.S., on the other side of the equation prescription drug abuse is a growing problem with doctors as willing participants or even users themselves.
Propofol overdose, the likely cause of death in Jackson’s case, is a commonly abused drug. There are five times as many cases of propofol abuse than there were ten years ago. In fact, studies show that one in five anesthesiology programs reported a case of propofol abuse by medical professionals.
But the problem is hardly limited to the drug known as “the milk of anesthesia” for its effectiveness. The National Survey on Drug Use and Health reports that more than 7 million people in the U.S. abuse prescription drugs.
The largest problem of all is painkiller addiction. Jackson appears to have been in that group with his alleged dependence on the popular narcotic Demerol.
Unfortunately, these pain medications are often prescribed by doctors without expertise in pain management, as was allegedly the case with Jackson’s dermatologist, Dr. Klein. The doctors who most often prescribe narcotics for supposed pain are family practitioners, followed by internists and dentists.
A survey from IMs Health, a health consulting firm, reveals that Americans take 80 percent of the painkillers in the world, a shocking percentage. But painkillers are overused and abused in part because doctors like Murray and KIein overprescribe them, making large quantities readily available. Though more than half a million doctors prescribe narcotic painkillers in the U.S., it is a small number who prescribe the largest amounts.
The numbers here are getting worse. IMS Health has determined that there are 50 percent more narcotics prescribed in the U.S. than a decade ago. Vicodin (which is less restricted) use alone has grown from 116 million prescriptions in 2006 to 131 million prescriptions this past year.
Perhaps most concerning of all are the number of accidental overdoses resulting from this overuse. According to the Centers of Disease Control and Prevention, 17 states report that accidental overdose kills more people than motor vehicle accidents.
What is to be done?
In Florida, which leads the country in prescription drug misuse, where buses of patients arrive from neighboring states seeking painkillers (known as the "Oxycontin Express"), attempts are being made to clamp down on doctors who sell painkillers for profit. The Florida Board of Medicine is partnering with the US Drug Enforcement Agency to close illegitimate “pain clinics,” to track bulk purchases of narcotics, and to identify and punish bad doctors who write prescriptions without even examining the patient.
It remains to be seen whether such actions in Florida and other states will be sufficient or will just lead to more demand for grey and black market alternative sources. One thing’s for certain; this problem of over-prescribing prescription drugs, especially painkillers, won’t be solved overnight.
The place to start is with the worst enablers, but for every one who is sent to prison, there are hundreds more for hire with prescription and pen in hand.
Marc Siegel, M.D. is a professor of medicine and medical director of Doctor Radio at NYU Langone Medical Center. He is a Fox News Medical contributor and author. His latest book is "The Inner Pulse: Unlocking the Secret Code of Sickness and Health."
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