In a series of TV news interviews on the opioid crisis, past Obama Surgeon General Vivek Murtha repeatedly blames the runaway over-prescribing on: 1) doctors’ beliefs that the opioids – which have been listed since 1970 as Schedule II Controlled Substances due to risk of abuse and addiction – “are not addictive when prescribed for pain” and 2) “marketing” by drug companies – questioning the medical profession’s ability to independently use clinical and ethical judgment to protect patients.
The remarkable series of interviews (watch below the end of this post) includes the nation’s former chief medical officer and public health authority explaining the runaway over-prescription of opioids that created the opioid crisis by asserting that “practitioners were urged to treat pain aggressively” (at 1:00 in the CBS This Morning clip) and that “many of us were even taught – incorrectly – that opioids are not addictive” (starting at 4:10 in the CBSN clip).
In another interview, also from 2016, the Surgeon General repeats (starting at about 2:38 in the MSNBC clip) that “clinicians were urged to treat pain aggressively”, that he personally was trained, 20 years ago, opioids “were not addictive so long as they were given to someone with legitimate pain”. He adds, “Even today I encounter doctors who still believe that [that opioids are not addictive] because they haven’t been taught any different”.
These are remarkable and remarkably disturbing statements on a number of counts, and demand our examination of them, a critical discourse about them.
But first, some background. The high abuse and addictive potential of opioids including those prescribed for chronic pain is long-established, generating a long history of statutory control e.g. Harrison Act (1914); Boggs Act (1951) and others.
The 1970 Controlled Substances Act lists opioid drugs commonly prescribed for chronic pain as Schedule II Substances, highly controlled as “drugs with a high potential for abuse, with use potentially leading to severe psychological or physical dependence”.
Those histories and basic facts would almost certainly be part of the training of any professional in healthcare administering or prescribing the drugs.
Opioid drugs and their potential for misuse have been part of American culture and mass media reports for many decades. Common cultural knowledge.
In that context, Dr. Vivek Murtha’s statements, barely challenged by his interviewers, taken at face value constitute a frank condemnation of both U.S. medical schools and education, and of the capacity for medically-trained professionals to independently use clinical competence and reasoning along with ethical judgment to protect Americans seeking medical care.
The assertions by the nation’s top medical official demand explanation from the medical community and institutions protecting healthcare consumers from harm:
- As to how it is possible that U.S. medical schools were teaching that opioids were not generally addictive in the context of the longstanding evidence base to the contrary, the statutory control, the explicit calling-out of the “high potential for abuse, with use potentially leading to severe psychological or physical dependence” in the 1970 Controlled Substances Act, statute that controls prescribing practices of all medical professionals.
- How it is conceivable that in 2016 the Surgeon General encountered “doctors who still believe that [that opioids are not addictive] because they haven’t been taught any different”. Consider the astounding nature of that statement by imagining a survey of adult Americans in 2016. How many would not believe that opioids are addictive? How many would claim that their beliefs about the addictive nature of opioids stem from what they have or have not “been taught” as opposed to scientific information about problem opioid use they are surrounded by in culture and mass media, the same popular culture and mass media that doctors are exposed to?
- In that cultural and information context, how is it conceivable that any unimpaired student in a medical school would accept at face value assertions by instructors that opioid drugs are not addictive, then practice medicine on that basis, without researching that question?
- How is it conceivable that medical practitioners, prescribing Controlled Substances Act Schedule II Substances, – highly controlled as “drugs with a high potential for abuse, with use potentially leading to severe psychological or physical dependence” – would take at face value and base clinical practice on the drug safety advice of “pharmaceutical companies”?
Murtha’s comments constitute weak and hollow rationalizations and excuses that miss the relevant issues and constitute disparagement of the many fine, competent, ethically practicing medical professionals – I know because I’ve worked with some of them – who have not overprescribed opioids or been directed by the “pharmaceutical companies” and who are able to use ethical and clinical reasoning to avoid contributing to the opioid crisis.
Instead of a tool of the medical industry and allied interests serving as a press secretary, we need medical field leaders with the intellectual courage to say something like this –
In the medical field, we’ve gotten off track and made fundamental errors in overapplication of our scope of competence and practice. We have unreflectively overapplied our model and training to problems that are not medical at all in nature – like common chronic pain – helping to create and then meet demand by a misled public for a pill for every ailment, every distress. That created a tragic opioid crisis.
We’re making the same error by attempting to rely on a medical fix for the opioid crisis we created, instead of supporting the fields of psychology and behavioral health in treating compulsive substance use – another problem that is entirely non-medical in nature and cause, as evidenced by decades of application of medical and disease models with no public benefit.
It’s time for change.
And time for us to force a critical discourse.
And take the power back.