The Centers for Disease Control and Prevention recently reported that physicians' prescribing practices have finally caught up with us in a big way. In 2009, the annual number of deaths (37,485) caused by improper/overprescribing and poor to non-existent monitoring of the use of tranquilizers, painkillers and stimulant drugs by American physicians now exceeds both the number of deaths from motor vehicle accidents (36,284) and firearms (31,228). Deaths from street drugs during 2009 were vastly less than those caused by prescription drugs. Medical doctors are leaving regular drug dealers in the dust.
Every 14 minutes one American is killed by prescribed painkillers and psychiatric drugs. The number of "anxious" people or prescription tranquilizers taken by "anxious" people for "anxiety" has jumped 286 percent between 2000 and 2009, and should reach 341 percent by the end of 2011. Really. The prescription of stimulant drugs, amphetamines and methyl-phenidate -- Adderall and Ritalin -- has skyrocketed. The U.S. now consumes 86 percent of these drugs worldwide. The prescribing of painkillers, the leading killer, has also risen dramatically, 328 percent, during this same time period. Vicodin kills the most pain and people, and is the single most prescribed medicine on the face of the earth.
The vast majority of these 37,485 deaths were not caused by intentional suicide. Causes of death range from overprescribing, over-usage, not following the prescriptions directions, drug mixing, mixing drugs with other substances such as alcohol, accidentally doubling doses, replacing doses thought to have been missed, etc. Because of overprescribing, the streets are awash with prescription drugs, which bring lots of money. We doctors have inadvertently created a vast black market for all of these prescription drugs. A prescription of 20 Vicodin pills, for example, perhaps purchased through insurance with a very minor cash outlay, is worth about $1,000-$2,000 on the street -- a nifty profit. Pain relievers (Vicodin, etc.), tranquilizers (Xanax, Klonopin, Ativan, Valium), stimulants (Adderall and Ritalin) are all easily obtainable on the street, although at very high prices. Interestingly, the cost of these prescription drugs on the street are considerably higher than the cost of heroin and cocaine.
Information is not available on which disciplines of physicians prescribe which of these drugs. Some inferences can be drawn. Painkillers, for example, according to the CDC, are the most dangerous of all these drugs. They are usually not prescribed by psychiatrists but by other physicians. Psychiatrists usually prescribe tranquilizers and amphetamines, as well as other drugs not identified by the CDC as killers (anti-psychotics, mood stabilizers, antidepressants, etc.) Other physicians also write prescriptions for tranquilizers, antidepressants, amphetamines and painkillers. Which disciplines in medicine prescribe the most of the drugs that cause the most unnecessary deaths isn't clear. Realistically put, however, all us physicians are in this together.
The only specialty group of which I am a member, psychiatrists, is the only one about which I have direct knowledge. We are major contributors to the prescribing of many of the drugs the CDC has identified as killers: tranquilizers and stimulants. We are the 5-15 minute drug-check prescription writers.
We have other drawbacks. We nearly always lack the type of knowledge other physicians have. A cardiologist, for example, can identify a "heart attack" by history, physical exam, blood, electrical and X-ray tests and take appropriate, scientifically-proven treatment measures and measure the results of these tests. We surmise based on patients self-evaluation and our discussion with them, diagnose, and then write prescriptions. Having been "diagnosed," discussions with the psychiatrist, minimal at first, become shorter and shorter. The patient comes in for a med check and only a few minutes later emerges with his new prescription, maybe with an increase, decrease or maybe a drug change or addition. Not good at all.
What to do? Least we all run all psychiatrists, including me, and other physicians out of town, let us remember that the vast majority of physicians, psychiatrists included, are ethical and moral beings and generally do a world of good for the vast majority of us. The very large majority became physicians to help people, hardly to hurt them, let alone kill them.
There's a lot we can do. As physicians, we can be better educated, more aware of the very serious prescription drug problem that we propel, intentionally or not. We can have higher thresholds for prescribing, be much more cautious, write generally for less, talk more and educate our patients. We need more education on the illicit use of legal drugs. The DEA needs to be stronger and more aggressive. More backbone to say no wouldn't hurt.
The pharmaceutical industry certainly doesn't help, although one would be in dreamland to expect them to try to sell less drugs and make less money. They do their best to make more drugs, promote them, sell them, encourage their use, find new uses for drugs and make profits. Societies' woes fatten their wallets.
Let's not leave us out. Us civilians. We also drive the problem. We are a pill-crazed society. We want pills. We have to want less. The war on drugs didn't work. Efforts at education about drugs usually fall deafly on the ears of the deaf and are welcomed by the ears of the already believers -- preaching to the choir. Will we respond better to the horrendous information about prescription medication misuse than we did and do to information about illicit street drugs?
"We have met the enemy, and it is us." -- Pogo