Opioid manufacturing and prescribing is a multi-billion dollar industry that only seems to be growing into even more obscene figures year after year.  The pharmaceutical industry finds itself in the precarious position of filling a void in the marketplace and adhering to ethical codes of conduct and integrity in its business practices.  Big profits and morality in business are often diametrically opposed principles incompatible with free market enterprise and western capitalist modes of thought.  

“We really have to strongly consider who it is you offer opiates to, and who you don’t,” Dr. Joe Contreras, from Hackensack University Medical Center, said.  Contreras is the uniquely distinct position to bridge these competing interests where corporate greed and personal responsibility intersect as he prescribes opioids to patients across the spectrum.  Cancer patients are the majority of people he prescribes these medications to, although there are the rare occasions where people who suffer from debilitating and chronic pain use his services.  

“In fact I have had a patient with cancer pain who has overdosed, but in discussion we found out that it was accidental. We’re much more careful,” he said.

A Boston Medical Center survey found a disturbing theme among doctors continuing to prescribe opioids to patients who had overdosed, even while under their supervised care.  This wanton disregard and reckless abandon to the Hippocratic oath taken by doctors is a real major concern.  

“We were shocked and alarmed at how frequent and high that continued prescribing rate was,” Dr. Mark Larochelle said.

Larochelle spearheaded the study focusing solely on non-cancer subjects.  The underpinnings behind the study suggest that there needs to be a better communication model interface between doctors and patients so they may be aware of these accidental overdoses and any indiscretions.  

The study really underscores the heart of the matter which is how are we supposed to progress and make strides in the right direction when we have no clue what we are doing and absolutely no accountability.  

“If it were within my institution, and within our network, I would absolutely find out about it. If not, I’d have to rely on the patient volunteering that information to me,” Contreras said. When asked if that’s a flaw in the system, he said, “It absolutely is.”

The American Academy of Pain Management seems to be of the opinion that increased legislation and oversight on the part of government institutions will get the problem under control, but that remains to be seen.

“Around the country we’ve all been working towards an electronic health record, but the trouble with those records is that they often don’t interface or talk well to one another. We do have prescription monitoring services in 49 out of the 50 states that tell us when patients receive prescriptions for opioids. Unfortunately, those prescription monitoring services don’t include information about overdose and that’s something that the American Academy of Pain Management that we’re considering as a policy measure to ask states to put that in place,” Clay Jackson said.

New Jersey began its prescription monitoring initiative almost two years ago now and Dr. Contreras believes it has been able to successfully keep tabs and observe the doctor shopping that has become rampant.  He illustrates the need for transparency in all aspects of the program from doctor to patient confidentiality and information consent.  Another integral facet not to be lost in the political fluff and smoke and mirrors is educating doctors.

“I think that they’re not informed because for many years there was a misconception about the safety of these drugs. I think we’re learning more and more as the country and the state are now experiencing epidemic levels of abuse of opioids. We’re learning that these are very dangerous drugs and information should be given out to patients about how addictive they can be,” said Angelo Valente, Executive Director of Partnership for a Drug-Free New Jersey.

This isn’t the first rodeo as this legislation has been introduced and shot down before.  So starting this year the Partnership is undertaking the helm and unrolling a campaign of ads, asking parents if they would give their child heroin, an opioid, for a broken arm, sports injury or root canal.