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Are clinicians complicit in the Fentanyl epidemic?

I have a friend. He is non-medical, just a person who knows a lot of people. He grew up on the rough side of town.

He has lost five friends or relatives this past year, he tells me. All to Fentanyl overdoses.

Most were young, in their twenties or thirties. Two were friends of his son, who is in his early thirties.

Most had been on prescribed opioids for a confirmed back injury—a fall while working in construction or an old football injury from high school or college.

Several had had their pain meds cut off. They had been obtaining them from their doctor, who then informed them he or she could not continue to prescribe them. So, they turned to street drugs, which were tainted with Fentanyl, and died.

Is there no other way to address opioid use? Can’t doctors prescribe methadone or Suboxone? Or keep their patients on reasonable doses of opioids to manage their chronic pain? That has to be a better alternative than witnessing people succumb to Fentanyl overdoses.

I know that some physicians have gone to jail for overprescribing pain meds. I am not sure if these were truly “pill mill” doctors or well-intentioned, conscientious practitioners. I understand that doctors are apprehensive about continuing patients on opioids; it might be easier to discharge the patient.

But surely, somewhere between the hysteria surrounding patients on opioids, there is a group of patients who have used Lortab or Percocet for decades without increasing the dose—who have benefited from a level of pain management for chronic pain related to back injuries, surgical mishaps, or other conditions that occurred through no fault of their own. I have encountered these patients and treated them during my practice in rural clinics in Kentucky.

It seems disingenuous to assume that every patient on pain meds is destined for a lifetime of drug abuse and a rapid descent into a life of misconduct. Most of the patients I treated were fathers or mothers raising families and trying to do the best they could despite dealing with serious chronic pain.

I hate to think that people are receiving inadequate care from their so-called providers and resorting to illicit street drugs for relief—resulting in tragic deaths due to the presence of Fentanyl in the drugs sold on the streets.

How many people have you heard of who have died young from a Fentanyl overdose? The number should be zero. We should be able to do better for our patients.

Something is amiss in this country if we cannot find a middle ground.

Janet Tamaren is a family physician.

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