Who’s to blame for the opioid crisis?

If you’ve ever broken a bone, had a surgery of some sort, or even suffer from some chronic pain, you are probably familiar with opioids. Common kinds of opioids include Vicodin, Percocet, Oxycontin- these are all just derivatives of oxycodone and hydrocodone.

These opioids are both a blessing and a curse. Normally, mild pain like headaches and backaches can be dealt with by over-the-counter painkillers. On the other hand, opioids can be a godsend for people dealing with severe pain that they couldn’t otherwise continue their daily lives without.

When used properly, as in a monitored hospital or dosed out by a responsible third party, they are safe ways to manage pain. It’s when patients are sent home with 50-pill packs of Percocet and no warning other than a “these are highly addictive” that they become a problem.

There has been a dramatic rise in the number of opioids over the last 20 years . Between 1991 and 2010, the number of prescriptions almost tripled. Since then, we have seen an exponential rise in these already shocking numbers.

This begs the question of who is responsible? When you figure out who is responsible, you can then go about who to turn to for the solution.

Patients lead busy lives and don’t have the time nor are they willing to take leave from work or home responsibilities to deal with pain. The hustle-and-bustle of the typical day-to-day life of people, in general, has only grown as time has gone on.

By the same token, who’s to say that a doctor is responsible for every single patient they prescribe opioids to? Doctors take an oath to “do good,” and if prescribing their patients those opioids means fewer hospital visits complaining about pain and allowing people to continue doing what they need to do, isn’t that doing good?

These well-educated doctors are well-aware of the pressing issue that is the opioid epidemic, so it’s easy to ask why they just don't stop prescribing so much.

In fact, a study by the NIDA showed that patients only actually use about 28% of the pills in a typical prescription, so why are doctors prescribing so much?

There’s a lot of circumstances that doctors must consider. One detail particularly evident in rural communities is the lack of convenient access to healthcare.

Patients from these areas have often traveled far and wide to see these doctors, and they can’t necessarily travel back and forth to refill their prescriptions if the doctor were to prescribe a responsible amount of pills in a single prescription.

There is also a pressure the doctors face, especially doctors working in hospitals, and that’s a financial incentive. The Center for Medicare and Medicaid Services currently makes incentive payments to hospitals based partially (putting it humbly) on these patient satisfaction surveys.

These surveys ask questions like “Did the hospital do everything they could to help with your pain?” and are answered on a “never,” “sometimes,” “mostly,” and “always” scale. Here’s the catch: hospitals only receive credit for those answers when patients respond with “always.”

If you think this single survey is insignificant, in a study of 1,100 physicians in Ohio by the Ohio State Medical Association and the Cleveland Clinic Foundation, 74% reported that they felt increased pressure to prescribe opioids because of the pain management incentives in patient satisfaction surveys.

Other doctors argue that if they don’t give people the painkillers they ask for, they will just go to another doctor. People need their quick solution.

So who is the bad guy? Is it the educated and high-paid doctor who knows more than anyone that these drugs are addictive? Or is it the irresponsible patient taking Percocet like it's Advil?