Last spring, the family of former National Hockey League player Derek Boogard filed suit against the NHL, alleging that the league was essentially responsible for his overdose death by introducing him to prescription painkillers and not monitoring his addictive behavior (like “doctor-shopping” and rehab relapses) closely enough.
Although this lawsuit likely won’t be resolved for several years, it could trigger a possible paradigm shift in how powerful painkillers are prescribed — a shift that is long overdue.
Boogard is just one of thousands who have died from the misuse of opioids. There are a number of reasons for this, both systemic and societal.
As a society, we have become accustomed to getting instant solutions to our problems, whether they are simple (like returning a purchase) or complex (like treating chronic pain). This expectation of instant and complete pain relief has been exacerbated by the increasing pressure on medical practitioners to achieve high levels of “patient satisfaction” — and unfortunately, patients on a slow-but-steady pain treatment regime typically aren’t as happy as those whose problems are instantly fixed by prescription drugs. Unhappy patients tend to be very vocal in online rating forums and social media sites.
As a result, prescription opioid painkillers have become almost the default treatment for acute and chronic pain, leading to some shocking and alarming statistics. It is estimated that there were enough prescription painkillers prescribed in 2010 to medicate every American adult around the clock for a month. More importantly, there were 38,329 drug deaths in the U.S. in 2010, compared to 16,849 in 1999. Of these deaths, 60 percent (22,134) were due to prescription painkillers, as compared to 4,030 in 1999. And it could have been worse — there were nearly half a million emergency room visits related to prescription painkiller abuse.
The trend line here is pretty clear. Because of this, the Food and Drug Administration has taken a series of steps recently to prevent prescription opioid abuse, including tougher restrictions on hydrocodone and making the generic form of oxycodone illegal (since it is more easily abused).
While I applaud these steps, there is more than can and should be done by both the medical community and by patients themselves. As physicians, we must guard against overreliance on prescription painkillers. While there are circumstances in which they are necessary, they shouldn’t be a default.
We must start by helping patients pinpoint the specific causes of their pain through diagnostic procedures and imaging, rather than immediately jumping into surgeries and prescriptions. This approach isn’t only good medicine; it is good business and good public policy.
Additionally, I hope a focus on pioneering, minimally invasive procedures — such as neurostimulation and cooled radiofrequency ablation — move to the forefront of medical practice. These interventional procedures are not only less expensive than traditional types of surgery, they require shorter recovery times and less follow-up care.
The last, and perhaps most important, component to making chronic pain treatment more efficient is increasing the participation of patients in their own care. Medical providers should engage their patients in weight loss, home exercise and smoking cessation programs — all of which have been shown to have an impact on spinal pain. All of these preventive measures will help people avoid injury, illness and other causes of chronic pain in the first place.
By helping get patients more actively involved in their own pain management, as well as reducing our reliance on prescription drugs, we can go a long way towards preventing future tragic incidents like Derek Boogard’s.