The U.S. Department of Health and Human Services’ declaration of a national public health emergency in 2017 included a reference to the fact that 91 people die each day from opioids. Pharmaceutical companies encouraging physicians to freely prescribe their opiate-based products and unscrupulous doctors profiting by indiscriminately, and in some cases illegally, prescribing opioids have been identified as factors contributing to the current health crisis.
Officials searching for solutions may find striking similarities between today’s public health emergency and the situation that existed in post-Civil War America. Pharmaceutical companies marketing opiates as cures for menstrual cramps, asthma, headaches, and other common ailments and diseases had physicians willing to prescribe them for their patients without any thought given to the consequences.
Heroin for your child’s cough
Opium was the medication of choice to relieve the pain of wounded soldiers during and after the Civil War. Thanks to a lack of regulation over opiates at the time, soldiers returning home from the battlefield had no problem finding physicians willing to inject them with morphine or provide another form of opiate to satisfy them.
A growing awareness of the addictive nature of opiates caused pharmaceutical companies and the medical profession to look for anon-addictive alternative. Bayer, the German company most people now associate with aspirin, introduced a new cough suppressant for children toward the end of the 19th century. The company touted its new product as lacking the addictive properties of morphine and other opiates commonly used to treat coughs in children. Bayer named their new product “Heroin.”
Lessons to be learned from history
If the thought of a parent giving a child heroin to suppress a cough is unfathomable to you, think about the trust you place in your doctor to prescribe safe medications for you and your children. The trust that physicians would honor their Hippocratic oath and do no harm to a patient was as true then as it is now. Yet, the willingness of 19th-century physicians to blindly accept pharmaceutical company claims about the drugs they produced led to widespread addiction and dependency.
Just as doctors in the 1800s believed that heroin, an opiate derivative, would be safe for children and not addictive, 20th-century medical professionals were equally mistaken when they believed that the pain experienced by patients treated with opioids would prevent them from becoming addicted. Educating medical professionals and the public about the dangers posed by opioids was effective in the past and should be part of programs on the state and federal levels to curb the current wave of addiction and deaths related to prescription medications.
Enacting and enforcing laws
Laws enacted to attack the opioid crisis in the early decades of the 20th century focused on reducing the available supply of drugs. Still, such laws do not take into account the 20 percent of patients suffering from chronic pain for which opioids may be the only effective treatment. The approach taken by officials in Oklahoma maybe more effective in curtailing over prescribing by physicians.
Oklahoma limits the initial quantity of opioids a physician may prescribe for a patient to a one-week supply at the lowest dose. Doctors may not prescribe more medication without reassessing the patient’s need for the drug and determining that abuse or dependency is not an issue.
More can and should be done, including expansion of the use of prescription drug monitoring programs in each state to track the prescribing practices of physicians. This could allow medical professionals and state officials to identify and bring enforcement proceedings against medical professionals over-prescribing opioids.