The horizon is not so far as we can see, but as far as we can imagine

Doctors Paid More by Opiate Manufacturers Prescribe More Opiates

Quelle Surprise?

In 2014 and 2015, opioid manufacturers paid hundreds of doctors across the country six-figure sums for speaking, consulting and other services. Thousands of other doctors were paid over $25,000 during that time.
Physicians who prescribed particularly large amounts of the drugs were the most likely to get paid.

Now the article and researchers are quick to point out that causation is not proved, but…

This isn’t an unknown effect. Doctors who get paid more for surgery are more likely to perform surgery, even if non-surgical alternatives are considered a better idea. If they own a share in the institution doing the surgery, even more so.

I don’t like to get down on opiate prescribing, because I think the larger problem is all the doctors who won’t prescribe them. Even in Canada, it seems like every doctor’s office has a notice saying they don’t prescribe narcotics.

Huh? And if the patient is obviously in a lot of pain, you’re just going to let them suffer? We’re in a period of hysteria over narcotics.

That said, it’s also important to note that, yes, you tend to perpetuate the behaviour that you reward.

This is why money should largely be kept out of doctors’ decisions about appropriate care (and everyone else’s). It should not be a consideration except in the most extreme cases. A doctor with no skin in the game, monetarily, will tend to make better patient care decisions, because patient care will be their primary concern.

And, oddly, not only is that good for patients, in most cases that don’t involve end of life care, it is also cheaper, though that’s not why you do it.

Money doesn’t belong in large number of places. It should not be a concern for frontline care workers in almost all cases.

Exhibit five million somethingty.

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  1. Hugh

    Pain management is an area that physicians do not do well. It needs a good initial assessment and close follow up. The first is usually skirted and the second is simply not done. There are time considerations, medico-legal ones, and shaky clinical training in pain management.

    The medicine is tricky. Addiction is defined as any use beyond that needed for pain. There are no limits on time or dosing under this guideline, except for unacceptable side effects and mortality.

    And this does not even begin to get into the issue of pill mills. Speaking of which, Trump wants to kill drug dealers. Would this include physicians who overprescribe? Would jt include the Sacklers who own most of Purdue Pharma, the maker of oxycontin, its executives, and drug representatives?

  2. That’s funny, because my assigned medicare “doctor’, a white girl from Chicago that stands as short as I and outweighs me by a hundred pounds and whose only interests seem to be sticking her finger up my butt and infecting me with a live virus, doesn’t seem to understand the simple combination of the (American) English words “No, I don’t use drugs”.

  3. First, get rid of THC restrictions. It is almost impossible to gain addiction and is easily watched by nurses for side effects.

    This will leave many few in intense pain – the kind that more expensive and dangerous chemicals are needed to treat. But then, it is a lower load – so more attention can be paid.

    There are costs – but lower on the scale. And you don’t need to misexplain several points of bio.

    You also won’t prescribe things that are a whole bunch worse.

  4. Z

    I know it doesn’t have the clear body counts as the opiate ODs do, but I suspect the overuse of the ADHD/Adderall type drugs has had a far greater negative impact on our society.

    I suspect a lot of people in power are on these types of drugs … they seem to make people feel more powerful, more energetic, more selfish, and a hell of a lot less empathetic … and I’d bet that it has led to a much bigger body count when looking at further order effects.


  5. Ché Pasa

    Yes, well, we’ve known this for some time, haven’t we? The issue of vast oversupply of prescription opioid medication in some areas, together with profitable over prescription of opioids (in the same areas, surprisingly enough) followed by increasing deaths from overdose, which in turn is followed by strict limits on availability of prescription pain medication, which is followed by the more and more widespread availability of stronger and more deadly illicit opioids, leading to more deaths from overdose is a cycle pretty well documented by now.

    It does not seem to be accidental or inevitable. Not at all.

    In the meantime, people who suffer from severe chronic pain cannot get sufficient (or in some cases any) prescription medication for their pain. Not surprisingly, some turn to black market alternatives. With predictable results.

    Culling the herd, right?

  6. atcooper

    I’ve had the pleasure of knowing a fellow with muscular dystrophy and he preferred THC above all else because it allowed him to maintain some concentration.

  7. Hugh

    I agree with Z. It isn’t just overprescription. It is also overdiagnosis/sloppy diagnosis leading to unwarranted prescriptions.

  8. Z


    Yeah, I think most of the ADHD/Adderall type drug prescriptions given out are the result of a willful dance between the patient and physician. The patients know what to say and they go to doctors who they know are easy to get a prescription from. I’d imagine that the vast majority of people using those drugs are not ADHD at all but are using them to increase their focus and hence boost their productivity at school and work.

    I sense that it has become a hidden epidemic … another one, of course, that the pharmaceutical companies have promoted and financially benefited from … and it’s produced a lot of hollowed out, selfish, hyper-aggressive people that are drawn towards positions of power.

    It’s apparently a very powerful, clean speed that I’ve heard has a lot of similarities to crystal meth. It makes people focus … on themselves and their “needs” … and, from what I’ve seen, the people that use it think a mile a minute and about one inch deep. However, in our sociopathic, productivity obsessed society it is fuel on the road to success.

    The body counts from this drug don’t come from the users, but from the people that are subjected to their actions.

    I’ve got a lot more to say about my experiences with people using it, but not much time right now to say it. Hopefully, this is a subject that comes up for comment at some point. It’s well worth discussing. I think its effects on our society are widely underestimated. In fact, most people have no idea about it at all because if you don’t use it you are not likely to understand it since the people that use it don’t often openly divulge that they do and reveal their crutch. I have never used it myself and I had no sense of it until recently. It’s been quite a revelation.


  9. Hugh

    I stumbled across this article that gives a kind of official medical version to the opioid crisis:

    In short, it cites a one paragraph letter to the New England Journal of Medicine in 1980 which asserted that in a retrospective review only about .03% of those treated for pain with opioids became addicted. This letter was subsequently cited hundreds of times and, with other shoddy research, shifted the use of opioids from the treatment of acute pain to chronic, i.e. long term lower-level, pain. This resulted in a much more widespread prescription of opioids. The process was further accelerated by changes in reimbursements which tied these to patients’ perception of their pain management. That is a situation where both patients and physicians had strong incentives to keep the opioid pipeline open and running full tilt. What could go wrong? The article says that currently one-third of Americans use prescription opioids. I would assume that does not mean all now, but I don’t know. And that the US accounts for 80% of the world’s use of opioids, which is believable.

    The problem with the article is the idea that somehow for nearly 40 years, physicians did not know and public health policy ignored the blatantly obvious connection between opioid prescription and the mushrooming addiction epidemic.

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