We physicians are bad at politics.  Our organizations rarely represent our interests and often the opposite.  This is our own fault because we are, well, busy.

For years, opinion polls have shown that the medical profession ranks at or near the top in public perception of honesty and integrity.  Politicians, on the other hand, are consistently at the bottom of these same surveys.  This is certainly noticed by the political class and likely bothersome.

Politicians across the spectrum have advocated restrictions on physicians ordering narcotics for pain control, citing excess prescriptions as the prime cause of the current opioid crisis.  State laws have been passed to restrict how much pain medicine can be ordered.  Doctors have been prosecuted for "over-prescribing," sometimes with lengthy prison terms.  Due to the fear of reprimand, loss of medical license, and even incarceration, there has been a drastic reduction in the amount of opioid prescribed (1).  As a result many people who live with chronic pain are unable to get proper treatment, which often includes the judicious use of narcotics.  They suffer needlessly because politicians have legislated how doctors can treat patients.

The statistics on the opioid crisis are deceiving.  Deaths from illegal street drugs and prescription medications are lumped together, making it appear as though they were equally culpable.  Since 2011, the number of yearly overdose deaths from prescription medications has been about the same, while deaths from street drugs have increase exponentially (2).  At the same time as the number of narcotic prescriptions has decreased significantly, the rate of opioid deaths has continued to rise sharply.

Anyone with a minimal knowledge of statistics would have to conclude that prescription narcotics are not the cause of these deaths.  If anything, it is the exact opposite.  If someone with real pain is not treated appropriately, he may well seek street drugs, which include foreign-made medications of dubious quality and even hard narcotics.  Using street drugs to self-medicate is dangerous and increases the risk of overdose, addiction, and death.

The majority of opioid overdose deaths are due to heroin and illicit fentanyl (2).  These drugs are readily available throughout the country.  Failure to secure our borders and inept policies in the war on drugs have resulted in a large supply of illegal narcotics with subsequent lower prices and greater potency.  The combination of availability, low cost, and high potency is a blueprint to increase opioid overdoses and deaths.  Clearly, it is the incompetence of the government that has led to this situation, not physicians treating pain.

We physicians sometimes get to save lives, but more often, on a day-to-day basis, we serve our patients by relieving suffering.  This makes a huge difference in the quality of people's lives and earns their respect and trust.  Why have politicians decided to interfere with this aspect of the doctor-patient relationship?  Is it an attempt to shift blame for a problem they caused?  We politically feckless physicians are an easy target.

Is it pure political posturing?  Politicians always want to appear to be doing something (anything) during a crisis.  Is it resentment toward physicians?  Managing how they are viewed by the public is a big part of a politician's skill set.  Is it ignorance?  Few politicians have treated people with severe pain.  Is it all of the above?

The bottom line is that targeting physicians has not changed the rate of opioid deaths and if anything is making the problem worse.  As an "unforeseen" consequence, people with well documented pain syndromes are not properly treated and pay the price.

(1) CDC Centers for Disease Control and Prevention.  CDC.gov.  U.S. Prescribing Rate Map, 2017.

(2) NIH National Institute on Drug Abuse.  drugabuse.gov.  Overdose Death Rates, Aug. 2018 revision.