Recently, while working at a methadone clinic, I met a woman in her 30s whom our healthcare system (and criminal justice system) has failed repeatedly.
Jamie—not her real name—has been addicted to heroin for several years. Her addiction started with a prescription for narcotic pain medication after a hysterectomy at age 24. She thinks her uterus was removed at that age due to polycystic ovarian syndrome, but hopefully she is mistaken. She has been through some nursing school, implying some medical knowledge, so regardless, someone failed to explain adequately to her why she underwent this surgery, which is typically indicated for cancer and/or refractory uterine bleeding and always postponed as long as possible.
FURTHER READING: To curb opioid abuse, new technologies must be embraced
Someone, or several healthcare providers, failed by performing this surgery without explaining the reason and obtaining informed consent. Informed consent would include a specific reason for the surgery, which would be memorable to the patient, including a list of all potential risks and benefits. Even if she remembers the reason incorrectly, hysterectomy at age 24 is highly unusual without a memorable event such as cancer.
After surgery, she developed severe anxiety due to hormonal changes, for which she self-medicated with opioids and other drugs. Jamie also has a diagnosis of lupus, which causes various pains, and this diagnosis allowed her to obtain prescription pain medications legally from doctors for several years.
Another failure of the health system was prescribing narcotic pain medications for chronic pain complaints despite inadequate, high-quality evidence suggesting safety or efficacy. From 1990 to 2010, physicians liberally prescribed opioid pain medications for many reasons: we were told/taught that addiction was rare, and we were subject to criticism and/or negative evaluation by patients and employers, which for some physicians had led to malpractice lawsuits for failing to adequately treat pain. This liberal prescribing behavior stemmed from another system failure—identification of pain as the fifth vital sign and adoption of this metric throughout the system, despite the obvious logical fallacy. Pain, by definition, is not a vital sign.
Overprescribing of opioid pain medications continued for several years, leading some unscrupulous entrepreneurs and physicians to open “pill mills” designed to feed rampant addiction for huge profits. As government and law enforcement began to recognize the negative consequences of the pill mills, they did what government does best—passed laws to solve this problem and crack down on the over-prescribers.