Dishing out opioids was asking for trouble
he saga of the opioid crisis is finally drawing to a close with the news last week that Purdue Pharmaceuticals has filed for bankruptcy – the only way, apparently, that they can meet the $12 billion claims arising from the adverse effects of their powerful painkiller Oxycontin, which is allegedly a contributory factor to 400,000 fatalities in the United States.
The company may be culpable in overzealously promoting its immensely profitable drug, but so too are doctors for prescribing it for so long and on an industrial scale. What persuaded them to do so?
Looking back through my files recently I came across an article from 20 years ago in which I endorsed (rather uncritically perhaps) the arguments in favour as set out by pain specialist Dr Russell Portenoy.
“Opioids can be a safe and humane treatment,” he wrote, citing a study of 40 patients with intractable pain of the back, face or pelvis for whom, after “years of inadequate treatment by other means”, they produced “adequate relief ”.
It was claimed at the time that opioids, while open to being abused, rarely (if ever) become addictive. For some, opioids do work very well indeed – but certainly dishing them out to ever greater numbers of patients, and encouraging them to take them round the clock, might be asking for trouble.
And sure enough an authoritative article in the New England Journal of Medicine just five years later showed this to be the case.
But by then the policy of liberal prescribing, mandated in official guidelines, had become deeply entrenched in routine medical practice – and so it would continue until, very belatedly, the company was compelled to file for bankruptcy 15 years later.
The ear wax aerial
An acoustic engineer suggests two possible explanations for the experience of the gentleman “driven mad” by intrusive music seemingly channelled through his costly new hearing aids.
These latest devices come with a Bluetooth capacity that connects wirelessly to a smartphone and allows the wearer to have telephone conversations or listen to music. It could be that this function is faulty and he is “tuning in” to the electronic devices of others in proximity also using Bluetooth to listen to music on their headphones.
Alternatively, his hearing aids might be picking up a strong signal from a radio station: “The presence of moisture or wax in the internal electronics can cause its parts to act as a radio aerial.” Either way, the aids are presumably defective in some way and the manufacturers should either replace them or offer a refund.
An underlying cause
Finally, there is regrettably not much that can be done for those laid low following a viral illness other than to reassure them that they will eventually get better. Hence my thanks to a reader for the reminder that there may sometimes be a treatable underlying cause.
Earlier this year, he had a nasty
The policy of liberal prescribing had become deeply entrenched in routine medical practice
attack of flu from which he duly recovered, but remained physically and psychologically debilitated with pitiful energy levels and depressive type symptoms (low mood, irritability and forgetfulness) attributed by his family doctor to “post-viral fatigue syndrome”.
This dragged on for three months, until May Bank Holiday, when he woke in tremendous pain, his face so swollen that he could scarcely look out of his left eye.
The casualty doctor at his local hospital established, without much difficulty, that this was due to a major tooth abscess that had obviously been brewing for some time, for which he prescribed a five-day course of two antibiotics, metronidazole and amoxicillin.
As expected, the pain and swelling of the abscess rapidly subsided but simultaneously, mirabile dictu, his debility of the preceding months also lifted and he reverted to being “the happy, energetic and positive person that is my normal self ”.