Hidden Forces Behind the US Prescription Drug Epidemic

October 1, 2018
Anna Lembke, MD

Examining How Myths, Policies, and Practices Contributed to a Crisis 

After noticing more and more patients in her practice struggling with prescription drug addiction, psychiatrist Anna Lembke, MD, investigated the problem of rampant overprescribing in the US medical community and the hidden forces encouraging it. Her resulting 2016 release, Drug Dealer, MD: How Doctors Were Duped, Patients Got Hooked, and Why It’s So Hard to Stop, became an influential bestseller. Health Affairs deemed the work a “thought-provoking book [that] should be a must-read for medical trainees, providers, and health policy leaders working at the forefront of addressing the prescription drug epidemic."

Associate professor of psychiatry and behavioral sciences at Stanford University School of Medicine, California, Dr. Lembke will present a Featured Session at the upcoming Psych Congress conference. She recently talked with Psych Congress Network about the state of the US prescription drug epidemic, our modern-day aversion to pain of all forms, and how her medical colleagues have reacted to her book’s provocative title.

Q: Is there any good news with the current state of the opioid epidemic, or is the situation still especially bleak?

A: The good news is that opioid prescribing in this country has decreased by approximately 20% relative to its peak in 2012. Efforts to re-educate doctors and implement policies to curb overprescribing have had an impact.

The bad news is that we are still prescribing 3 times as many opioids as we did in the 1990s, 4 times as many as are prescribed in Europe, and more than 10 times as many as in Japan. Europe and Japan are apt comparisons because they are also rich areas with aging populations and comparable needs for analgesia.

In other words, although we’ve made progress, we still have a long way to go.

Q: Since the publication of Drug Dealer, MD, you’ve consulted with lawmakers and other officials looking to stem the opioid epidemic in the United States. What led you to become an authority in this area and then to write this influential exposé on the causes of opioid addiction?  

A: In the late 1990s and early 2000s, I was seeing more and more patients in my practice struggling with addiction to opioids and benzodiazepines prescribed by their doctors. I myself was also prescribing benzodiazepines and stimulants too liberally without recognizing I was harming my patients. When I realized there was a problem and tried to alert my colleagues, I met strong resistance, even among well-educated, compassionate, and well-intentioned health care providers. That made me curious about what I now recognize as the invisible forces inside medicine that can cause even a good doctor to provide bad care.

Register now for Psych Congress 2018, taking place Oct. 25-28 in Orlando, Fla.

Q: What surprised you in your research for the book? 

A: I was astounded by how much the pharmaceutical industry has a hand in dictating standards of medical care. Their outsized influence on what is hailed as “evidence-based medicine” was a huge factor in creating the prescription drug epidemic we face today. For example, The Joint Commission, which confers the gold standard approval that hospitals need for Medicare reimbursement, acquired opioid propaganda for free from Purdue Pharma [the maker of OxyContin] and sold it to hospitals trying to meet the new Joint Commission quality measure of “pain as the 5th vital sign.” Not only did the Joint Commission profit from this strategy, but it also perpetuated the myth that opioids were being underprescribed.

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