Heartrending stories are seen in these offices daily: the young teen
who has talked about nothing but getting pregnant finally succeeds;
yet another patient dies of a drug overdose, accidentally or intentionally; or the baby rushed to the hospital, the victim of child abuse.
Then there is the consequence of years of selling their bodies and
souls for the drugs they seek, in return getting Hepatitis C and HIV,
jail and mental institutions. It is especially painful to medical office
staffs, who have tried to intervene to help those whom in the final
telling, could not be helped. What was once thought only happened
in big cities, arrived with a vengeance this year in multiple small
communities, particularly here in southern Indiana. The discovery
of a severe HIV epidemic brought into glaring focus what has been
simmering for years underneath the seemingly bucolic landscape.
able to care for them because they are too busy getting their next fix.
Narcotic abuse, as with other addictions, is an individual choice
at heart, but is a family disease, making some members enablers or
fellow addicts, others codependent or others completely estranged
for self-protection.
In my practice, I have a discussion about pain management
before surgery so the patient and I are on the same page. This reduces patients’ unreal expectations, and since I will stick with our
mutual agreement, I feel somewhat more comfortable prescribing
limited amounts only for postoperative pain. I know this is a drop
in the bucket. I worry about the role some pain clinics play, with
ongoing prescribing; I worry about the effort (or lack of) to wean
or ultimately take them off the drugs altogether.
So, it is here…now what? An enormous amount of time and
money has been spent on how best to solve the problem, but still
the problem remains. Will a certain subset of people be written
off because nothing seems to break the cycle, since grandparents,
parents and teens are currently getting high together? What about
the babies of those addicted? Will they be different? Many of these
children are in foster care because of neglect, since families are un-
There are no easy solutions; current responses include imprisonment, and sometimes regimented medical programs if the person is
lucky. Concerted efforts have been made with state support through
the health department in Scott County. The problem is so widespread
that nothing short of national debate and implementation of well
thought out comprehensive measures are needed. Otherwise the
end is not pretty: opiate addiction is progressive, often fatal, and can
leave its ugly mark on the national psyche. However, it behooves us
to have a pragmatic discussion with the patients and offer treatment
options instead of writing a prescription or just saying outright no.
A patient in the throes of his addiction will find alternate means
from the street, sometimes with lethal results.
Dr. Aziz practices Othopaedic Surgery with St. Vincent Medical
Group.
FEBRUARY 2016
17