For many years, I handled sufferers with power ache. One reality grew to become evident early: most older adults prescribed narcotics use them responsibly. My scientific acumen, formed over greater than forty years, intuitively knew this to be true. Nonetheless, I understood that instinct and opinion alone are inadequate. Compassion in drugs have to be paired with objectivity.
Now the information confirms what follow lengthy urged. A nationwide survey of adults aged 50 and older reported that 8.9 p.c of these 50 to ∂64 misused prescription opioids, however misuse dropped sharply to simply 3.2 p.c amongst these 65 and older. Meaning 96.8 p.c of seniors don’t misuse their treatment, but present prescribing tradition typically treats each older affected person as if they’re potential abusers.
This isn’t how compassion works. It isn’t moral to let practically all sufferers undergo as a result of a small minority would possibly misuse. Abusers are shortly recognized: their tales collapse underneath light however agency scrutiny. A affected person as soon as claimed her narcotics had been stolen when her purse was taken from her automotive. I expressed sympathy and advised her I’d gladly refill her prescription; all she wanted to do was present a replica of the police report. She by no means returned. No lie detector was obligatory. Her story collapsed underneath the burden of its personal implausibility.
In the meantime, accountable sufferers (lots of them aged) are left untreated, stigmatized, or deserted. Insurance policies pushed by worry of audits or “pharmacy policing” have led to unintended penalties. Sufferers with reputable ache are pushed to alcohol or to the road, the place fentanyl contamination makes each capsule probably deadly. In attempting to keep away from one tragedy, we now have created one other.
For sufferers 65 and older who’ve by no means misused medication, the good thing about narcotics underneath medical supervision far outweighs the chance of habit. High quality of life (the flexibility to stroll, to sleep, to stay with out agony) is extra essential than appeasing auditors or regulators.
The answer is easy: use objectivity. If the issue is abuse, say no. If the issue is ache, say sure. Anything abandons sufferers to pointless struggling.
Claude E. Lett III is a doctor assistant.
