Michael Jackson had pain, unbearable pain. Not just the chronic physical ailments of a middle-aged performer, but also the unique pain of being Michael Jackson; the pain of stardom too early, of being uncomfortable in his own skin, of multiple failed marriages, of a damaging lawsuit, and of a never-ending parade of rumors and innuendo.
As we found out last week, Michael Jackson was treating his pain aggressively with prescription drugs. Reportedly, one of these drugs was Demerol, a painkiller so addictive and dangerous that it has been banned from many Emergency Departments. Another was Oxycontin, a drug that if chewed or crushed rather than swallowed whole causes a heroin-like high. A third may have been Diprivan; a powerful anesthetic that should only be used in carefully monitored settings because it suppresses the drive to breathe. Regardless of whether some or all of these drugs played a role in his death (and my guess is that they did), it is pretty clear that Michael Jackson was an abuser of prescription drugs. And in this, he was certainly not alone.
Prescription drug abuse is a big problem in this country, and one that is getting bigger by the day. A 2006 national survey estimated that 5.2 million Americans take prescription painkillers for non-medical reasons each month – that’s more people abusing prescription drugs than cocaine, hallucinogens and methamphetamine combined. And this number does not include those people who have been diagnosed with chronic pain, a group who are known to suffer from a high incidence of untreated depression and other psychiatric problems. Among the tens of millions of prescription painkiller users, thousands die each year from unintentional overdoses – in 2004 alone 7,500 deaths were attributed to narcotic painkillers (synthetic opiates such as Oxycontin). This, from a numerical standpoint, makes prescription narcotics far more lethal than either cocaine or heroin.
So, as Michael Jackson’s sad demise illustrates, we have a prescription painkiller problem, and I, for one, wonder if we are over-treating pain. Have we, in the process of attempting to ensure the comfort of the gravely and terminally ill, created a morass of prescription drug addicts? Of codeine collectors, Percocet poppers, VicoHeads and Dilaudid darlings? I see these people every day; because while Michael Jackson had his own Dr. Feelgood, many prescription drug abusers rely on their local emergency physician to get them a fix. Some of these “patients” are in their twenties and have no clear medical reason to be hooked on 360 pain pills per month. Of course, I’ll admit that pain is a difficult thing to measure, and I am sure that the majority of my patients have real pain. But some of them are just plain junkies. And junkies will say or do just about anything to get high. They will give fake names (which is a criminal offense) and construct elaborate stories. One patient recently told me that his house had burned down, taking with it a six-month supply of Vicodin and Xanax, and demanded that I refill the medications immediately, as he was due to catch a flight to Costa Rica in a few hours. Upon further investigation, the fire department had no record of such a fire and his flight to Costa Rica was merely theoretical. Prescription drug addicts will even cause themselves physical harm in order to get a prescription – a colleague of mine once caught a patient trying to fake a painful kidney stone attack by scratching at his urethra with a paper clip.
In an Oregon study tracking 30 drug-seeking patients over the course of a year, these patients had more than 12 pain-related ED visits annually, visited an average of 4 different hospitals and used 2.2 aliases. Sadly, if healthcare providers at one facility refused to give unnecessary narcotics, the patients were usually able to obtain them elsewhere (over 90% of the time). Two of the 30 Oregon patients died of drug overdose. They weren’t named Michael Jackson, so their deaths didn’t garner much attention. But they should have, because they were preventable.
It’s time to recognize that not all pain is equal and that we need a structured means to cut off the supply lines to abusers and funnel them into treatment programs. Some addicts may be beyond help, but we must stop facilitating the habits of those who can be rehabilitated. And, friends, family and physicians need to confront people who appear to be entering a cycle of narcotic dependence lest they themselves become ‘the man in the morgue.’