Most people know the United States is in the grips of an opioid epidemic that claimed the lives of over 33,000 Americans in 2015 alone. But few understand how the epidemic began. To learn about the origins of the crisis, we reached out to Dr. Bobby Dey — a retired physician who once ran the top opioid-prescriber medical practice in America.
He says the crisis is really a case of good intentions gone wrong. The situation began around 20 years ago when physicians decided to take pain management more seriously.
"You've got to go back in history to when they made pain a fifth vital sign," Dr. Dey told Civilized. "They made pain as important as the pulse, body temperature, or blood pressure because it wasn't treated adequately. They did it for the right reasons. But when they did it, the physicians were obligated to prescribe patients with opiates."
That obligation inadvertently made physicians and patients dependent on a type of medicine with a glaring flaw that often leads to fatal overdoses.
"There are many downsides to opiates. One of them being that people develop a tolerance over time in that you need higher and higher doses over years and years for the treatment of chronic pain. I usually give a crushed foot injury as an example of something that's terminal in terms of symptoms that are never going to go away. If you crush your foot, it's always going to hurt. So those patients are typically on opiates for the rest of their lives."
Dr. Bobby Dey, pain management specialist
"If opiates didn't cause tolerance, we would not be here," Dey argued. "If I could give somebody 20 milligrams of Oxycontin a day or four Percocets a day, and ten years later, still be giving them that amount, they would be fine."
But that's not the way opioids work. So patients need higher and higher doses, physicians write bigger and bigger prescriptions, and neither one is really at fault.
"It's an inherent problem with the medicine," Dey explained. "There is really no one to blame. And the thing about opiates is — on the flip side — they work for pain. Opiates are the mainstay of treatment for pain-management specialists just like chemotherapy would be the mainstay treatment for oncologists. Nothing works better for pain than opiates."
Nothing that is approved as medicine, that is. But Dr. Dey thinks that cannabis could make opioids more effective.
"While giving my patients opiates, I noticed that some were taking cannabis — either on a recreational level or to treat the side effects associated with opiates. Those patients did not require an escalation in their dosing over time. Those patients were taking cannabis 3-5 years out, and I was giving them the same dose as I did prior to that."
So cannabis could fix the inherent flaw in opioids when used used in tandem. Or they could replace opioids entirely as an alternative painkiller, as recent studies have suggested. Either way, Dr. Dey believes the federal government is obligated to research medical cannabis thoroughly for the sake of patients across the country.
"There have been small studies but certainly not developed studies that show cannabis works as a treatment for chronic or constant pain," Dey said. "These patients with severe pain either need something different or stronger. And when you have something like cannabis that's been under our noses since forever. I mean, it's been there as an available drug for a very, very long time, you really are obligated to use it for its beneficial potential. Especially given that we're in this crisis really through no fault of anybody other than the properties of the drug itself."