America’s Failed Opioid Policy Drove the Tulsa Shooter to Violence
There’s an old adage among physicians that “the patient can always hurt you more.” This refers to the emotional toll personal mistakes and surgical complications can have on physicians when treating ill patients. A recent event has given that old adage a new, more tangible meaning.
Michael Louis, a patient at a Tulsa, Oklahoma, medical office, underwent spinal surgery last month. After being released on May 24, he repeatedly called the clinic to get further treatment for his lasting pain to no avail. On June 2, he targeted and killed his surgeon, Preston Phillips, before killing himself in a mass shooting.
While this story is shocking, it is not unpredictable. Doctors are often threatened by patients in immense pain after they are abruptly cut off from their opioid medications. How did we get here?
Policy makers and health care practitioners tend to misinterpret and misapply the 2016 Centers for Disease Control and Prevention (CDC) guideline for prescribing opioids for chronic pain, taking for a mandate what was meant as a general rule of thumb. Released as a measure to combat the overdose crisis, the report recommended imposing limits on the number of opioid prescriptions doctors could provide. This led many doctors, intimidated by possible consequences, to abruptly taper patients off pain medicine that has worked to treat and control pain for years. Horror stories about doctors being arrested or having their licenses suspended have led many physicians to give up treating pain altogether, refusing to see pain patients.
Misguided drug policy has stigmatized chronic pain patients, who are often suspected of being “drug abusers.” And many doctors are just as misguided as journalists and politicians in their understanding of the pharmacology of opioids, as well as the difference between chemical dependency and addiction.
Because the government and medical boards limit surgeons’ ability to prescribe opioids, surgeons, like us, can no longer treat a patient’s complex pain using our best clinical judgment without administrative oversight. This system builds a wall between patients and their doctors, creating an adverse environment. This is not what we expected when we took the Hippocratic oath.
Up to 40 percent of spinal deformity patients have had some sort of spinal surgery in the past (performed by a spinal surgeon like Phillips or like Richard Menger, one of the authors of this article), meaning many of them are on opio
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