The Feb. 15 editorial, “The iatrogenic roots of the opioid epidemic,” fails to point out the whole context of the problem. If you put together all of the elements, it is a perfect storm of unintended consequences.
Yes, physicians are complicit in the prescription of these compounds. But what about the drug companies with their misleading and ever-expanding direct marketing? What about the relentless pursuit of increased patient satisfaction metrics and the attendant financial losses for failure to achieve same? And what about the American Pain Society's push to list “pain” as the fifth vital sign? And then there are the Joint Commission's standards for assessment and treatment of pain.
We've been warned to be careful what we incentivize, because it will come back in spades. We are now dealing with all the unintended consequences of a multiplicity of directives.