The Oxy Dilemma

On an otherwise unremarkable grey and cold January afternoon two years ago in the Washington, DC area, my mother and I were returning to her apartment in time for lunch. Excitedly, my mom offered a variety of dining options, focused mostly on her proud inventory of fresh breads, cold cuts, and cheeses. She wanted to put the meal together, but I assured her that I was fully capable of assembling my own sandwich, especially in her present condition. You see just 24 hours earlier, almost exactly to the minute, a surgeon had tied off the final stiches to my mother’s hip replacement. That wild look in my mom’s eyes and frantic speech was the Oxy taking over her body.

This all came to mind last week with the news that a group of pharmaceutical companies, distributers, and litigating states had reached a settlement concerning abusive selling and distributing tactics of Oxy. By now we are familiar with the story of Oxy, the miracle drug that, unlike other powerful medicines, would save patients from excruciating pain with barely a chance of addiction. Society (and a fair chunk of the medical industry) all took a bite from this apple of pharma Eden and, just like Adam and Eve, were cast out from paradise. While nobody will publicly take any of the blame, now there’s $26 billion to start repairing some of the damage.

I would be more hopeful if some of the money would do some good, but the signs are not promising. While not allowed to fill state budget gaps, the money can go treatment centers (nice, but kind of after the fact), pill and needle disposal education (which doesn’t address using too many pills or shooting up drugs), or providing funds for first responders (and while paying for more NarCon sticks is great, it would be better if folks didn’t need it in the first place). So while the landmark tobacco settlement at least tried to promote better behavior from the tobacco companies (no more billboards, super-slick marketing, or Joe Camel cartoons), after the Oxy agreement we are still left with an extremely powerful narcotic, legally manufactured and distributed, and freely prescribed by medical professionals. Isn’t this how we got here in the first place?

After getting my mom comfortable in her bed and dulling her mind with daytime TV, I went about a week’s worth of playing a combination of loving son (OK, I am a loving son) and Nurse Ratched (I couldn’t let her fall because she forgot to use her walker or accidently let her start in on her 6:00 PM wine). One important role was to keep track of her medications, and part of that meant a bottle of 40 Oxy pills—one every six hours. The first few days required full Oxy dosage, but after that we had a good rapport of me offering pills at the allotted time and she would figure out if she needed them. Once in a while she would ask for one unprompted, and I was happy to oblige. It may have been amateur pain management, but I think we made a good team and kept her from suffering unnecessarily. In the end she went through about half of the bottle, with 20 or so pills still left. Had mom wanted, she could have shilled those extras on the street for $20 a pop, and traded up her Two Buck Chuck for some excellent Trader Joe’s Reserve wines.

And while some states now have requirements for electronic prescription submission and ID requirements to pick up meds such as Oxy, is it right to prescribe that many pills in the first place? I’m sure the medical literature from all the studies indicate that ten days of four Oxy pills may be safe and, technically, not addictive, but would you want to wake up from no pain or responsibility? No doctor, or their office, wants to have patients ask for more pain killers, much less having them go through the hassle of traveling to the drug store and picking them up while still hurting. But shouldn’t we start with the bare minimum prescription and then work our way up? While medicine is so advanced that you can replace a hip and send the patient home the next day, has the medical community abdicated their responsibility to monitor care, especially from powerful pills, in the name of convenience?

I ask these uncomfortable questions because nine months after mom’s hip surgery she had a knee replaced (she couldn’t do both at the same time because they were on opposite legs). In a déjà vu moment, the kind orderly wheeled my mom to the hospital pharmacy where she would pick up her discharge medications. Befitting the fact Halloween was only weeks away, we trick ‘o treated a grab bag of post-surgery meds and headed to her apartment for another week of recovery. There were 40 more Oxy pills.

 

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