Wednesday, August 10, 2011

Drug Abuse in America: Part 2/3

Have you been to an ER in the last decade? If so, do you remember being asked about your pain level? The infamous question in the adult realm, "Sir, can you rate your pain on a scale of 0-10... zero being no pain and ten being the worst pain you've ever had in your entire life." Every wonder why this was? Maybe you weren't even in pain and they still asked you. Do you remember being in the ER perhaps two decades ago where there wasn't a big push to know what your pain was? Maybe, you weren't even asked.

What is JCAHO and what might it have to do with the drug abuse problem in the US?

JCAHO is an abbreviation for Joint Commission on Accreditation of Healthcare Organizations.  It is an organization made up of individuals from the private medical sector to develop and maintain standards of quality in medical facilities in the United States.Okay, great Jordyn, how can this possibly relate to the prescription abuse problem in the USA?

Joint Commission comes out with goals for medical care of patients. In the 90's, one of their thoughts was that pain was not being adequately addressed among healthcare professionals so it became a standard for them to have us ask, evaluate and treat patients' pain.

This Time magazine piece gives a nice consensus about how well intentioned bureaucracy intrusion can have disastrous effects on how medical care is delivered and ultimately leads to consequences for the patient:

"The U.S.'s opiate jag began, like so many things, with the best of intentions. In the 1990s, the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) — the accrediting body for hospitals and other large care facilities — developed new policies to treat pain more proactively, approaching it not just as an unfortunate side effect of illness but as a fifth vital sign, along with temperature, heart rate, respiratory rate and blood pressure. As such, it would have to be routinely assessed and treated as needed. "It was a compassionate change," says Barber. "Patient-advocacy groups pushed hard for it." And, she points out, drug companies did too, since more-aggressive treatment of pain meant more more-aggressive prescribing.

But the timing was problematic. The new JCAHO policy went into effect in 2000, which was not only about the time the new opioids were hitting the market but also shortly after the Federal Trade Commission began allowing direct-to-consumer drug advertising. When market, mission and product converge this way, there's little question what will happen. And before long, patients were not only being offered easy access to drugs but were actually having the medications pushed on them. No tooth extraction was complete without a 30-day prescription for Vicodin. No ambulatory surgery ended without a trip to the hospital pharmacy to pick up some Oxy. Worse, people with chronic pain were getting prescriptions that could be renewed again and again."

What other government policies do you think are having a negative effect on patients?



  1. Thanks so very much for bringing this situation to the attention of your readers. Good information, and something more people need to realize.

  2. This is an eye-opening post. I have a (very mild) chonic pain condition, and always wondered why doctors seem more interested in alleviating the pain than just, you know, aggressively treating the root of the problem. Why do I walk out with a script for more Vicodin than I can take and still function as a human being, and not a referral to P.T. to fix the cause of the muscle spasms? Knowing about the JCAHO guidelines gives a whole new spin on where the medical community is coming from, and how it can be frustrating for _both_ sides. Thanks!

  3. Thanks for your comment, Richard.

    Shandiss, I'm glad this gave you some insight. I agree with you. I had a hip injury once and the physician thought I needed physical therapy. My insurance company gave me six sessions which wasn't quite enough.

    Is it better for an insurance company to pay for physical therapy or cover precription meds and a possible subsequent addiction?

    These are the issues we need to be talking about. Particularly when the government is hoping to become your health insurance provider.

    Many blessings to you.