Louisville Medicine Volume 63, Issue 9 - Page 19

Heartrending stories are seen in these offices daily: the young teen who has talked about nothing but getting pregnant finally succeeds; yet another patient dies of a drug overdose, accidentally or intentionally; or the baby rushed to the hospital, the victim of child abuse. Then there is the consequence of years of selling their bodies and souls for the drugs they seek, in return getting Hepatitis C and HIV, jail and mental institutions. It is especially painful to medical office staffs, who have tried to intervene to help those whom in the final telling, could not be helped. What was once thought only happened in big cities, arrived with a vengeance this year in multiple small communities, particularly here in southern Indiana. The discovery of a severe HIV epidemic brought into glaring focus what has been simmering for years underneath the seemingly bucolic landscape. able to care for them because they are too busy getting their next fix. Narcotic abuse, as with other addictions, is an individual choice at heart, but is a family disease, making some members enablers or fellow addicts, others codependent or others completely estranged for self-protection. In my practice, I have a discussion about pain management before surgery so the patient and I are on the same page. This reduces patients’ unreal expectations, and since I will stick with our mutual agreement, I feel somewhat more comfortable prescribing limited amounts only for postoperative pain. I know this is a drop in the bucket. I worry about the role some pain clinics play, with ongoing prescribing; I worry about the effort (or lack of) to wean or ultimately take them off the drugs altogether. So, it is here…now what? An enormous amount of time and money has been spent on how best to solve the problem, but still the problem remains. Will a certain subset of people be written off because nothing seems to break the cycle, since grandparents, parents and teens are currently getting high together? What about the babies of those addicted? Will they be different? Many of these children are in foster care because of neglect, since families are un- There are no easy solutions; current responses include imprisonment, and sometimes regimented medical programs if the person is lucky. Concerted efforts have been made with state support through the health department in Scott County. The problem is so widespread that nothing short of national debate and implementation of well thought out comprehensive measures are needed. Otherwise the end is not pretty: opiate addiction is progressive, often fatal, and can leave its ugly mark on the national psyche. However, it behooves us to have a pragmatic discussion with the patients and offer treatment options instead of writing a prescription or just saying outright no. A patient in the throes of his addiction will find alternate means from the street, sometimes with lethal results. Dr. Aziz practices Othopaedic Surgery with St. Vincent Medical Group. FEBRUARY 2016 17