AG’s opioid lawsuits unjust and misguided

There is an unfortunate but very human tendency to react to one bad idea with another bad idea especially when the second bad idea allows us to blame someone other than ourselves for the first bad idea. The recent announcement by our state’s Attorney General Office to sue two leading pharmaceutical providers in Montana, part of a growing national movement to blame corporations for our ongoing opioid epidemic, is based in such a reaction. This response is not only unjust but misguided for the negative impact it will have on the field of medicine.

From the perspective of a physician who was trained during the era of the 1990s that birthed our current opioid epidemic, I can vouch that corporations appeared at that time to have very little to do with the ideas that led us to our current opioid crisis. I attended medical school at the University of California, San Francisco which certainly was, then as now, no bastion of corporate influence. The idea then in vogue that we were taught consistently by attendings and professors was that patient pain had been horribly undertreated by physicians in the past and that the root of this was a paternalistic notion that physicians knew what was best for their patients. In thinking that they were protecting patients by limiting the amount of narcotics given to patients we were taught that physicians were instead causing needless harm and suffering. Thus, the notion of pain as a fifth vital sign was being created and insisted upon our giving priority to and we were encouraged to be far more liberal in the distribution of narcotics than our predecessors had been.

While it was common place for pharmaceutical representatives during that era to provide lunches, dinners and even trips to market their products, I can recall not once during my entire medical school and surgical residency experience an opioid product being marketed to us. Rather my distinct impression from that era was that the notion of undertreated pain was coming from patient advocacy groups, successful lawsuits on the issue of pain management, and governmental hospital accreditation agency mandates. Well-intended though they may have been, the generation who had been the activist of the 60s and were moving into positions of authority in the 90s seemed all too eager to embrace those notions of anti-paternalism and drug liberty; thus, it became the paradigm of the land.

No one now argues, though, that we as physicians should be giving out more narcotics because the carnage that idea produced over the past two decades is so obvious. However, for society to turn around and sue the corporations that produced the narcotics that we, the physicians, were prescribing at the behest of us, the society, is an equally bad idea. Our present generation of authority, infused often with the current progressive in vogue neo-Marxist notions of universal victimhood and oppression, now seem all too eager to seek to blame the corporations who produced the product that our previous bad idea demanded they produce more of.

Just as with every other powerful tool, narcotics can be used both for good and for bad. Risking a bit of paternalism, narcotics are not very good at addressing chronic pain and truly can be addictive and deadly, especially when misused. However, opioids when used appropriately are among the greatest gifts of a benevolent Creator to humanity, as anyone who has had a surgery, major injury or painful illness can attest. There simply is no other thing so good for addressing acute pain.

Therefore, to sue those who produce narcotics for us is not just unjust but also misguided. Just as those who sue publicly regulated utility companies shouldn’t be surprised when they see rolling blackouts as a result, nothing good can come of punishing the providers of a needed service for providing that service. As well, to insist that a pharmaceutical company somehow has a responsibility for regulating or monitoring how much narcotic medicine is prescribed or distributed is a big mistake. Insisting that they have that responsibility will force them to take that responsibility and that would be bad for medicine. That isn’t and shouldn’t be their job. It should be appropriately trained doctors, acting responsibly and in their patient’s best interest, who have the sole and ultimate responsibility to decide when and how much of a narcotic is appropriate, not a corporation.

Ultimately, the doctors who prescribe them and the patients who demand them are the ones responsible for this opioid crisis, not the companies who make them for us. Shifting the blame to anyone else is just another bad idea.

— Dr. Matthew Bailey is a board certified orthopedist. He lives in Whitefish.