First off, we have a very serious problem with opioid addiction and overdose deaths. It is a public health emergency. And usually, when we talk about this, the usual suspects come into play. You have heard them. Mexican heroin and Fentanyl. The latter comes mostly from China, not Mexico. And most of these drugs enter the United States through ports of entry, per federal data.

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What is usually ignored is how your neighbor got addicted. It could be your mom, your son, or you. The entryway is your doctor’s office, and the most over-prescribed drug is OxyContin.

Mind you, these drugs have a very proper role in pain control. They are essential with some skeletal pain, dental issues, and cancer. So do not think they don’t have a role. The problem is how easy it is to get them for patients.

I have a point of comparison from two countries because I got scrips for three different classes in the last month (dental issues, I know better I took them as instructed until simple Tylenol was enough to control pain.) My mom also was prescribed increasingly strong opioids for her cancer pain in another country, by her palliative doctor.

So let’s just say I got an education as to how two different countries work when it comes to this issue. And I also got a good education on side effects from her doctor.

First what happened to me. I had two teeth that ended up needing a root canal. I was prescribed OxyContin for the pain, which incidentally did not even touch it. A dentist that works with mine, specialist, prescribed Percocet. It did work, but I filled both prescriptions within seventy-two hours at the same pharmacy, with no question whatsoever. It came from two different prescribing dentists, in somewhat high-security scripts. I was asked to fill a paper form, and that was the end of it.

Two weeks later I filled a script for Tylenol three, which has codeine, at a different pharmacy. I did not fill any paperwork. And again, nobody asked any questions. The education I got from either pharmacy was a pamphlet. With a pain level of eight and above, I was not going to understand one word. (Fortunately, I got that education from my mom’s palliative doc within twelve months because my mom was on them over the last year of her life, due to her cancer.)

This to me was a personal example of how easy, potentially, it is for patients to shop for prescriptions and get hooked.

So what was the other country method? My mom, near the end, was prescribed Fentanyl. If you have a relative with Cancer, don’t be too surprised. Her doctor and I talked about tolerance to lesser opioids and pain. Quite frankly, we were not worried about dependence at that point, but tolerance. He prescribed this drug and gave me a whole education on the drug. The prescription did not go to a regular pharmacy. The paper was even higher security than any I got in the United States.

The pharmacy specializes in meds like Fentanyl, and some benzodiazepines. They confirmed the validity with the doctor’s office. I had to take legal responsibility for receiving the drug. My driver's license, not a paper form, went into a national database, in case of misuse or distribution. And it took three days to get this filled. If you have chronic pain, it could be an issue.

In case you are wondering, this other country is Mexico. Her doctor said that they learned from our mistakes. One way to deal with our crisis is a national registry, which they have. When you take your script to the pharmacy it should pop that you bought this recently, or somewhere else. It should also pop if a doctor, or better yet, multiple doctors prescribe this often. And by all means, when a pharmacy gets more pills than the local population, it should trigger an alarm with DEA. At the very least, it should lead to some sharp questions.

And there are other red flags.

And at the very least, we need lists of people with addiction disorders as a first step. We know deaths are skyrocketing. However, we really do not know the true extent. Why? We pretend the epidemic is from imported illegal drugs. However, it is starting with doctors. And I will hazard, a small number to boot. They are involved in what is described as doctor shopping.

If you need any of these drugs, ask for education on side effects beyond paper. I ate a lot of beans since constipation is common. Take only the dose prescribed, and dispose of any leftovers in a safe manner. This last point is critical.

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