#368 Musings Beyond the Bunker (Friday June 3)
Good morning,
Many have asked how my recovery from back surgery has been going. First, the stenotic pain and sciatica are gone! Second, while there remains back pain, it is going down daily. The most important takeaway is that when people say, “take recovery slowly,” one should listen. I overdid it the other day and paid for that indiscretion with a couple of days of increased discomfort. This “take it slow” process does not fit well with some personalities…
PRESCRIPTION DRUGS
After my back surgery, I was discharged with 30 oxycontin pills. Andrea and Lauren were discharged from their respective surgeries with 60 pills each. Each of us used around five of the pills in the first three days and that was it.
In addition, each of the pill bottles was labeled with a dosage recommendation of one every four hours (qualified by the phrase “as needed”). I understand that people react to opioids (and many other medications) differently and will require different doses to relieve pain. That said, it is hard to imagine that there are those who require such a large number of pills after surgery. While it is possible that each of us has a super-human pain threshold, it is at least as likely that we were over-prescribed.
That we have an opioid problem is a known challenge this country faces. This problem is exacerbated by a health care system that, notwithstanding much press regarding the excessiveness of prescriptions, still seems predisposed to prescribing as much as possible. And drugs are advertised on television, prompting patients to make demands of their physicians. For a sober story of the opioid epidemic, fueled in large measure by Purdue Pharmaceuticals and the Sackler family, check out Dopesick, starring Michael Keaton, an eight-episode drama on Hulu.
A few random thoughts:
We are prescribing too much and too often
We are prescribing too much medication, to be taken too often (should the hospital say that the dose is “every four hours”? Two pills a day might be enough for most.
The dosage information on the bottle should state this is a maximum dosage, and not a recommended dose.
Far more education is necessary to warn people of the risks of opioid-based pain killers. While I am pretty well informed and received guidance from the medical team, I fear others may not approach these meds as tentatively.
Over 5,000 people die each year from Oxycodone. Other drugs most linked to deaths include Alprazolam, Fentanyl, Morphine, Methadone, Hydrocodone and Diazepam. [By the way, if someone can explain to me why cocaine often is laced with fentanyl, often killing the customer, I would be most grateful.]
Drug related deaths climbed from 70,630 in 2019 to 91,799 in 2020. Data for 2021 is not yet complete, but an estimated 53,000 people died of prescription drug overdoses in the first half of the year.
I won’t even go into descriptions of the muscle relaxant I’ve been prescribed. Its recommendation is three pills a day. I have taken ½ pill before bed and woke up groggy. I’m not sure how anyone can be expected to function at all on the recommended dosage of three per day.
Finally, there is the issue of prescription drug usage in psychiatry. We know precious little about the human brain. What we do know is that it responds to certain medications, often through mechanisms we do not fully understand. These medications can be piled upon each other in cocktails that create and nurture in patients dependence on even more of these drugs. It is a plague on our society. More about this another time.
HISTORICAL MINISERIES
Through the pandemic and beyond, I have settled on my favorite genre of cinematic entertainment—historic dramas that are either true to a narrative or are historical fiction within a time period and related to the events of the time. Among the former are Chernobyl, Challenger: The Final Flight, and even The Crown. Among the latter are Deadwood, Boardwalk Empire, and Band of Brothers. But there are many others. Some of the best start out as podcasts.
On the theme of back surgery and historical recreations, check out Dr. Death, the true story of Dr. Christopher Duntsch, a neurosurgeon of questionable skill and appreciation of his own limitations, who killed and disabled patients in his Texas practice. What should have been fairly straightforward surgeries were totally botched, with devastating results. The efforts to revoke his license were met with stiff opposition from a medical community and medical boards that are predisposed not to find malpractice and to defend physicians against all evidence. Christian Slater and a surprisingly understated Alec Baldwin play the two doctors on a mission to expose the criminality of Duntsch’s actions.
DO ACTORS CHOOSE ROLES OR DO ROLES FIND THEM?
How is it that some actors will seemingly appear in anything—much of it drek (Chevy Chase, Adam Sandler, and Eddie Murphy, for example)—while others seem to ply careers of carefully curated serious roles? Michael Stuhlbarg seems to be one of the latter. He is always riveting and appears most often in high quality historical roles.
Stuhlbarg plays Richard Sackler, the mastermind and chief perpetrator of the crimes of the Sacklers in pushing opioids on the American public, in Dopesick (see, my random thoughts in a single Musing often can be related…!). In Dopesick, he shows the emerging ruthlessness of Sackler in pushing oxycontin on an unknowing public, manufacturing data and studies, hijacking the health care system (from regulators to pharmacists, to physicians), in a complex scheme of deception that has contributed mightily to our prescription drug problems.
Stuhlbarg also appears in several other recent favorites, generally as real-life figures. I originally enjoyed him in Boardwalk Empire, in which he portrayed Arnold Rothstein, the gangster who was behind the “Black Sox” scandal, fixing the 1919 World Series (the White Sox lost to the generally deemed inferior Cincinnati Reds). His performance in Boardwalk Empire was masterfully understated and, along with Steve Buscemi, Michael Shannon and Shea Whigham, recreated historic and imagined events in Prohibition-era Atlantic City.
Stuhlbarg steals most scenes he’s in, having played Edward G. Robinson in Trumbo and currently starring as Colin Furth’s attorney in The Staircase. While I confess to be a sucker for dramas that involve recreations of crimes and legal battles, this one is particularly well done (I’ll report back when it’s over).
Have a great weekend,
Glenn
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