Why No Narcotics?

It’s not because we’re mean.

Emergency medicine has seen a massive swing in its use of narcotics over the past few decades. In the days of my residency triage didn’t routinely include a 1-10 pain scale. We got by with… “hurts like stink, getting better, doing ok now thanks.” Then piles of articles appeared suggesting we were letting patients suffer needlessly. I remember guest lecturers brow beating us that we were woefully negligent in our pain management. “Treat the pain! Treat the pain!” was the drumbeat. Routine 1-10 pain scales were instituted in triage, along with patient satisfaction surveys. In parallel, drugs like Oxycontin, Roxicet, Dilaudid arrived with full page ads. Mostly good intentions, but as you might expect, the meds started flowing like water.

Prescription narcotic use went through the roof to the point that we ring the bell today for narcotic addiction in the world.

Not surprisingly, the pain scale has morphed into the “how quickly would you like to be treated” scale. (I’ve stopped using the pain scale, and prefer to ask about slopes instead… getting better/getting worse.)


In New Mexico I worked on a nonprofit called Endorphin Power Company, which was aimed at helping people who struggle with drug and alcohol addiction. We designed a “4-pillar” model, which stresses exercise, education, community and service. I don’t have the funding (or strength) to formally repeat that experience in San Luis Obispo. But the 4 pillars are “copyleft” for anyone. One thing certain is I don’t want Pre-R to become another addiction amplifier.

Narcotics have their place for broken bones, heart attacks, palliative care, but not under the Pre-R umbrella. We address basic acute medical problems that do not require narcotics or emergency departments. If you suffer from chronic pain, I will gladly give you a list of physicians who specialize in pain management. If you are seeking rehab, I will highly recommend you click Ken Starr, MD… or visit “EPC” in Albuquerque.

The topic of narcotic addiction is a tough nut to crack. I tried in New Mexico for quite a long time and EPC continues on that path. Sometimes I wonder if folks will look at the destruction narcotics have brought us lately the way we think about opium in China years ago. All that said, simply put, Pre-R offers apples. If you seek oranges, I’m sorry to disappoint.

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