Pop Health dissemination via music video…

A PHS Student notes the powerful message of hip hop artist Macklemore’s single “Drug Dealer.” They write:

Macklemore, an influential hip hop artist, has unveiled his addictive personality using music as an outlet. In his latest single, Drug Dealer, he etches a powerful landscape – one filled with prescription and over-the-counter drugs that percolate through the walls of our healthcare system. The aim of Drug Dealer is bringing to surface the abuse of prescription (and over-the-counter) drugs. Earlier in the semester we discussed socioecological models on health and how Scott, once a respected nurse/caretaker, was driven to a lifestyle dependent on drugs. Under the guidance of John Mullahy, we also considered health as a consumer product. Given that prescription drugs are a product of healthcare and are intended to improve health, they are a health good – a unit of health that you can just pluck off of the shelf and buy. Macklemore (and many other victims of addiction), however, brings forward an idea that we haven’t covered about health resources in 795: there’s such a thing as too much of a health good. The salience of this idea raises so many questions: how do we address the consumption of these drugs? How should their access by addressed? Should their tax rates be increased? Should drug management be more intensive and more engaged? Where’s that crystal ball when you need it?

Here’s a link to Macklemore’s single:
https://www.youtube.com/watch?v=Gps0LQq3uEo

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3 thoughts on “Pop Health dissemination via music video…

  1. This is such a salient point to today’s practice of medicine. It was also really heart wrenching watching this video. As a young physician, I haven’t seen the rise in narcotic abuse; rather, I started practice in the midst of the epidemic. Seeing twenty-somethings arrive in the emergency department dead after a narcotic overdose is far too common. Macklemore really kept it real in this song, stating the demons are telling him to open the bottle and take more pills while he is going through the intense sweats of withdrawal. It’s real, and for most, it’s unbearable. Listening to the words of the this song, “my drug dealer was a doctor, a doctor”, made me think, ‘I hope that is never unintentionally me’.

    I don’t have all the answers to the questions in the prompt regarding this song, but there are some tools to help in narcotic management. Here in Wisconsin, there is a statewide database called the Prescription Drug Monitoring Program (PDMP), where pharmacies document when controlled substances are filled (and when they were prescribed). This is a great tool because it allows you to see if patients are obtaining multiple prescriptions from multiple providers or under the guise of different addresses. It is now common practice at my clinic to search a patient prior to prescribing any controlled substance (ie narcotics, ADHD medication, barbiturates, etc). It is amazing what I have found on there when I have not expected it – and the information found has changed what my intended plan was for the patient! Also, we have a chronic pain program at our clinic, which is where a patient signs a contract if they will be prescribed narcotics for an extended period. This contract states they will only be obtaining narcotics from our clinic, which can be verified on the PDMP, they will not use any illicit drugs, they will agree to random drug tests, and they will attend 3 group pain classes with our psychologist to learn about different effects on pain perception (ie higher stress may manifest as more pain). This has fortunately assisted me in being very stingy in prescribing opioids, which is what more doctor’s need to do. We don’t need to jump to opioids for all pain relief because, chances are, for a fraction of patients, it will do more harm than good.

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  2. Thank you for sharing this as a blog post. It is already a powerful song from any standpoint, but takes on extra weight given what we have learned in this class. This tackles the issue of opioid drug overdose at the individual level as well as at the population level, and cites very prominent public figures who have fallen victim to addiction. Macklemore is brave to put his own struggle in the spotlight in such a raw manner. This sort of act can draws attention to this very relevant issue, and will hopefully encourage others who struggle to seek the help they need.

    There is no easy way to address this issue. I’m sure most doctors know the potential consequences of handing out opioid prescriptions, but perhaps take an attitude of “what’s the harm?” when facing one individual who, for example, has chronic pain. Solving an immediate problem outweighs the potential downstream risks of addiction and overdose. Another challenge is the wide availability of opioids. If someone cannot get their own prescription, they can simply buy pills or heroine, as was recounted in Evicted. These options are usually cheaper and faster than obtaining a personal prescription.

    So, I’m glad you bring up the issue of access here, and the idea of opioid access being “too much of a good thing”. This is a similar issue I’ve explored working on antimicrobial resistance. People can receive prescriptions for both types of drugs far too easily in many circumstances, which leads to misuse and eventual system-wide consequences. There certainly can be too much access for this type of health commodity. Access does not just need to be provided, but it needs to be provided in the RIGHT way.

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  3. Prescription drug abuse is unfortunately incredibly complicated; oftentimes, physicians just want to be able to help their patients who are in pain, only to end up with addiction cases.

    I recently was talking with a doctor of 30 years. He was telling me that most often, prescription drug abuse doesn’t start with acute pain (e.g. post-surgery or post-trauma), but rather with chronic pain. The only way to prevent it is to find non-opioid methods of pain control, but unfortunately they are often insufficient or unavailable. It is generally easier to give a prescription to help the patient ease their pain immediately.

    In an ideal world, we could treat root causes of chronic pain, find non-opioid pain relief measures, and prevent easy access for healthcare professionals to pain medications (like Scott). Physicians and other professionals are striving for these goals, but until they can be achieved, it will be very difficult to root out the prescription drug abuse problem.

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