On an outsider view of the FDA approval to opioid use on young children...

I read, with feelings, the recent report on the FDA approval of powerful opioid use (on drugs like OxyContin) on young children.

Thankfully I don't have any personal experience opioid use, or from any immediate families or friends. There has been such explosive increase in use of drugs of any kind on young children on ailments like depression and ADHD that I don't doubt at all the very genuine and real concerns from opponents of this FDA approval. Substance abuse from opioid drugs like OxyContin has approached epidemic scale in some communities that drug abuse will take hold from all demographics that can spread like wild fire.

This has brought back memory of one incident, perhaps my closest (however remotely) encounter of such dilemma.

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Years ago when my son (firstborn) was born, he's suffered high fever two days after we checked out from postpartum. We rushed to the ER of the regional hospital (one of the best in the nation). Since he was less than a week ago, ER mandates him to stay overnight for tests and observation for four days. The doctors, and particularly the nurses, had been very kind and helpful who set up a bed for me to stay with my baby at all times. (Thankfully all tests came back clear, and it's suspected that he's probably just very dehydrated since he's not getting enough breast milk from me which we have since moved to formula and he thrives on it since.)

We were in a room at ER with two beds, one for my son. The second bed laid a child probably less than two years old. On my first night, I called the nurses' attention to that kid whom I worried she might be having trouble breathing, as I heard very strong wheezing sound from across the curtain petition. The nurses checked on the kid accordingly, and assured me that she's doing fine. Or so I thought.

The next day, I saw the family of that young child streaming in at various hours of visitation to see how she's doing. There were a lot of flowers, they stayed until the visiting hours were over, they were obviously a loving and caring family to her which is always a comfort to know. The family also talked to the doctors when they made their rounds, and checked on how she's doing. They were assured repeatedly that she's doing fine.

It wasn't until the very early morning of the day after, that I realized that the child was not doing fine. A team of more experienced doctors and their residents came in. There must have been at least twelve of them, scrambling for the standing room around the bed of the child. The curtain petition was pulled open during the day, and I got to observe from the sideline.

It turned out, the prognosis was not good. I never heard what the actual ailment was, apparently there seemed to be a foregone conclusion that the illness was terminal, hence there wasn't even any discussions among the doctors and residents what the underlying cause might be. No matter. The doctors were more concerned about pain management (that seemed to be their focus on her palliative care at that point). They knew she's in pain, at all hours. She's immobile, and seemed to be in some semi-comatose state. There was only one argument remained for debate, which was "how to manage her pain."

One group of doctors suggested the use of some strong painkillers to ease her pain, while the rest of the group raises very serious concerns that she would become addicted to the painkillers (which was almost a certainty that all of them agreed). The residents didn't say much, probably because they were still in training and were not experienced enough to voice any opinions, one way or the other. They had discussed long and hard, but eventually, the proponents won out. They decided on giving her the very strong painkillers to ease her pain because, as I recall quite clearly what one doctor said, "she most likely won't live to see her teenage years," hence the subsequent issue of lifelong addiction would almost be moot.

The discussions and debate were spirited, but one thing I came away with it, was that, none of the doctors knew the absolute answer. No one ever could. All they could do, was to choose the lesser of two evils. In short, they really had no idea what the eventual addiction might be like for this kid, should she be so lucky to live a longer life than expected.

When the kid's family visited that afternoon, one of the doctors who was in the morning discussion group broke the news to the family that they (the doctors) had decided to use the powerful painkiller on her. This would alleviate her level of pain, and she'd be more comfortable. The family did not object.

What I find rather surprising, is how sure that doctor sounded when he delivered the chosen course of action to the family. He did not voice any concerns or apprehension to the family about any doubts of subsequent addiction. I suspected the family might never know or find out until years later. I couldn't recall if this doctor was the proponent or opponent of the painkiller use, but his deliverance of the news, his I-know-best attitude leaves no room for anyone to remotely doubt that this doctor might ever have any slight doubt at all.

For the next two days when I stayed in that same room with my son and the sick girl, when I continued to hear her wheezing breath (particularly at night), and to this day, I often wonder if that's really "for the best" or not. Is it really a better option for the family (and the kid too, if she ever had a say in all this matters that concerned her so deeply) to be happily ignorant about the consequences? Nonetheless it's a turning point for me, that I can't take a doctor's word for it anymore, that I would always get a second opinion, that I always do my own research. The illusion that "doctors know best" has all but completely shattered.

Those were the days before OxyContin burst onto the market, but the debate about the use of powerful addictive drugs on patients, particularly young children, remains the same. It's easy to have a blanket statement on preventing the use of such highly addictive drugs on children, as a matter of course. But as I think back on the intense debate by those doctors, all of whom were debating with the best interest of that child in mind, yet they could come away with such opposing conclusion, even though the facts that they used were all the same, one can only conclude that there's no one right answer to all situations. Whether one focuses on the immediate short term pain relief, or longer term adverse side effects of addiction, is all a matter of where one draws the focus. It's a question of what kills you first.

In that sense, this FDA approval would have given the green light to doctors who might come down on the proponent side, though it should never be construed as the first line of defense or course of actions that any doctor should prescribe to all young children, without so much as a spirited debate as those doctors that I'd observed in that ER room did.

I do truly believe, that the family has a right to know about the pros and cons of that recommendation (of the use of opioid). Being happily ignorant should not be the default option for patients and their families. I never talked to that girl's family during those four days, never mind telling them about the doctors' debate on their child's pain management options. Sometimes I wonder if I should have uttered a word to them, to let them know that they might want to research a bit more on the option before agreeing to the doctor's recommendation. But then, I would be trampling on their privacy which is not something I would want to do.

I'm generally skeptical toward pharmaceutical companies' push of any particular drugs. Again, debates among doctors should be a default option, rather than relying on just one doctor's decision, particularly on treatment that can eventually lead to lifelong addiction. The doctors know best attitude is simply not good enough for me anymore.