The common narrative these days is that prescription opioids are driving the opioid “crisis” and doctors must be restricted from writing “so many pills.” While the initial wave of self-imposed and statutory restrictions on using opioids for the treatment of chronic, nonmalignant pain were successful in decreasing the total volume of pharmaceutical grade opioids being dispensed, deaths from overdose and other adverse events continue to rise:
Note the peak of prescription opioid prescribing hit in 2011 and has been falling steadily since (as of 2016, to 2006 numbers), while the deaths from opioid related misadventures began to rise dramatically. This is likely due to the fact that limiting prescription opioid prescriptions does nothing to deal with the DEMAND for these drugs; when one avenue is closed, people will switch to more available drugs (heroin, street fentanyl, krokodil, etc) which, due to erratic dosing, are inherently more dangerous. Until we deal with the demand for opioids for abuse, through treatment, early intervention, etc., this problem will just shift from one arena to another, but will not “go away.” All health care providers (with vanishingly small exceptions) want to make sure they are not part of the problem. Many are concerned, however, that their patients with legitimate pain are being called to pay for the shenanigans of others.
There is a beautiful editorial in the Journal of Pain Research that every clear-thinking policy maker should read. It presents a very balanced analysis of the current situation and ultimately states:
It is easy to demonize and point fingers at industry, prescribers, or anyone who calls into question the newest battle in the never-ending war on drugs. While we would agree that anyone involved in the distribution of illicit drugs such as heroin and illicitly manufactured fentanyl derivatives should be stopped from harming others, and the misuse and abuse of prescription opioids have played a role in the problems we see today, in the right hands prescription opioids can help eliminate human suffering.
…we need to find ways to work together, instead of against each other, emphasizing civil discourse instead of finger pointing. We are concerned that some people who are intent on blaming prescribers, patients, and the pharmaceutical industry for the problem without offering solutions (other than perhaps eliminating prescription opioids) are making it more about them than the people they are actually trying to help. We have many problems, but there are also many solutions.
This article from the journal Pain Medicine paints a somewhat different picture than that you may have read before. It’s important that we don’t “throw the baby out with the bathwater,” when it comes to legitimate patients with chronic pain, and opinions like this need to be considered as policy (corporate, governmental, personal) is being written.
We’ll stay on this story!
yr obt svt,
Steve
