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Solving the Problem of Overprescribed Opioids

Patients show up in physicians’ offices seeking treatment for chronic pain, and unknowingly risk addiction. What can be done?

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By Dr. Richard Juman

01/28/13

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In 1804, Frederich Serturner experimented with opium and created something new—morphine—named after the Greek god of sleep and dreams, Morpheus. More than 200 years later, at least 8 million Americans fall asleep at night under the influence of an opioid. Every morning, 40 of them don’t wake up.

As described in a previous article on this subject, the United States is in the grip of a prescription opioid disaster: with 2 million people addicted, drug overdose is now, for the first time, responsible for more deaths than car accidents, and prescribed opioids are responsible for most of the fatalities. What can be done to control this epidemic?  

In reality, there are two separate problems. First, what should be done for the millions already hooked on Oxycontin, Vicodin and other opioids? How can we prevent so many of them from becoming part of next year’s statistics?  Second, what can we do to prevent the next 2 million, people who are showing up in physicians’ offices now, seeking treatment for their chronic pain, those looking for relief but putting themselves at risk for addiction?

“It’s hard for physicians to say ‘no’ when patients demand opioids for pain because both patients and physicians have come to believe that opioids offer a solution."

Members of both groups have at least one thing in common: they live in a country that assumes, whatever ails us, that there will be a quick, complete and external fix for it. According to Jane C. Ballantyne, MD, FRCA, Professor of Education and Research in the Department of Anesthesiology and Pain Medicine at the University of Washington, a pre-eminent authority in pain management, “We live in a culture in which the expectation is that we can 'fix' everything." Unfortunately, because of now-suspect research, overzealous marketing by the pharmaceutical industry and a campaign that encouraged doctors to stop being “opioidophobic” about pain, Dr. Ballantyne notes that “it’s hard for physicians to say ‘no’ when patients demand opioids for pain because both patients and physicians have come to believe that opioids offer a solution."

Physicians frequently prescribe opioids for use in the treatment of acute pain, in some cases without exploring the patient's substance use history or assessing for the risk of addiction- a problem in and of itself. But with respect to longer term use, it really seems to require a master’s touch in order to use opioids safely and effectively. For example, Mark Willenbring, MD, former Director of the Treatment and Recovery Research Division at NIAAA/NIH Founder and CEO of Alltyr: Addiction Treatment for the 21st Century, believes that opioids can be “very helpful in restoring function in chronic pain”, but bemoans the fact that “there is no consensus about who should receive how much opioid and for how long” and notes that doctors need “much better education in pain management and opioids.

While experts may disagree as to whether there should be any role for opioids in managing chronic pain, they agree that the long term use of opioids is not the answer. Put simply, they just don’t do a good job of  managing pain in the long run. According to Anna Lembke, MD, at Stanford University Medical Center, “it’s important to realize that opioids are not actually very effective for chronic pain, and can in some instances even make pain worse by causing a condition called ‘opioid-induced hyperalgesia'."

So, unfortunately, there really is no single, simple “magic bullet” solution to chronic pain. Chronic pain is a long slog of a burden that needs to be met full-on by an actively engaged, motivated, psychologically resilient, hard-working patient if quality of life is to be maintained.

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