The problem is not allowing someone with a grave terminal illness to have the dignity of strong pain relief. It is giving an 18 year old a month supply of an opiate for a wisdom tooth removal. Simple answer... doctors need training in addiction, there needs to be guidelines for dispensing that are monitored and we need to fund drug prevention programs so we do not have a society vulnerable to addiction. Lastly, when addiction does happen we need available effective treatment
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It’s very important that we don’t conflate end-of-life palliative care, with chronic, non-cancer pain (like chronic low back pain or fibromyalgia). For the former, opioids have clear benefit. For the latter, our experience over the past thirty years shows that opioids cause great harm with little or no benefit. We need to be liberal with opioids when treating patients dying from cancer but conservative when treating poorly understood pain that might last for decades.
In the 90’s the pharmaceutical industry convinced us to use more opioids partly by confusing these two issues. Let’s not do it again.
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Clearly, you have not talked with people with chronic pain other than those dying of cancer. I search for the expensive and elusive solution to the opioid abuse epidemic, we are painting the problem with too broad a brush. The result is misinformation and media hype that demonizes and misrepresents the legitimate and often essential treatments for pain.
We can blame pharmaceutical companies for hyping opioids and doctors for over-prescribing or criminally hawking them, but we must also consider the responsibility of patients whose poverty, lack of education, depression and sheer search for a high drive the statistics.
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I echo EAK's sentiments. Individuals with intractable pain are having their lives destroyed by sentiments such as yours. Opioids do, in fact, provide long term results allowing chronic pain patients to lead functional lives. Meanwhile, the rate at which people become addicted to opioids from an acute situation (broken bone, dental surgery) is less than <1% based on a study of over 500,000 people. Long term opioid users with intractable pain also have a risk of OUD of <1%. And a question...why should non-cancer pain be viewed differently from cancer pain? Why is it okay for some people to have to suffer because they weren't "lucky enough" to have cancer? And what of the cancer patients who are being denied opioids because their cancer is in remission but they have post-treatment pain?
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I've had fibromyalgia for over 10 years and not one doctor has ever mentioned opioid pain relief. Ever. People who are in constant pain very, very rarely become addicted to opioids. Because a small percentage of our population has become addicted it's decided by the 'experts' that all must do without. This would have no benefit to anyone, the patients that need the meds suffer, and the addicts are already using heroin and fentanyl. I think if this 'epidemic' was only affecting African-Americans or rural whites in flyover country (like meth, remember?), we would not be hearing about what a scourge it is to our country. The 'war-on-drugs' is lost, we need to legalize drugs now. Prohibition does not work.
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As an MD who cares for dying patients I have seen terminally ill patents in pain who refuse to accept opiates because they are afraid to become addicted, and post-operative patients denied appropriate short-term pain therapy out of an excess of caution by physicians. We are throwing the baby out with the bath water. There is a great need to re-educate physicians and patients about the correct usage of these powerful, potentially dangerous, but essential and irreplaceable medications.
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Throwing the baby out with the bath water is right in this climate. People in pain need pain relief to heal. Overcorrection is an awful way to manage the many reasons people experience real pain and it is sometimes very dangerous not to treat pain to a satisfactory level in some people. There was a pain initiative in NJ years ago that people with medical conditions should have pain treated to the level they tolerate. This has zero to do with the people who use these drugs to get high to disabuse themselves. Doctors who limit meds for pain to those who they know to have pain and for as long as they have pain are not practitioners in the art and science of medicine. This is up to doctors to know it’s their responsibility to stand up for their patients and be sure they have the relief they need. It’s not a political issue. Pain is real and can be dangerous in some and prevent healing for others. It is subjective of course and doctors need to be sensitive and discerning taking time to know their patients and best care needs.
10
Many of the opioids in question are licensed and tested for severe cancer pain. Patients are now screened for substance abuse problems prior to getting them during cancer treatment. Cancer survivors demand proper treatment for pain from the illness or treatment in a responsible way. For patients whose cancer does not respond to treatment, they deserve the proper and careful use of opioids to make their lives as comfortable and stay as functional as possible. These are basic principles of palliative care.
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Stewart: is this to imply that if a person has, or had a "substance abuse problem" that they ought not to be treated for pain with drugs that are possibly similar, even when suffering possibly terminal cancer?
Do they not bleed red? Do they not also die ? the idea of "screening" cvaancer patients to eliminate "substance abusers", sounds like old racist laws which separated public accomadations according to skin color. Now we should offer proper and humane treatment only to those who are "morally" acceptable?
I seem to recall doctors doing similar things over 40 years ago and causing so much agony and suffering that such prescribing procedures, based upon a doctor's personal or moral objections to a drug or to a person, were made essentially illegal in most states. Because some kids are foolish enough to use easily available drugs and accidentally kill themselves is not a reason to deny drugs to people in need. I seem to recall one of the children of Robert Kennedy was kept away from the family "compound" because he was a narcotic addict, and family matriarch Rose Kennedy was being prescribed narcotics. He died of an overdose in a local hotel. Banishing and treating addicts as black sheep is precisely what got us into this mess.
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Maybe it could be leased to Netflix, etc. where many more people could see it, or sold online as a DVD or download.
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