This article implies that prescription opioids are a gateway drug to heroin.
Who says?
What about alcohol? Alcohol has been shown to be the first drug used by young people, some of whom graduate into harder drugs like heroin, some become full-blown alcoholics & most others do not become addicts at all.
Are the statistics of the "opioid crisis" really about heroin addiction & deaths? Fentynal laced with heroin or heroin laced with Fentynal? If so, THAT is what should be said.
No doctor has ever prescribed either of these for anything.
Yet lumping these street drugs in with legitimate prescription opioid pain medications is creating a frenzied, artificial "crisis" that is doing REAL DAMAGE to the health care of patients with real pain.
Insurers are now using it an excuse not to cover legit pain medications, drug companies are raising prices, doctors are rationing or refusing to prescribe them, patients asking their doctors for pain relief are being viewed as drug-seekers making patients defensive and loathe to ask for legit help...
I distrust that legitimate opioid pain medications are being stigmatized just as the large baby-boom generation ages into 20-30 years of increasing need for medical care, including pain medication. Who needs it more than the elderly?
6
The best way to end the drug crisis would be to legalize drugs and abolish the DEA. Instead both political parties are pressing for more stringent regulations which will only prevent patients from getting the medications they need.
6
Chronic pain is a reality for many. Low dose Opioid use seems a reasonable alternative to large dose NSAID use. The side effects of high dose NSAID use are significant. Low dose Opioid use is effective. I know.
11
Limiting written prescriptions seems very naive, people can easily obtain painkillers shipped from China and South America. I suffer from a plethora of painful afflictions having lived/aged with HIV for 36 years. My issue is I cannot tolerate NSAIDS nor Acetaminophen due to Kidney and Liver Disease. Very Low dose opiates is my main option. My doctor understands this.
10
I am currently experiencing acute disabling severe pain.. I unfortunately had a bad fall during some redecoration and injured my low back. From the time I first hit the floor, 2 months ago, I have been in extreme pain in my low back radiating down my left leg. I can’t sit or walk and am bed-bound. I am the primary caregiver for my seriously ill spouse,
Due to state law, I am permitted no more than 5 days of opiate level pain relief for acute injury. Period. As I had Successful(!)surgery 30 years ago, no doctor wants to treat my back. I am expected to have tests,and” search for, find and have office visits with spine specialists “in a nearby state. Getting there is my problem. So is intractable pain. I am left with tears and screaming into my pillow. Doctors, who usually resent any “interference” with their practice, have become pathetic sheep about pain management in this state. Who are they helping? Or hurting? Have we have returned to the 1800s, when safe pain relief was unavailable? Is my state legislature my doctor?
During my prior SEVERE injury, my pain was treated. With opiates. I did not not become a heroin addict. It is beyond me why I would take a strong pain killer if I didn’t have severe pain.I have read most of the studies mentioned and have knowledge from my prior employment. Prescribing restrictions have little effect on “ opioid mortality” anymore than occasional marijuana use led to heroin use or insanity.(a firm belief in the 1950-20??
16
I understand everything you are saying about the pain. It’s incredibly hurtful to have the medical profession work against pain alleviation. Not sure where you are in NJ but there is a pain management doctor in south Jersey who prescribed 30 day meds.
4
So how do people with pain survive in countries where doctors do not so readily prescribe opiates? Or do other cultures just have higher pain tolerance than Americans? Please report what works best elsewhere. There are alternatives!
2
@Albert Donnay - the white elephant in the room is that there isn’t a non-addictive drug that treats pain as well as opioids. There are many alternatives, but none as effective for certain kinds of pain.
So why aren’t we investing in research to come up with a powerful, non-addictive painkiller? That is the true long term solution.
4
The whole idea behind methadone and suboxone is it eases the pain of withdrawal and stabilizes addicts, and they are opioids and can be abused as well but not as high a risk. True chronic pain patients have pain to. You can't say "hey these addicts have pain, a carefully monitored dose of an opioid with less risk will actually let them come back into society and their families" and then say that pain patients who are actually low risk already with their medication regeme dont deserve the same because addicts abused those. Pain patients already jump through way more hoops to get their pain meds, from random drug tests to pill counts, to a national registry than the actual people abusing drugs do. Yes,end true pill mills. Yes give addicts suboxone. And yes treat patients who have legitimate health issues, with the medication that they need too.
Ill admit, I have precancer, and while I wont kill myself, I am considering letting it go. I am not on pain meds, though I have been in the past, because I was trying to hold out as long as possible and I had the misfortune of getting worse, right as this peaked. Im really struggling, and Im close to 50, so I have years left. Im trying desperately to still work. I can't do it. A laundry list of painful issues because I lost the genetic lotto; I was adopted and the product of brother sister incest rape. My entire body is failing due to a connective tissue disorder. Ive fought through until now, but can't live my life this way. I wont.
8
As a chronic pain patient. All the CDC has done is taken my quality of life away. And they have made me far more disabled. And not being able to be up moving around is going to worsen a few of my conditions. Before my meds were cut I could still workout (light),I could still cook for my family help kids with homework and I could play with my kids.
But now I am mostly confined to my recliner because movement makes most of my conditions extremly painful. Just living hurts like hell.
I did not get high from my meds just pain relief. And the pain managment Drs had me try every other option before opioids which was a very hard time to get through.
Most of my conditions have worsened and the nature of them they will continue to worsen.
I often think about just killing myself to be out of pain. But I fight with everything I have so my family doesnt go through that.
Genetics testing determined the best medicine and dosage. Genetics has everything to do with what meds will help and which wont and what kind of dosage is needed.
You can not one size fits all chronic pain. Genetics plays such a huge role as does what type of pain and the patients diagnoses. The CDC should know better.
I just want my life back I want to play with my kids work in my garden and be able to do things with my husband.
I did nothing wrong I had to jump through constant hoops for relief but at least I was living now I am just existing just barely.
The CDC has caused a major human rights issue
20
@Maria
The CDC has caused a major human rights issue
This is the appalling consequence of bad science and equally bad public policy. Patients who suffer chronic and debilitating pain are being told their lives are less important than those of addicts. The writes about the issue in such a way that leads readers to erroneously conflate opioid treatment (the only effective treatment for chronic pain) with drug addiction and death. People do not become addicts because they took opiates for two weeks post surgery and to think otherwise is to be naive bordering on stupid. It is true that if no prescriptions are written it would be harder for addicts to steal or buy these medications, in which case they would simply return to overdosing on street drugs, but it is fallacious to believe that this is the answer to stopping addiction in the first place.
8
Let's go to the way things were before the Harrison Act. Warn people of how addictive opioids are before prescribing. This whole notion that they're not addictive is patently false, and these lies got us to where we are now.
Patients can make a judgment on whether the risk of addiction is worth it. If they start, give them every opportunity to wean off. If they can wean off, great. If not, prescribing known, safe dosages indefinitely will keep them alive. Opioids are incredibly safe in normal doses.
The prohibition of prescribing to maintain an addiction (Harrison Act) is what leads people to do desperate things to get drugs.
22
@Old Fashioned
This analysis is exactly on point. People will always use opioids, and government regulation should be focused on ensuring drug purity and accurate dosing, not on locking people up and inserting barriers between physicians and their patients.
2
As a longtime recovering addict who started abusing prescription opioids, I think they should be legalized.
We already have drugs which are legal (alcohol) which damages your liver more than any carefully dosed natural opiate; not heroin bought on the streets; that is insane. So is drinking a 2 liters of vodka a day.
Methadone and or Suboxone "clinics" are actually for profit methods, run like an orderly drug dealer, with a doctor somewhere that signs off on it. They rationalize they are helping, and they are, in some ways.
I don't have anything against alcohol, in moderation. I am simply someone who cannot drink it in moderation, and haven't in over 33 years. I am not patting myself on the back; I have made some huge mistakes; especially from overdosing on hydromorphone (Dilaudid) several times before I got clean and sober.
There is no simple answer, or cure.I am saying (perhaps) we need to sometimes think outside the box; radically.
12
Studies and statistics can be helpful as input. Single-minded, myopic governmental mandates are not. Thoughtful dialogue between an individual patient and an individual doctor -- that 'Rx' has to be the key to better answers with opioids and medical care in general.
6
From your article: "Opioids could largely be reserved for much more severe pain — accompanying major surgery and cancer, for example."
The articles fails to note that this was precisely the situation prior to 1999, which was when a combination of pressures from drug pushing companies such as the Sacklers' Perdue Pharmaceuticals, and greedy, unethical doctors, forced the FDA to change the legal prescribing rules.
Prior to 1999, the only legal prescribing conditions were in fact short term post major surgery, and intractable cancer pain.
Immediately following the corrupt rule change, drug manufacturers, hospitals, and Wall Street rolled out
"pain clinics" which proliferated all across Middle America and got millions of Americans unnecessarily addicted - all for billions of dollars of profit.
Of course, many people must have their opioids now. They are addicted, and there is little to be done about that aside from methadone maintenance.
For this reason, the views of the "medical community" should be largely discounted. The profits of their medical corporations are now very much dependent on the drug trade they did so much to establish.
Ordinary citizens must fend for themselves when the forces which should be protecting them and discouraging addiction instead cooperate to form an essentially legal drug pushing trade. The drug companies, the doctors, and the government cannot be trusted to take strong action and justly punish themselves.
6
Okay, I know I’m from Oregon where Cannabis is legal, but this article doesn’t even mention the potential of treating pain with CBD, which is really helping a lot of people in states where it is available. This is not an option to gloss over - the legalization is spreading, as it should, and could become a reality in the entire country in a few years.
12
@Patty — does it work for chronic pain, I wonder?
I am a recovering heroin addict and my biggest fear for years was that I would have to take narcotics one day. After 19 years of sobriety I was diagnosed with breast cancer I went through 6 excruciating surgeries so I had to take narcotics. But what most people don't know is we heroin addicts are immune to narcotics. The amount I needed to stop pain is way above the medical protocol. I was constantly judged and accused of drug seeking by different Drs and even anesthesiologists luckily my breast surgeon and plastic surgeon knew that I was not drug seeking. A.A. taught me to always be honest about my past and I was to every doctor ive seen in the last 23 years. Unfortunately the chemotherapy caused an autoimmune disease and permanent damage to my nerves and organs and I live in constant pain. Ive been accused of drug seeking in the ER on more then one occasion. And it is so hurtful to me because I did the work. I survived heroin addiction. I don't feel like I survived breast cancer but I am still here. I live in constant fear that one day I won't be able to get the narcotics I need in order to just bend my limbs and walk. And I fear that one day I will have to go back to heroin. And I would rather die then live like that again. I wish someone would do a story about what these laws do to actually hurt and kill heroin addicts they do not help in any way. They might stop a few people from starting narcotics due to a toothache. But this blanket policy has made the problem worse.
22
@Carol A i agree they are giving patients no other choice than to go to the street version just like prohibition of alcohol that didnt work either
1
I broke my wrist, both bones, and my hand was in the shape of an “s”. It was so painful I couldn’t breath. The ER doctors refused to give me anything for the pain for 5 hours after waiting 3 more hours because the x-ray had a line of patients. What about an “s” shaped hand didn’t they see? That I was faking it to get drugs? I, for one, am tired of being treated like a drug addict because the medical community has historically dished out painkillers like candy. I do not even like taking it when I need it.....but yet any time I’ve needed something, even cough medicine, I am treated like a drug addict seeking drugs. That’s how it is in Tucson. Doctors are more interested in their DEA prescribing profile than treating their patients properly.
42
@DE Doctors are afraid of being chased around by a microphone-waving fanatic demanding to know why they prescribed opioids. So-called crusading "journalists" want to substitute the widsom of the mob for real medical judgment. My local TV stations are rife with ignorant halfwit "reporters," who think they've got a scoop when what they're really doing is forcing patients to self-medicate with heroin, fentanyl, and booze.
15
@Wimsy
No one is “forced to self medicate with heroin, fentanyl and booze”. That is a choice made by addicted people. Also, it nothing to do with reporters as the DEA now tracks doctors and their prescribing patterns.
3
Prohibition won't be the solution to our problem. Limiting prescriptions won't be the solution to our problem. These things have never worked and will continue to fail to work. Look at places like Sweden for how to fix our opioid crisis. The only problem is the US has far too strong of a Puritan bent that we will kill ourselves before we start providing heroin to people, because there are too many irrational, fearful people.
23
The the long term solution is known but hard
Sir Angus is the Nobel Memorial Prize Winner of Economics 2015 , Princeton U.
"The media gets the opioid crisis wrong. Here is the truth."
By Anne Case and Angus Deaton
Key Sentence
"But the long-run solution is much harder to attain. We need higher wages and better jobs for working people. The past 40 years suggest that is a far more difficult goal to attain."
Case and Deaton, Washington Post 9/12/17
Those better jobs with higher wages for working people were shipped to China
--
11
@Lars
Actually, the better chunk of them were replaced with robots. We've increased our manufacturing output, but have lost a ton of our manufacturing jobs. Some have gone to other places, but a large bulk of that has been due to automation, and that problem is only going to get worse over time. We aren't going to fix our problems by clinging onto the past. We need to work to get people trained for new fields and find ways to subsidize the lives of people who can't be retrained. Both of these things are cheaper and have better social outcomes than what we're doing now, but politicians only want to peddle prohibition and push false narratives about the rich fleeing our country if we make our taxes reasonable.
10
@Lars - Absolutely spot-on. And th good paying jobs are here: our INFRASTRUCTURE issues are beyond th pale. Again, and again, and again... the workers of the Building Trades still make decent money because their Unions haven't been completely broken, yet. Not just th construction workers but all th related businesses do well in infrastructure investment: suppliers, drivers, salespeople... all making good money, spending money, paying taxes, it's all there in front of us.
We simply have to start asking why th US billionaires and corporate elite won't give th US Congress the go-ahead to do what's so obvious!
Somebody's got to ask.
1
I too suffer from chronic pain from osteoarthritis and occipital neuralgia. I've tried all the non-opioid "solutions" and none worked. The only thing that did work some years ago, was a small dose of vicodin but things being the way they are, I have not been able to get a prescription for it since that time ten years ago. Like many, I cannot take NSAIDs due to a bleeding disorder. I stopped going to neurologists, arthritis specialists and pain management doctors because I'm tired of being told (1) I'll become an addict; (2) opioids don't work on pain or (3) it won't kill me so suck it up (neurologist's words, not mine). Shame on all the doctors who didn't stand up to the FDA or the DEA and let these draconian prescribing measures happen. I guess according to federal agencies, there's no such thing as chronic pain. It's no surprise that Frakt says it's causing harm. I knew that long before this article was written.
32
Given that the USA constitutes about 5% of the world population, but consumes about 80% of the prescription painkillers, we might want to consider our overall approach to pain management.
7
@Kevin Yes, and we'll have YOU decide who's worthy of receiving help for chronic, excruciating, debilitating pain.
10
@Kevin
I love when people that have no chronic pain conditions decide treating moderate to severe chronic pain other than with opioids is the obvious answer. That is, until you or a loved one experiences a condition/s where the only way to provide a semblance of a life with quality is to routinely take opioids.
15
This isn't a simulation. This is already happening. While the prescribing of opioid pain-relievers has been shortly curtailed, OD's from tainted street drugs like heroin, cocaine and meth, continue to rise. Even so, DEA continues to enforce a police state upon the medical office and doctors and patients are patently terrified. They've also continued to pursue alternatives like Kratom and cannabis. Pain patients are being denied care across the country - suicides and deaths from pain-induced cardiac complications are rampant.
21
I've been living with chronic pain for years. HIV caused nephropathy in my legs and feet. Degenerative spinal stenosis, osteoporosis, and scoliosis. I also have viruses, other than HIV, which contribute to pain, esp. pain in my joints. I use Methadone as my primary pain medication - and Percoset for pain that isn't sufficiently addressed by Methadone for me to function.
I've always been amazed that doctors (even board certified pain specialists) have so little knowledge of using Methadone as an analgesic. It's use has been tainted because it's used to help people get off, and keep off, of heroin. But, it isn't addictive (yes, there is a difference between dependence and addition), and is responsible for far fewer deaths than any other opioid, because it's simply more difficult to abuse. It causes no high, or any druggy feeling (which is exactly why it's used to treat people with heroin addiction).
If pain doctors were simply educated in the use of Methadone as an analgesic, there would be far fewer deaths, and fewer lives ruined from opioids. My pain doctor wanted to take me off of Methadone and put me on Morphine - still with Percoset for breakthrough pain. Sure, take me off a medication that doesn't cause addiction and put on one that has a high rate of addiction - with a second addictive drug to boot. I went to a different pain specialist, one who didn't want to make me into an addict - thank you very much.
16
Years ago the state of CA wanted me to be put on methadone for my severe chronic pain. This upset my Dr & me. This would have immediately marked me as having been addicted to Heroin, which I've never touched. Your idea is good, yet my point is valid too. Tons of teaching would be required throughout the medical profession. I've suffered from severe bone pain and now have osteoarthritis and osteoporosis. Along with Stiff Person Syndrome. I'm on a pain patch. With codeine for breakthrough pain. My current dose has been the same for over 5 years. I have other dx's that cause severe pain too. Being dependent while suffering from chronic pain, is vastly different than being addicted. Better screening for addiction in family histories is needed. Addictive Personalities does run in families.
9
@Mark Rice Methadone causes hallucinations in some people.Reactions to pain medicines can vary.
4
@Mark Rice My late father was given methadone by the VA for years to help him deal with his severe chronic pain. He also took hydrocodone in-between his methadone. I can't imagine what would have happened to him if he had been denied these two drugs. Whenever he tried to stop using them, the pain was so horrific that he screamed. He took these drugs for over 20 years and lived to the age of 87. What is happening today is extremely cruel and ignorant. Most people don't get addicted to these drugs. We are adults who should be allowed to take responsibility for the decision whether or not to use these drugs if we are suffering in pain. Plus, we all know that prohibition never works well. It only causes more problems.
8
Based on the comments, it would appear that opioids are the only treatments are effective for chronic pain.
This is contrary to all the guidelines on the management of chronic pain developed by experts based on actual research which shows opioids are only minimally effective for chronic pain and that their potential adverse effects outweigh their benefits.
But, of course, who wants doctors who practice medicine based on actual research.
And for those who say the experts can't know what they are experiencing, I would ask if you would only go to a cardiac surgeon who had had surgery similar to yours or a doctor with diabetes to treat your diabetes or one with schizophrenia to treat your schizophrenia. Somehow in those cases physicians' knowledge is what is of paramount importance.
4
@Steve That statement does not accurately characterize what people on this thread are saying. Nor do all experts agree on best practices for integrating research into clinical practice, given limitations of existing research.
13
@Steve
Actually, every recent review on the effectiveness has concluded a lack of evidence, not that they are minimally effective, so guidelines don't really matter, as that's akin to the classic food pyramid, not being based on research. Couple that with the fact that no long term therapy for chronic pain is significantly more effective. We do want doctors who practice medicine based on actual research, but you seem to have a very, very misguided notion of what the research is on this subject.
6
@Steve There are no "long term" studies of any treatment regimes for chronic pain, where long term is greater than a year, and where studies equal rigorous research. There are, however, many years of anecdotal evidence about treating chronic pain patients with opioids. The problem is that that data is not taken seriously. Why? Because that data is considered biased. Those patients who state they receive relief must be reporting that because they are drug seekers.
And by the way, why do you characterize the training that a cardiologist or an endocrinologist or a psychiatrist to be any better than that of an anesthesiologist who then studies in a pain management preceptorship?
And as long as you are comparing diabetes treatment to treatment for chronic pain, why do you think being on an opioid for life is any greater or lessor a risk than being on insulin? Did you know that diabetics should have an insulin overdose treatment, just like chronic pain patients should have naloxone? It's called glucagon.
6
One of the major nerves in my body was very badly injured by a test which had been banned by the organization which board certifies doctors in its field of specialization. Allowing the test to be performed by a resident actually caused the damage. After 7 years of experimentation, I take a cocktail of pain killers, only one of which is an opioid. Without the opioid I would have to take so much of the non-opioids pain soothers that I would go back to falling due to dizziness (shattered wrist, concussion) and having seizures due to hypoglycemia.
I had a hideously painful procedure performed by a neurosurgeon at Johns Hopkins in an attempt to lower my pain. It which was a failure, but I will try anything to lower my need for pain killers. In the middle of discussing other pain control options, the neurosurgeon insisted again that opioids do not stop chronic pain. I told him again that he was looking at proof that that axiom is not true and that as a scientist he can’t ignore the facts.
I find it incredible that a neurosurgeon employed by one of the country’s best hospitals is so brainwashed, he can’t accept a fact that that proves he is wrong. He is the equivalent of the medieval doctor who believes in the four humors and that Galen and Hippocrates have propounded all there is to know about the human body.
18
@Bathsheba Robie Pretty terrifying!!!
1
Conservative Nobel Economist Milton Friedman estimated that legalizing drugs would result in half the number of prisons and prisoners, ten thousand fewer homicides and a sharp reduction in overdose deaths. He thought it immoral that the government would destroy the lives of drugs users by converting them into criminals and imprisoning them.
Before drugs laws, people self-medicated. The settlers of the western frontier self-medicated. Thomas Jefferson and Benjamin Franklin grew poppy in their gardens. The medical profession did not enjoy a prescription monopoly, and the average cost of health care was $5/yr. ($120/yr. today).
Americans are under the thumb of the most powerful state in the history of man. We endure more scrutiny, jump through more hoops, and pay more for healthcare than any other country. Average Americans have less freedom than the Afghan poppy farmer. Boomers want to die off without being held hostage to a profit-motivated medical-industrial complex. Please!
21
@Bill My gentleman friend's elderly Mother once yelled at him in my presence--essentially, You kids messed it up for all of us! I grew pot in my medicinal garden [cp. herb garden and vegetable garden and kitchen garden] and now you guys made it illegal! [Waving outside to said gardens.]
The kid in his late 40s, Mom like 80+ and this is in rural Virginia.
4
Why no mention of buprenorphine in this article?
1
@Nick Maybe because it's hard to administer, it causes sedation, dizziness, headache, hypotension, slowed breathing, and more. Those are the most common side effects - then there are the less common - abdominal cramps, blurred vision, coma, confusion, constipation (also a common side effect of any opioid), and more. No drug is a magic bullet.
1
@Mark Rice
" it causes sedation, dizziness, headache, hypotension, slowed breathing, and more. "
All standard opioid side effects.
@Nerdelbaum Frink
I read that if you are on antidepressants it can cause issues with too much serotonin. As antidepressants are actually a first line drug for pain, sleep and mood- especially for women, dont get me started, its not necessarily a good first choice. Apparently there are some treatments for a few things with a low dose of naltrexone. I think what healthy people don't realize, we are usually out of options these days by the time we get to opioids. And each med has side effects. For example I was hospitalized with three non bacterial ulcers from aleve. Steroid shots give me tachycardia, antidepressants make my bladder bleed. Morphine actually gives me such bad urinary retention I need to have a catheter. Now Im really sick with multiple issues but except for pill mills, opioids are not really as easy to come by as people think. Alot of "prescription" pain killers people are oding on are from the dark web/ other countries too and now there are counterfiet pills.
2
"A large proportion — 80 percent by one estimate — of heroin users in the United States previously used prescription opioids."
According to the Cochrane Review, about 0.5% of people who ever take prescription opioids end up using heroin.
Responsible chronic pain patients are not responsible for the heroin crisis.
28
@Liz
That's because almost everyone has taken opioids, and your deflection to "chronic pain patients" is not reflective of the statistic you provided. Please find a statistics for chronic pain patients and not "people who ever take prescription opioids" because those are two very, very different groups.
That said, I agree with you to some degree, but you're still rather naive and misguided. The larger problem isn't even the existence or sale or use of these drugs, and it's rather a social repercussion.
1
@Nerdelbaum Frink
True chronic pain patients are monitored closely and have been for a while. Its not a whole lot different than suboxone for addicts, except its actually stricter. On a pain contract you cant even drink. Ive known quite a few heroin addicts. None of them were heroin users. And most pain patients I know aren't addicts. Dependent yes. But the majority of them are getting their pills cut back or taken, and they are not doing anything illegal to get their high. Their suffering and hoping that at some point we will, as a nation, stop the pendulum swinging and find a reasonable middle ground
2
@Nerdelbaum Frink
True chronic pain patients are monitored closely and have been for a while. Its not a whole lot different than suboxone for addicts, except its actually stricter. On a pain contract you cant even drink. Ive known quite a few heroin addicts. None of them were pain patients. And most pain patients I know aren't addicts. Dependent yes. But the majority of them are getting their pills cut back or taken, and they are not doing anything illegal to get their high. Their suffering and hoping that at some point we will, as a nation, stop the pendulum swinging and find a reasonable middle ground
2
Many of the popular drugs for ADHD treatment fall under the FDA Schedule II/IIN drug category: drugs with a high potential for abuse that may lead to a severe psychological or physical dependence. Prescription opiates are also in this category.
Yet, they do not share the dispensing restrictions that are placed on ADHD stimulant drugs which include paper prescription forms only (no call ins) & no refills. I’ve never understood why
Also, I’m not sure if unlike stimulants, there has been much investment in creating new formulations of the active drug to make it harder to abuse and more controlled and extended release.
The stimulant Vyvanse (Lisdexamfetamine) is an excellent example of a formulation that through modifying the molecule that created an option that must be taken orally (It won’t work if you snort it.) and a more controlled release over the extended period of time. I want to see more painkillers with this type of performance that would make them better maintenance drugs for chronic pain.
5
@Jenni P Thats changing in a lot of states. And I am on nuvigil which is a stimulant, for narcolepsy and my sleep dr phones it in.
1
Most prescription opioids require paper prescriptions, no call ins and no refills.
Only the mildest like Tylenol with codeine can be prescribed otherwise. Even Vicodin requires a controlled substance prescription under current regulations.
Moreover, there has long been interest in making long acting slowly release opiates. That’s how OxyContin was developed, in fact. But there are formulations that are harder to abuse and other narcotic formulations, MS Contin for one, that have also tried to mitigate abuse with long acting preparations.
All of these can still be abused but only with a fair amount of effort. However it’s an area with quite a bit of interest and active research amongst pharmaceutical companies.
Why is it that here in the U.S. so many people feel that the number one priority should be restricting pain medications and if that leaves pain patients without adequate relief that's just the way it has to be? The moralizing goes on and on. Of course, I don't wish death on anyone who does not wish it for themselves -- that said it is difficult to take the great concern for people's longevity seriously when we , as a society, offer so many people so little assistance to improve their lives. but we are ever willing to take a drug away or to imprison people for "endangering" themselves with disapproved drugs. American prisons are anything but healthy places to be. I am so very thankful that I don't require opioids -- the stories of the torture people who have been injured or have another reason to need them and are denied are heartbreaking.
25
@Nicholas Why is is? 'Cause everybody's an expert on how other people should live their lives.
3
In all of this, I hope policy makers don't lose sight of the fact that some people, such as those with severe arthritis, sometimes need these medicines to avoid unacceptable suffering, loss of sleep, etc. I have seen a loved one with severe pain, rationing pills, taking half the effective dose in order to stretch out a meager supply. The fact that some people abuse these medicines shouldn't make them effectively unavailable for those who need them.
33
@Mr. Bill
This is THE one thing that must remain on the mids of all Those Who Know So Well as they play with peoples' lives.
People crash CARS sometimes; are they the next thing to be limited, access-controlled, or outright banned?
6
The article manages to sail right over the issue of suicide. Did the original study do the same? No attempt made to understand the worst harm done by restricting opioids for those in the greatest pain, most at risk.
Also, no mention of the biases that would creep in. Medicaid? No pain meds for you! Try Tylenol. But cancer would be like a free pass. "Difficult" patient? Weird accent? Forget it! But if you're upper middle class with great insurance...
17
The states that have legal medical marijuana have reduced patients use of opioids by 1/3.
It’s time to fully legalize marijuana and follow the decades of research that Israel has done on the medicinal aspects of this plant.
13
@Anita Larson Care to cite your sources? Vermont has medical marijuana *and* a growing opioid crisis. Heroin overdoses in Colorado have *increased* since recreational marijuana was legalised.
2
I’m talking apples, you’re talking oranges.
Vermont legalized medical marijuana less than a year ago. It will take more time to see this reversal.
As for CO, I wasn’t talking about heroin overdoses, I’m specifically talking about prescription opioids. But if you actually look into those heroin deaths, they are largely attributable to mixing heroin with fentanyl, which can be deadly in even tiny doses.
3
The "opioid epidemic" is a symptom of bad economic and social services policy creating more stress on vulnerable people and a shortage of primary care.
Maps of US opioid deaths look almost exactly like maps of low education, unemployment, and shortages of primary care.
Somehow, Europe has ~1/50th the problem. How do they do that? Kristof's article: "Portugal treats addiction as a disease, not a crime" has most of the answers. Although they spend far less on 'medical treatment,' they spend more wisely, with 2x what we spend on primary care, 3x on mental health and 2x on social services. So instead of letting PTSD veterans live under bridges and buy opioids on the street, they supply housing, counseling and medical addiction treatment, all part of universal gov run health care.
We're throwing money and lives away, funding the Keystone Kops (DEA) to chase drugs, gushing money at insurance and drug companies, (all wasted) but not funding primary care, mental health, social services and MAT for addiction, which all work.
We need universal single GOVERNMENT paid health care (not US Medicare, paid through for-profit insurance companies,) adequate social services, progressive tax policies and other public policy to suppress the excesses of capitalism and inequality.
We need public policy that puts public good above private profits, instead of privatizing profits and socializing losses.
20
@DataDrivenFP
Re: throwing money and lives away... gushing money at insurance and drug companies ...
Indeed. Fundamental problem: our government & policies are now subverted in that instead of being less powerful (subject to proper regulation and enforcement), they now exercise a level of control over government that cannot be recovered easily, and worse - prioritizes profit over people's lives.
3
@DataDrivenFP,
First I should say that I totally agree with the thrust of your comment. But one thing needs clarification.
When you refer to Medicare as being paid through for-profit insurance companies you must be referring to "Medicare Advantage" plans which are a fairly recently instituted subset of Medicare. Traditonal Medicare which is still going strong does not involve for-profit insurers.
My personal problem with Medicare for all is that I think it is being oversold as was the problem with the ACA. Traditional Medicare has 20% copays with no cap for most services outside of hospital charges, lab work and so-called preventive services. You can buy supplemental insurance to cover that - I do - but I think the average working family would be surprised to know the limitations of Medicare.
5
@DataDrivenFP
Ive always been for universal care but the way the government is handling this honestly scares me, especially with medicare patients, the disabled who are in the most pain to begin with. Then again inurance companies are following suit
1
Heroin addiction & deaths are lumped in with prescription pain killers in the dishonest & contrived campaign against the so-called opioid "epidemic." It's one thing to use treatment of heroin addiction to help in a compassionate recovery campaign for everyone who seeks it. But I don't hear any compassion in the hysteria. I'm thinking that the massive, relentless campaign is driven by the interests of the pharmaceutical industry. But why?
There's a large aging population that the healthcare industry is needing to serve in a way that will keep us quiet while it still brings in huge profits. I see this as yet another human need that is being chipped away at.
An aging population will be needing more pain relief as it gets older, up to and including hospice. By semi-criminalizing prescription pain meds and, thus, pressuring doctors not to prescribe them and insurance plans not to cover them, they can make greater profits An older patient who is desperate for pain relief will be more likely to pay full price for relief. It may mean that instead of food, but, hey. And then there will be those too poor to pay full price.
It's another attempt at cutting back on the expectation of relief and decent health care. And I am not paranoid, just an aging person ready to fight these jerks.
16
@Caryl Towner - excellent!
Did I miss the part about using CBD for pain, especially chronic pain? I know it's not legal everywhere but it's so effective.
People with broken bodies need relief but there must be a better way for long term care. It's not just aspirin or smack, nothing else.
2
Obviously opioids shouldn't be first line unless obviously needed. Some of us, my self included, have been sick all our lives and tried pretty much everything. And actual pain management clinics take a multidisciplinary approach, and opioids are not used first line
I am wondering what will happen to me if my arthritis gets worse. I can't take aspirin or any similar drugs because of other health problems (I take blood thinners). Tylenol doesn't do much for me, even extra-strength Tylenol. Some days I would give a great deal for a couple of aspirins, but the risks are too great. How will I manage when I need more than Tylenol? Looks as if the government couldn't care less.
14
I see little mention that there is a difference between addiction and dependence and it’s not just semantic. Dependence means you take your medication AS PRESCRIBED but still need to be weaned off it when you stop it. Addiction is another thing entirely, where someone chases a “high” taking more and more. If my 85 year old mother is dependent on pain meds just to walk I think taking those drugs from her would constitute elder abuse.
23
@Scott D
I agree- how is a pain medication different from insulin or blood pressure meds? Pain is a symptom, and people deserve relief from it. Pain and pain relief is an issue between a doctor and a patient. Addiction is an issue between a doctor and a patient.
I think one thing America likes to do is act as moral police and probably, given the fact that opiates make you high, they want to restrict that well being. Alcohol probably kills a lot more people every year- probably more than heroin and opiates combined.
I think plenty of people need pain pills, and you know what, if someone wants to sit around bombed out on percosets for fun, how is that any worse than sitting around drinking for fun? And the depression and malaise that leads to that kind of a lifestyle can't be fixed by making this or that illegal.
3
@MC I agree with much of your comment, but if you are in severe pain, the "pain pills" do not make you high.
Pain is relieved, and that can make you happier because more functional, but not high.
2
For what it's worth, your top story photo looks like methylphenidate (generic Ritalin). Methylphenidate is not addictive; it can be stopped without withdrawal symptoms and used as needed to treat narcolepsy or ADHD. The amount you'd need to take at once to get "high" is so much that it likely wouldn't work twice if used that way. Good story, but I don't think the art fits.
3
The United States is definitely NOT the place where limiting patient's acess to medications could ever work. Limit some drug and the next day pounds of it will show up in every zip code.
The tinkerers who play with such ideas always lose any elections they try to affect.
5
I am glad this is in the conversation. It seems like you are intelligent and did a fair amount of fact gathering to prep for this article. I don’t feel like you have an accurate objective picture of the situation. Like Sean (Washington) I don’t smoke, use illicet drugs, drink alcohol... or have a parking ticket. I value clarity & sobriety...I do yoga everyday. I have had several major surgeries.. a portion of my spine is titanium. I am in pain a lot of the time and small doses of opiates (Norco) knock the pain back and leave me lucid and able to lead a normal life. Over the last 15 years my insurance company incrementally stopped supporting wellness programs that dealt with chronic pain. We used to have access to chiropracters, biofeedback, accupuncture, physical therapy and massage therapy... all covered by insurance. Little by little that has dwindled down to a handfull of visits per year of any combination of these. Doctors have trouble getting insurance companies to cover holistic care. They are however, very quick to write presescritions. So if you are feeling the need to expose abhorrent behaviour, why not look at THAT sytemic failure. Moving away from prescribing meds is great if it is replaced by other means of pain mamgement. Exopose, the criminals (Insurance companies) and advocate for healthy solutions. Now there is a story.
13
We're finally starting to get some nuanced articles on opioids.
Hurray!
Deaths from drug overdoses and opiate abuse are symptoms, not the primary problem.
"Understanding the demand side of the prescription opioid epidemic TJ Cicero MS Ellis
Conclusions: Our results suggest that self-treatment of co-morbid psychiatric disturbances is a powerful
motivating force to initiate and sustain abuse of opioids and that the initial source of drugs—a prescription
or experimentation—is largely irrelevant in the progression to a SUD.
So the real problem behind opioid deaths is untreated mental health problems that people self treat with opioids. If not opioids, they'd be using alcohol, and we'd be seeing an increase in alcohol deaths. Oh! Alcohol deaths have gone up too!-- 35% from 2005, now 88,000 a year. And suicide has gone up ~33%, now 44,000 a year. Maybe instead of getting our shorts in a knot about HOW people are killing themselves, we ought to do something to actually address the underlying problems?
Over the last 50 years, inequality and changes in jobs have increased stress for 99% of us, increasing symptomatic mental health problems in the most vulnerable.
The so-called "opioid epidemic" is a symptom of bad public policy creating more stress on vulnerable people and a shortage of primary care.
We need to understand the problem and treat the root causes, instead of proposing well-meant but misguided solutions without understanding the problem.
8
@DataDrivenFP - Awesome, I wish I had written this!
I had minor dental surgery last year and was written a 10 day prescription for an opioid (I didn't fill it, so I don't recall which one). Meanwhile, my brother was crippled in pain passing a kidney stone while waiting over a week for an ultrsound appointment and got nada. There has to be some middle ground here.
26
@Sharon Get the script when given, hoard it safely, and use/give as necessary. This is new reality.
5
One month ago I had major spinal surgery. I was on a Dilaudid epidural at the hospital for a week and on oral Dilaudid for 3 weeks at home.
It killed my pain and I was able to safely and gradually wean myself off it. Now I'm on Tylenol and feeling okay.
Mine is not an isolated case. People need these drugs for legit reasons and should be given them. There is a safe way to use them and most people will opt for that route. There is zero reason to deny pain relief to people who are suffering, whether it is short-term or long-term.
45
This is a management problem. For those who need pain relief, and those who are addicted as well, careful, continual monitoring would probably go a long way toward saving lives. It would also help problem users become more productive and steer them into rehabilitation. Prohibition only causes problems to spin out of control. That has been a failure for generations.
14
Because I didn’t receive proper pain medication from several differing issues I now have CRPS, PTSD, high blood pressure, stunted hormone production. This forced me to walk away from finishing my doctorate (only 1 year left) and walk away from 6-figure corporate job. I now struggle to make $50k a year and need pain medication more now than ever but it is a full time job threatening law suits for malpractice and jumping through hoops to get medication that i’ve never abused (i don’t even drink or smoke nor do i have a parking ticket). hundreds of others i speak with regularly have had to resort to the darkweb for their pharmacy. that’s not good policy, that endangers people, it creates stress of having to test orders to make sure of purities, it is harder to measure dosages, it sends money overseas that could be going to american companies - it’s just bad policy.
47
The issue of treating chronic pain is more complicated than merely looking at a person’s physical needs. Addiction is a mental issue that should be addressed whenever a long term narcotic is prescribed by their physician. Mental health should always be a factor for individuals who either specifically request a strong pain med for dental work or a mild to moderate ailment. And yes, doctors should never initiate writing a prescription for anything minor. As a RN, I have witnessed this all too often. There is a ligitimate reason to prescribe opioids to patients following major surgery, cancer care & for those of us that suffer from any chronic conditions that have no other alternative treatment. People who have potential to misuse opiods need to be monitored closely by a tag team of mental health professionals & other physicians. Ultimately, the solution to reducing the millions of deaths due to overdose is a societal problem & should be viewed as a complex solution.
12
@MPMarvin
There are not millions of deaths from overdoses. Overdoses are not even in the top ten causes of death. The latest figures are something like 70,000 overdose deaths a year, and most of these are from heroin and fentanyl, not from Oxycontin or prescribed pain meds. Some of the 70,000 deaths are from deliberate suicides and some from IV-using heroin addicts, who have a death wish in any event.
The reality is that millions of people use opiates as prescribed and do not end up addicted or with problems. Why should people with a legitimate need for these medications to relieve their pain be forced to suffer because some people do not value their lives?
Now that marijuana is becoming legal across the nation, the huge drug enforcement and prison-judicial-law enforcement- industrial complex needs more bodies to justify their existence and fill the prisons, so now the focus is opiates. The more enlightened and less punitive countries treat addiction as a disease instead of as a criminal matter.
10
@MPMarvin
My concern with the direction ive seen involving mental health: people with chronic pain and health issues are often misdiagnosed as having depression or anxiety, especially women. Pain is often passed off as psychosomatic or conversion disorders. If you get past that hurdle, when your health starts to slide, especially without adequate pain management, you find you dont have time to socialize, you cant exercise. Antidepressants are often a first line treatment for pain, pretty much all of us have taken them. I am on an antipsychotic because I have narcolepsy and my insurance wont cover xyrem. And lets face it. Pain every day, is depressing. Being treated like its in your head or you are an addict if you even mention pain, even if you weren't about to ask for pain meds.
Idk. I don't think you can base much off that.
2
We can stop all prescribing for opioid naive patients as a first line of treatment in all cases while still prescribing for chronic pain for those currently benefiting.
Opioids should never be the first line of care for opioid naive individuals. This would be a win-win.
6
Finally, an article that even touches on the unfortunate truth that some of us out there in the world actually NEED these medications to have any quality of life. In 1997,
due to a very traumatic compression fall onto concrete, I began to have symptoms similar to MS. Couldn’t get out of bed for weeks, each limb felt like it weighed 100 lbs, extreme weakness, nausea, extreme exhaustion, narcolepsy, dizziness, severe diaphoresis, pain in the back of my head & spine, poor motor coordination, tripping over my own feet, choking & difficulty swallowing, apnea, loss of bladder control, severe headaches & more. I was sent to a Neurosurgeon, had an MRI & was found I had a significant hernia of the lower brain stem & cerebellar tonsils (22mm) out of the foremen magnum. Apparently
the severity of the fall & several other injuries & falls, the herniation had finally come down enough to start causing life threatening symptoms. The surgical procedure I endured was the most horrible thing I ever could have imagined. I had a 10” scar from the middle of the back of my head to down between my shoulders. They did an occipital crainiectomy, 4x4” graft over the dura of my brain, bone grafts between my upper cervical vertabrae, removal of posterior arch of C-1 & C-2, & lastly, put in plates that screwed my skull to the side bodies of C-1,2&3. I had 24 skrews to hold the plates in place. I had variations of this procedure 3 more times over the years. I have SEVERE chronic pain & I need opioids
36
@Laurel yes you do and i hope for your sake you are receiving them
I hurt my back in 2/02 while working as a GS-15, supervisory Engineer at CDC in a job I loved! I was first prescribed Percocet aka Oxycodone by the CDC Health Clinic. I tried to work! Each Orthopedist and Physitrist I saw continued to prescribe Oxycodone. I tried working 1/2 days, every other days. I tried PT ( Limited to an arbitrary 4 months by workers Comp.) I tried TENs, I tried epidermal, that started the neuropathy in my legs. I followed everything to a tee to get better.
I had some of the Brain trust MD’s /PHd’s At CDC yell at me during a meeting ( Federal meetings at GS 14/15/SES level just don’t last 1 hr but 2 plus routinely. My calendar was filled with 6 plus hrs of meetings per day). Yell at me for not sitting still, for standing up 20 minutes in, or shifting in my chair. I tried to explain to the MD that I had an L5-S1 bludge with annular tear. They have no clue! These are the same morons who wanted to go to HD and buy kitchen cabinets and plastic laminate tops for their lab benchwork because they didn’t get their lab project reconfigurations approved. Their program turned it down. Home Depot Chinese cabinets wouldn’t work in a high school science lab let alone a BSL 3 lab. This brain trust accuses custodians for stealing their lab research. Anyone that has beyond a BS in science knows the competive nature of science and knows labs work against each other, Janitors don’t steal it. Put your trash in the corridor and clean your own lab!
7
Chronic users could "just say, no". Why spend money, time & worry over folks who deliberately destroy themselves. Tough love, but so be it.
5
@Jack Schmedeman
Said no patient of chronic pain ever.
11
Just legalize growing poppies for personal use. Seriously.
Never drive impaired.
12
I've had many patients arrive at my practice who had been prescribed, some of them, a dozen, addictive pain modifying medications by someone else - usually from out of state, and almost always when from out of state, usually upper mid-west. Oddly perhaps, I have never initiated an opiate prescription, so I'd not be interested to hear how we all prescribe opiates like candies. We don't. The problem with my patients was here they are on multiple prescriptions that are not safe to be on, and not safe to discontinue suddenly. This is where the art and science and politics of being a doctor come together. Sadly, and I can't state loudly enough, SADLY, insurance companies generally will not cover what these people need to treat their pain and recover from their addictions. That is the bad news. There is a glimmer of good news, being a doctor in Oregon. Instead of reporting these people to the state criminal justice bureaucracy as is required in some states, our prescription drug monitoring program is administered by the public health division. Why we want to have some states turn these people and their doctors into criminals is beyond comprehension. However my experience in Oregon is we can shift them to methadone, which is an addictive medication, and that is the extent of their state insurance coverage. Little to no rehab coverage. Private insurance? Forget about it! And...so politicians accept money from the fraudulent Purdue Drug Co. mob. It's a world of a mess.
12
The author seems to miss the issue of chronic serious pain, legitimate access to *prescribed* opioids and suicide.
I had a diskectomy in 1997 at L4/L5. Continue to have degenerative disk disease. In 2011, I had a major compression at L3/L4 due to disk degeneration to practically zero and a large bone spur. Two months of Percocet (really helped--limited withdrawal but still effective then), steroidal injections and physical therapy. Stopped Percocet (no problem). Now get physical therapy occasionally and 2-3 times a year steroidal injections. I can work, drive, be productive.
But the back has deteriorated so the entire lumbar spine is a disaster. 3 orthopedic spine surgeons all said the same thing--they would fuse T/11 to S/1. EIGHT vertebra. If that didn't work (that's major major surgery), I would need serious pain meds the rest of my life. I wouldn't know how to buy street drugs and wouldn't even try. If I couldn't get *prescribed* steroids, and had major unstoppable pain, I would probably just end it. Now I use opioids (Tylenol #3) occasionally to manage. Once or twice a week.
Let's not punish the people who have terrible pain. Try it sometime. Not something you'll want to repeat.
27
Many people who have been cut off by arbitrary insurance company policies have and are ending their lives because untreated chronic pain is not living. It’s suffering over above the normal suffering of the human condition. Do I expect compassionate policies from a country that locks people up in jail for pot? Of course I don’t. We are a punitive culture of hypocrites. Chronic pain patients are going to be sacrificed at the alter of good intentions. Is El Chapo the biggest drug dealer in the USA? Or is it the CEO of McKessen that got a DEA investigation shutdown?
4
The biggest problem is this stigma facing addicts. All these "legitimate pain patients" who cast shade on addicts as if it's a moral issue do not help. A good number are probably addicted themselves and associate too much stigma with addiction so are in denial. I can't tell you how many "legitimate pain patients" I have watched walk around in a stupor while they claim it doesn't get them high.
Oh and those studies that say only 1% of patients go on to become addicted is from a shill study that Purdue paid for to trick doctors o to prescribing to patients who they knew had more likelihood to develop an addiction to it--they even came up with a fancier name for it so it didn't sound like addiction: Opioid Dependence Disorder. That was 1995, and Purdue admitted they did this, and paid 630mil for it. The end result is a good number of those "street addicts" became addicted thanks to prescribed opioids like Oxycontin, not due to some moral failing, so why should they be punished?
The opioid epidemic has been causing skyrocketing OD rates since 1999, ten years before fentanyl and adulterants. Think about it: Why did heroin make a sudden resurgence? Because addicts turned to it. From what? Prescribed opioids.
The band-aid is to reduce accessibility, but Pandora's box is open. Now the chronic pain patients have been thrown under the bus, and so just come to resent the addicts finally getting help. The real solution: Increase access to healthcare, treat both.
12
Each person has a different tolerance to pain. If you have a chronic pain condition, or have to have major surgery that will be painful for months, treat with a board certified pain management specialist. I can foresee that with less opiates given for pulled teeth, etc. that alcohol consumption will greatly increase taken with tylenol and a shot of liquor. Not a great idea for the liver and kidneys. Not that the DEA or FDA cares.
Why didn't the geniuses in the FDA and DEA realize that there was a year in the early 2000's in West Virginia where each man, woman and child there had 400 pills prescribed for percocet?
And now you have the FDA stating to people with serious painful operations that they need to get their pills weekly. MY husband is scheduled for surgery( bone fusions) that will have him in a non-walking cast for 3 months. When would I have time to run up and get a script for one week 's drugs each week. Are you people nuts at the FDA and DEA? Try doing that and working full time and caring for your spouse. My husband won't be able to drive for six months. Insanity.
30
Four years ago my mother-in-law died. She was in chronic pain and about to lose her leg at the time of her death. When cleaning out her house I found bottle after bottle of Oxycontin pills and Fentanyl patches. It was obvious that the pharmacy just kept filling a prescription that was obviously for more than she required. After her death I tried getting rid of them is a safe manner. No pharmacies would take them. The hospital wouldn't take them. I finally found one suburban police department that had a medication drop-off where I could leave them. Had I been unscrupulous, I could have sold those on the street and made a hefty chunk of change. I'm pretty sure this is how a lot of addicts get their drugs.
2
@K. Clodfelter CVS on East Coast had a medicine mailbox, in store, next to pharmacy counter. I brought bags of controlled substances from two households and spend 20 + minutes filling it like a slot machine.
Happy to do so, I was weirded out that even hospice at home didn't what morphine back!
It was hard to find an outlet to take stuff, thank you CVS!
Also have done the police station drop offs but very occasional--all this needs to be more available!
Just for curiosity about 6 times as many people die from smoking cigarettes and the number of people who die from our fast food world is even higher. Where are the stringent restrictions on those products?
24
Yes, people do suffer from chronic pain so let physicians decide based on their training. What about alcohol? Alcohol kills more people annually than opioids. Yes, alcohol is a drug and is promoted through mass advertising that mainly targets underage drinkers, binge drinkers, and alcoholics. Alcohol is a drug and a very dangerous one.
16
Austin Frakt is correct in his description of some unintended negative repercussions of policies that try to reduce prescription opiate abuse.
Efforts to mitigate the results of our nation’s opioid epidemic—a complex public health crisis—sometimes results in good policies with negative consequences.
For example, Prescription Monitoring Boards in 49 states, the District of Columbia, and the U.S. Territory of Guam, which keep track of prescriptions in a statewide database and provide oversight, have led some physicians to be more conservative with opioid prescriptions. When a physician tells a patient they don’t need prescription opioids, some take Tylenol or Advil, but others may pursue illegal opioids such as heroin or fentanyl.
We need to review our policies periodically to make sure the positive effects continue to outweigh the negative consequences. We also need to continue to focus on polices with proven successes: increase the availability of Naloxone, and expand access to comprehensive, evidence-based treatments, including proven medications, behavior therapy, and access to primary care to prevent the transmission of HIV and hepatitis C infections.
3
@Lawrence Brown, MD: What is the #50 state NOT Prescription Monitoring? And why not?
PREP and needle exchange proven to work but politically infeasible, as is Obama Care in most hard-hit states with high deaths and addition rates.
Hep C could be eliminated with those treatments and existing meds, but we are too hung up on politics and morality and costs.
Not to mention measles and non-vax in general.
What happened to the Public Health people?
Do we even HAVE a Head of Health Care now? Cannot even remember name of that position. Sad.
1
There are non-narcotic options for many types of pain. For example, nerve pain from a spinal or other injury, can be managed by non-addictive gabapentin. Part of the answer has to be smarter prescribing.
2
@DC I’m on Gabapentin. I’m not sure if it really works at all, but it does make me forget words and increase my appetite. If you look at studies, it’s questionable how much Gabapentin really helps most people with nerve pain, and ironically now I hear that the government is cracking down on it too since some people are abusing it.(I’m not sure how.)
12
@DC. Gabapentin has many side effects including double vision and memory issues. I had more trouble with it than with oxy.
9
@DC I took gabapentin for a week or so, and it gave me nightmares. Nothing has worked for the arthritis in almost all my joints except opioids. I have never gotten high from them.
If they were taken away, I'd learn how to get them from other sources. This stupid non-solution will send patients to the dark web where they will find other things which might harm them.
I couldn't live with the pain I'd have without relief. Nor would I.
7
As someone who has been prescribed pain control medication nearly my whole life for different debilitating conditions and in the last 8 years I have been through several procedures and they found a sizable lesion in my brain. Despite my diagnosis', extremely high blood pressure from the amount of pain I am forced to live in and a host of other issues that stem from taking grams at a time of OTC pain medications.. I CANNOT get help, no doctor is interested in improving the quality of my life. I'm a 34 year old mother of two young daughters that I basically can't do anything fun with because just the basics take everything I have, and most days end in tears. I often think about sourcing heroin or other street options because I feel like a dealer might care more than a doctor at this point and at least I might not hurt. I just want to go one day without being in pain... one whole day. It's a dream, I have been sick as long as I can remember, I just want to be able to keep up with my "normal" friends.
14
@C. Hill You have my sympathy.
6
Your story breaks my heart. I haven’t had a pain free day in 18.5 years. Is there no “Pain Management” Doctor you can find in your location? I’m so sorry you’re suffering like this.
3
I would give kratom a try. Seriously. It has changed many peoples' lives.
Biggest percentage of chronic pain patients don't abuse or overdose. True pain patients are not getting high euphoria just some pain relief. The people who abuse over half had some sort of substance abuse long before Doctor prescribed pain medication. Called personal responsibility to inform Doctor.
Once again about addict clean needles addiction services etc. Realize addiction awful need help. There are two populations here shouldn't be all about one and so little help for other.
No matter how you slice or dice Alcohol still kills more every year than pain medication. Government big dollars in taxes now same with marijuana. Marijuana sure has its place medically, but what's with recreational use in some states. Has DEA and CDC gone to far trying to save people from themselves at the expense of millions of others.
24
@Barbara Thurman doctors were coached by Purdue sales reps to ignore the potential for addiction. My mother was a recovering addict with chronic pain and gave her doctor full disclosure that she was in recovery. She OD'd several times and her doctor kept prescribing despite the urging of the family to stop. She didn't stop prescribing her pain meds until around 2007 when the DEA started cracking down. My mom turned elsewhere for them, and ended up fatally overdosing on methadone diverted from someone else. If her doctor had not prescribed a recovering addict what amounts to heroin, she probably would have stayed clean and sober. Perhaps if her doctor had not been so ill-informed; she actually claimed at one point that OxyContin couldn't get a person high. Another lie pedaled by Purdue; I can't tell you how many times I saw my mother nodding off on the stuff that supposedly can't get you high.
My mother was not the typical chronic pain patient, but she exemplifies the perils that faced recovering addicts who also deal with chronic pain. There was a pre-existing overlap there that was not considered until doctors realized they were contributing to it.
Yeah pain patients are getting the shaft... But addicts were getting it before now. Pain patients are the other rung of the ladder, but we're all being distracted from who is really stepping on us. It's not the government, it's not doctors, it's the greedy and self-admitted root of the problem: Pharmaceutical companies.
4
There are many chronic pain sufferers, many are Veterans who are being shut out of the pain management clinic by physicians. Most of these cowardly physicians are kowtowing to politicians rather than sticking with the directives of the hippocratic oaths they swore upon graduation. These physicians are gutless wonders worried about the wrong end of the "stick". The patient who is in need is given a back seat to political expediency. The American medical profession is being weighed down to the point that the patients aren't even valid NUMBERS anymore. We have all faded into the expediency of whitewashed woodwork. A 75 year old chronic pain sufferer should not have to beg for assistance or be made to pee in a cup and undergo a barrage of insidiously ridiculous checking and hash marking the same documents like an organ grinders performing monkey. Shame on you physicians sidling under the porch like flea ravaged backwoods hounds hiding from the ferociously ignorant band of politicians you have been so anxious to surrender to. Shame indeed.
26
@donschneider
Practicing criminal law for 40 years— both prosecution and defense— I marvel about all the hoo-hah about keeping patients who need these drugs away from them while the manufacturers and pharmacies that distribute them get off scot-free. Two years ago I sat in a federal courtroom listening to sentences— pretty light ones considering it was federal court— being handed out to some of over one hundred persons who were caught up, because they were being treated with opioids for real ailments, in a scheme to get scripts for 400 pills a month that they all cashed in at one of three pharmacies. I asked the DEA agent why the company that was shipping these copious amounts of pills to these pharmacies in an intercity neighborhood and the pharmacies themselves (the doctor had dementia, so he was not prosecuted) were not being prosecuted too, and he just shrugged.
9
“Well your hip replacement surgery went well. We cut open your hip, ripped a bunch of muscles out of the way, took a saw and cut the top off your thigh bone, jammed a new metal ball in there, filed off a bunch of cartilage, stuck in a new socket, sewed back all the muscles and closed it all up.
What? You’re in pain? Here, have an aspirin.”
55
@Peter
You'd be surprised what we can handle. My mom had a laminectomy--cut through the back and into her spine--and managed with Tylenol and something to ease muscle spasms, non-narcotic. I know she's tough, but she can't be the only one. The hard part for her was the months of increasing nerve pain prior to the surgery. She had narcotics prescribed to her, but avoided using them, relying instead on gabapentin.
1
@Peter You forgot one thing Peter, if many of the folks who have unnecessary, but highly profitable hip and knee replacements had been given mild pain meds allowing them to get a goodly amount of exercise so their muscles could aid in the repair of knee and hip problems these folks might not have had to have surgeries in the first place, but hey a 90 day supply of generic low dose pain meds is about $10.00 as opposed to a $100,000.00 hip replacement, what do you think the good Dr. today is going to recommend, in particular young physicians hundreds of thousands in debt from med school. It’s a different world today, the old common sense in medicine, like a couple pills a day to help you build up your body no longer apply, today it’s all about turning the patient into an atm machine: you see a g.p. if your lucky enough to even get an actual M.D. who spends more time on the computer than with you and then sends you off to “ specialists”, where the real money is for the Wall Street entities that own many physician groups who are no longer able to deal with insurance problems, paperwork, continual interference from the government (like changing the status of formerly safe pain meds to “bad drugs”, after forty years of being “ very safe’)plus keeping a lookout for the lawyers: yup, there’s only one way to describe our health care system, a very costly mess designed to enrich the folks least deserving of a dime, insurance honchos, financiers and ambulance chasers.
14
@Peter. More like. "Had a tooth pulled? Surely you are in pain, have no tendencies to addiction, and need a very powerful opioid. Here are 45. Dont worry...your insurance will pay most of it."
2
So what option will be left for pain?
I worry more about gun deaths of which 2/3rds are suicide.
Yet we only discuss murder.
Why are so many desiring opioids is the question.
7
@NotJammer Opioids such as Vicodin fill a genuine need for pain relief. I can attest to this, having been prescribed it for pain before and after knee replacement. I need a second knee replacement, as well as reconstruction of my left foot and ankle, and Tylenol 3 doesn't do much in the area of pain relief.
8
The problem is NOT prescription opioids, it's ignorance!! 45,000,000 Americans suffer from chronic pain. Most of them have used prescription opioid pain medication without issue for many years. Studies show only 1% of prescription users become addicts. So the ignorant and misinformed CDC is essentially forcing doctors into cutting these millions of Americans off their pain meds so that they have to suffer in agony, turn to those illicit and dangerous street drugs, or commit suicide. The government has NO RIGHT telling doctors how to treat their patients, and the result is a massive human rights violation.
34
@Buck
The CDC says that it is as many 24% of people who take opioids for chronic pain wind up abusing them.
1
@Buck
Could not have stated it better!
3
@Buck
That 1% stat has been produced by Purdue. Dig a little deeper, the numbers are horrifying.
I am a legitimate chronic severe pain patient who, as a result of botched dental surgery that severely injured my trigeminal nerve, suffer from trigeminal neuropathy. To deal with my severe pain, I've tried surgery, botox, exercise and Mindfulness. New Age homeopathic remedies do not work and OTC analgesics lack the firepower. So for the last 4 years I've taken low dosage Percocet to alleviate my nerve pain on an "as needed" basis. During this time, I've taken my Percocet as prescribed. I've not snorted it, injected it or graduated to heroin and/or fentanyl. I'm not an addict. I'm not "opioid" sexy or "opioid" newsworthy so my story never makes the news. I'm just an average guy (part of a silent majority of chronic pain patients) who will suffer greatly if Percocet availability is curtailed or denied because other people abuse this painkiller. Don't force us to pay for the sins of others.
41
@Jonathan Sprague
It sounds like you received every treatment for your problem except the one that is indicated for it: carbamazepine, an anticonvulsant.
1
@Steve I have an appointment coming up in two weeks. I'll raise this medication option with my pain management specialist. Thanks for taking the time to help. Much appreciated.
1
I’d like to know who’s looking out for the two pill a day for 15 year “addict” who’s a responsible adult.
We all have the sword of Damocles hanging over us while you “try something different” with the irresponsible.
23
There is no "opioid crisis" There is an illicit fentanyl crisis. Patients under managed pain care do not abuse. Managed pain care does not tolerate abusers. Addicts do not seek managed care. Most abuse is done with stolen prescriptions or drugs bought on the street that are tainted with Chinese fentanyl. The gov't. needs to stop punishing pain.
30
I use tincture of opium for severe fulminant fecal incontinence. I can no longer get the prescription. I use what I have judiciously.
It’s been two years since they last allowed me a new prescription but I use a third of a dose only for leaving the house so I still have some. The situation has left me home bound and suicidal.
It’s very frustrating living in a nanny state where responsible people are withheld medications that allow them some quality of life.
33
Get loperamide. It is opioid derived, but not much in demand on the street. Tincture of opium is really old school stuff.
2
I'm not pro opioid. They don't help everyone and there are side effects that for many prove too big a hindering factor. Addiction exists. Those obstacles are not going away anytime soon.
I am pro patient. If someone has been condemned with a painful and incurable condition, let them decide if opioids work for them. One can't fake unending bleeding ulcers inside of their abdominal core, or multiple traumatic dislocated joints.
Denying pain control to incurable conditions sufferers and the disabled isn't healthcare. It's a grand standing but pointlessly vile crucifixion.
23
I just had major surgery. My access to pain relief was severely limited because people other than I are drug addicts.
Dr.s office told me to take more of them. I said OK, I’m only taking about a quarter of what you prescribed and that’s working but, I’m going to run out tomorrow. “Sorry, we can’t refill that prescription” “But, you just told me to use more of it”
Our entire healthcare system is criminally insane
35
I’m glad someone has finally mentioned this. I’ve been tilting at this windmill for years. Forcing people off of relatively safe pills and onto street drugs, now more powerful and cheaper than ever, always was a recipe for disaster. In the long run it might cause the overdose curve to plateau, but in the short term expect it to kill a lot of people.
14
I had been having successful pain management for 12 years. I went from not being able to work or sleep due to a chronic pain issue to using 200 MG Tramadol daily and being able to sleep and work again. Until last fall when my doctor moved his practice and the clinic he was a part of refused to refill my tramadol without tapering me off for no reason. Luckily my old doc was able to help me taper by extending one month. Now I sleep in 20 minute increments in the night, can not manage in the day, and no longer can stand and do my work. Oregon doctors are so afraid of having their licenses removed that they have overreacted to the Opioid crisis.
26
The opioid problem cannot be solved with a one-size-fits-all solution. People who take opioid painkillers responsibly should not have their prescriptions limited.
On the other hand, most of us do not need opioid prescriptions for acute pain like a tooth extraction or a dental implant. I've had both more than once. Each time, prescriptions have been pushed on me "just in case."
This is for the convenience of the prescriber who does not want to be disturbed at night, not for the wellbeing of the patient. At most, I've taken two tablets after dental surgery that cut into my jawbone. By the following day, acetaminophen was sufficient.
We need a multipronged approach: patient education, doctor education, drug interdiction, non-judgmental addiction treatment freely accessible and clean needle programs, among others.
No one sets out to become a drug addict, but some are inherently susceptible to addiction when exposed to certain drugs.
I've treated over 7000 patients. They all wanted to be clean and sober, but some could not do it under current treatment guidelines.
11
@Barbara - I think well of my doctors and I don't think they would resent it if I needed their care in the middle of the night. But what good would it do to have a prescription when the pharmacy is closed?
2
At last, a HINT that common sense might be applied to the problem. Restricting access for a huge number of people who NEED pain meds is no solution to the misbehavior and addictive personalities of others.
15
Methadone
1
@Duncan
Washington State spent a few years prescribing methadone as primary pain relief to Medicaid patients, because it was the cheapest option.
They stopped after a number of high-profile accidental and fatal overdoses. In the liquid form that they were using, the margin of error was very narrow, especially in people already debilitated by disease and disability.
There is an implicit premise in this article that very few ever seem to question.
On one hand, you have 'legitimate' pain patients, who need opioid drugs, and our compassion for these individuals means we must provide access to opioids for these good unfortunate people.
On the other hand, you have those nasty addicts. They, due to their human weakness and character flaws, are the people we must keep opioid drugs away from, and if those degenerates want relief from the agony of withdrawal, we force them to have only the option of buying drugs on the black market, which are increasingly adulterated with fentanyl which vastly increases the risk of overdose and death.
The article makes one thing clear, pushing people out into the street markets kills people. What should appall every human being with an ounce of compassion is the idea that this is even a remotely acceptable state of affairs. But this is what a century of drug prohibition does to society, I guess.
19
While I understand the horrors of any kind of addition, this knee jerk reaction is unacceptable. There are people, such as those on blood thinners, who cannot take NSAIDs or aspirin as it can increase the risk of bleeding. Second, to dismiss pain from sprained ankles or tooth extractions as not needing stronger pain killers is ridiculous. Pain is a subjective experience. What may be tolerable to one person may not be to others. There is also benefit in interrupting a pain cycle early on through what works. Not everyone and probably not most people who receives an opioid is going to become an addict. To react as though they are is reactive and unproductive in the long run.
5
Well thought out article, but it doesn’t take its own logic to conclusion. That conclusion is that deaths could be reduced by more liberal access to opioids reducing the need for patients to turn to heroin.
5
sadly, I think the real issue is emptiness and psychological pain in the addict to be's life. Obviously millions of people are prescribed opioids after surgery and never abuse them. Others abuse, and move on to other drugs, why? Do they have different receptors that set them up for abuse, or just miserable /empty lives?
3
It's crazy how quick doctors are to prescribe opioids! When I had a nasty case of shingles about four years ago (at 41), my doctor wanted to give me opioids for the nerve pain. I refused to take them, and he then said "but you'll have to take a lot of Tylenol!" - which I then proceeded to do. It wasn't pleasant, I can assure you - I had to take 400mg every 5 hours, like clockwork - the pain would wake me up at night at exactly the 5 hour mark, until I popped another pair of pills and tried to go back to sleep. This went on for a few weeks, but I wouldn't have traded it for any quantity of Percoset or Vicodin or whatever else it is that doctors seem to want to prescribe at the drop of a hat. And if I had to choose, I'd do the same thing all over again - I am NOT going to put myself in the position of getting addicted to opioids, WHATEVER the situation. I would rather deal with the pain with NSAIDs, meditation and exercise - but NEVER opioids.
By the same token, I have absolutely refused to let my husband take any opioids when he's had root canal surgery and similar dental work done - I can't BELIEVE that the dentist is prescribing him this stuff!!! What is wrong with people??!!
I imagine there are some people for whom there is truly no alternative, and by all means they should have access to strong pain medication. But for pretty much everybody else, this has to stop, NOW!!
2
@NYer 1. With that level of acetaminophen abuse, you are lucky you didn’t put yourself into liver failure. 2. Pain perception and pain produced by various syndromes varies by person so your liver-risking approach might not help someone else and certainly is no standard to aspire to.
17
@NYer Nonsense. Hydrocodone is safe if properly used. I'd like to see anyone "absolutely refuse" to let ME take legally prescribed pain relief for legitimate pain.
8
Actually, 5 hour dosing maxes at 5 doses in 24 (allowing a little cheating) and a total of 2000 mg or 2 grams in a 24 hour period. That is not excessive, but chems every 60 days would be safe.
2
This continued argument is absurd, to conflate Street addicts who rob to support a habit or are abundantly obvious laying in the streets of America and “other” third world countries with patients who may rely on pain medications and take them in a responsible manner is not only ludicrous but has done a tremendous disservice to those in our society who play by the rules. Just lumping heroin and fentenyl with prescription low dose hydrocodone is disengenuious at best. First of all why would a Street addict bother with much more expensive pain pills when they get a much better high(which you don’t from low dose pain meds)from cheaper, more accessible heroin or synthetic heroin, your argument is not compelling nor is the idea that taking necessary pain meds is going to turn you into a dope fiend, as a matter of fact that same argument was made be many(probably by Liquor dealers) over the use of marijuana in the sixties and seventies. This political posturing over prescription meds has caused tremendous stress and pain for millions of Americans, you really need to find something else to pontificate over and our elected officials really, really need to start doing things to benefit, in particular, former middle class Americans. Just because you can’t jail bankers or your other big donors doesn’t mean you have to take it out on the rest of us little people.
6
As usual, when a problem occurs, Our response is to overreact. As a chronic pain pt. (lower lumbar region) hydrocodone has been a savior. It allows me to sleep at nite. Without it, I would never get a decent nite sleep. In North Carolina where I live, the only place now to get opioid pain medication is at so called "Pain clinics." There you are treated like a potential addict, bringing your pill bottle, taking a urine test at each appointment. Sadly, I was deprived of my pain meds by the clinic because I tested positive for cannabis, which I use as an analgesic, reducing my need for narco. Since NC has not passed a law legalizing marijuana for medical purposes, I was ejected from the clinic by a nurse who could not conceal her disgust. In California, where I am now for several months, I can use marijuana for pain, but a local doctor would not prescribe hydrocodone, " too much trouble," he said. I've been using this pain med for 11 years with no problem. I do not crave it. I do not get high from it. It lets me sleep. Pain pts. should not suffer because Drs over-prescribed it, distributors over-distributed, and some people abused it. Can we be sensible about this?
16
Look at France and the impact on opiate related deaths after permitting all docs to prescribe Suboxone - 70% decrease in two years. Simple solution.
4
Oh, no question. Addicts will use suboxone (Buprenorphine) in the absence of other opioids. “Subs” work well, are administered through the medical system, allow addicts to work, make profits for docs and pharmacy companies. What’s not to like, except that the addictions continue, albeit subsumed within the for profit medical system.
Truly, Buprenorphine works quite well for pain relief. It is very long lasting and has much less of a noticeable onset. Relative to someone on long term low dosage Vicodin or oxycodone it would probably be superior.
2
Imagine you are a healthcare company / insurance company and trying to figure out how to get rid of unprofitable patients: Hey, I got an idea! Let's eliminate what chronic, sick people use and force them to change healthcare providers. - Yes, people who use opiates on a regular basis would fit that scenario.
It may be a bit cynical, but you have to admit the result is the same. - By denying pain meds to patients with chronic pain, it's not going to improve the Quality of Life for the vast majority of those patients...but it will probably drive them to look for other alternatives to alleviate the pain...or end the pain.
10
The fear is that prescription opioids will lead to illicit opioids.
1
curiously that as the number of opioid prescriptions greatly increased in this country from 1990-2010, there was no corresponding improvement in the care of patients with chronic pain.
One would think if opioids were the answer to chronic pain, they would had an impact on it during that period. Most widely used medications show an impact on the conditions for which they are prescribed within a short period of time.
@Steve Nobody said opioids are "the answer" to chronic pain. They never were. We said they need to remain available as 1)one component of a multi-modal treatment plan 2) for use when no other existing therapy can restore function. The same way they were once prescribed, in the mid-90s. Might have stayed that way, had pharma marketing scams and pill mills not spread so quickly.
There was no improvement in chronic pain care through 2010 because insurance companies stopped paying $10k for multi-disciplinary pain programs (like the one I did) that were common in the 90s. Even then, not every patient with every rare condition can benefit much from such programs (I didn't). There is such a thing as palliative care that is not also end-of-life care.
7
@Reese Tyrell
What you overlook is that for many patients one of the goals of most multi-disciplinary pain programs was to get people off of opioids and replace them with other means of pain management.
And end-of-life care is not the same as treating chronic pain.
@Steve I don’t overlook that at all. Avoiding or tapering opioid therapy can be a worthy and laudable goal, when it’s possible.
At the end of these full-time multi-disciplinary rehab programs, the ~10% who are unable to achieve functional benefit are often referred to long-term palliative protocols.
“Chronic pain” is not one thing. It’s everything from an unexplained trick knee to rare genetic conditions where skin falls off, organs calcify, bones disintegrate. It’s incorrect to put all those conditions in one category.
1
This crisis is about much more than simply opioids. It has become out of control because there are major inadequacies in our healthcare system. Addiction is often the result of underlying psychiatric or emotional issues. So, we have many people suffering from drug addiction as a result of untreated issues like depression and anxiety. We also have people suffering from chronic pain issues that rely on opioids to function that are dependent but not necessarily addicted. Either way, due to prescribing regulations, many of these people are forced off opioids without adequate detoxification and aftercare. Rehabs are proven to be ineffective as they don’t address the individual needs of each patient. We should be focusing on making proper treatment accessible so users don’t feel they have no choice but to turn to the streets to use dangerous drugs.
4
@Waismann Detox
I'm sorry to disabuse but most people with depression and anxiety who are drug abusers have the depression and anxiety because of the drug addiction.
Go to an AA meeting sometime and you will hear many people say that they always told people that they drank because of their depression or anxiety and not because they were alcoholics.
@Steve. Totally false. Their depression normally precedes drug use. Not sure where you are getting your information.
"Opioid" is a poor, generic word to use battling a real life-and-death problem, because it is about three or four steps away from the very personal level where people acquire and misuse these drugs. It is a term that covers such a wide array of them, from codeine to carfentanyl, and each of those then has street names. Everyone is "opioid this" and "opioid that"... but it doesn't count for much when a kid is offered something by a friend at a party. At a hospital I was given pain killers for a scratched cornea and had to look up Tramadol out of personal curiosity to find out it was an opioid. People actually get started that way. Opioid is a too-distant word that might be useful for publications, but it does a disservice to the public.
5
Interesting, but one doesn't make policy based on a "simulation study."
5
I'm a registered nurse who has worked in many different environments from post surgical units to home hospice. I am extremely concerned by the idea that the answer to the opioid problem is restricting doctors ability to properly treat pain. This is bound to cause a lot of unnecessary suffering and prolonged healing for individuals who will never become addicts. It may also result in over-taking medications like tylenol and ibuprofen which are not without their dangers. It's irresponsible to decide that some procedures or injuries are more worthy of others...in the case of tooth extraction or sprains, an individual may have a day or two of very intense pain and need better relief than ibuprofen. Pain is individual and what causes excruciating pain for one person may be mild in another. No one can or should tell someone what kind of pain they have. I've been appalled recently to find friends being sent home from major dental surgeries and other surgeries with just ibuprofen and finding themselves in horrific pain, unable to rest, and having to call and request stronger medication. The answer isn't to pass sweeping rules that don't take into account individual pain reduction needs. The answer is simply for doctors to limit the amount of pills that they give - don't write for 30 when 4 will do. Most surgeries don't require more than two to three days of opioid relief and that's mainly at night when pain spikes and people need to rest in order to heal.
21
@Gigi Exactly. My daughter has had two knee surgeries and hated the pain meds, so she took as little as possible, but there were MANY pills left. She could have been given 4 and then gotten more if needed. Some people are not taught that opiods are not antibiotics and that you do not need to take a week's worth, no matter what. Doctors are very poor at explaining what they prescribe. This has to start at the doctor's office and a careful relationship between doctor or better yet, nurse, and the patient.
6
@Gigi You are a good nurse. Carry on.
3
I take Lortabs for chronic and acute back and knee pain. I'm not an addict-the addicts are those people buying drugs on the street, and those are the people dying of over doses of fentanyl and heroin. How that is lumped together with prescription drugs is beyond my understanding.
10
@Mgaudet
There are still plenty of people dying from overdoses of prescription opioids. That more are dying from illicit opioids doesn't change this.
2
The current PR campaign by the Office of Drug Control Policy is making it difficult, if not impossible, for chronic pain sufferers, especially seniors, to get their medication. Many people have NO problem with psychological addiction to opiate-based pain meds. And they don’t get high—to them it’s glorified aspirin. So punish everyone because a few are hopeless addicts? Might as well go back to prohibition. And, hey, why don’t we have an Office of Gun Control Policy?
18
People always talk about tolerance to narcotics creating the need for increases in medication. WhenI came home from the hospital 9 years ago after having a fusion of most of my back I was on a very high dose of OxyContin and dilaudud. For some reason my body decreased the amount I needed rather than increase. Over a few months I would have to drop the amount I was taking. I had nothing to do with this in a cognitive sense. One day I could take 100mg and the next day was too much and I had to reduce it. My point being that while most develop a tolerance to their dosage, not everyone does. There are also those that stick to the dosage prescribed by their doctor. I hate the catch all phrasing when it comes to narcotics. There is no such thing as all people or everyone who takes these medications etc. I don’t understand why benzodiazepines are not looked at the same way. They are highly addicting and you can die from the withdrawal if you are cut off from the meds without tapering. Somehow this does not seem to matter which I find curious.
4
@cat lover
Benzodiazepines are getting the attention that they deserve. And some of us, including myself, have been writing about the problem with them for over 25 year.
The latest rFederal government regulations on prescription of controlled substances including benzos.
3
"The CDC estimates that more than 70,000 people died of a drug overdose in the last year, most of them from opioids."
Still missing from any academic study that I can find is any attempt to sort out- how many of those 70K were NOT "overdoses", which implies "accidents", but were rather very intentional suicides.
People studying opioid abuse now admit that it is correlated with "despair".
Suicide; we know perfectly well, is also strongly correlated with despair.
Treating a suicide epidemic - as if it's just recreation gone awry - will not encourage any persons in despair to hang on.
And turning any such problem into a political football is guaranteed to cause blindness; on all sides; and greatly prolong the problem. And cause far more human pain than is necessary.
9
@Greenpa
There are studies that have examined what you prescribe. Obviously it's impossible to interview people who died as to why they took the opioids but based on interviews with those who survived OD's, the estimate is that 10-15% are suicides.
2
Once again, a topic that's all about what is rightly in professional nursing's domain to address: comfort, the legitimate sick role, transitioning patients from dependence to independence or interdependence on others to manage their pain, distress and disability to tolerable levels, and quality of life for patients, never mentions the "N" word. But nursing is fundamentally positioned to address these critical needs across all settings: public health, home, employment, long term, rehab and acute care.
Before DRG's launched the managed care (more accurately, deprivation of care and recovery) era in the early 1980s, registered nurses owned the provision of pain management and comfort care.
Once again, I'll point readers to the National Institute of Nursing Research (one of the bona fide institutes within the NIH), and to nursing researchers studying pain, comfort, the sick role and self management practices, such as Kathy Kolcaba and Jeanne Watson, along with Linda Aiken and many others who work in utter invisibility and without any due recognition for their work. It's a national disgrace that we ignore university-based nursing education and research in healthcare policy and funding discussions. People suffer and die needlessly as a result (see Aiken's work on nursing staffing and patient mortality rates).
9
I have been prescribed vicodin and Oxy and Hydro codone numerous times for dental pain or minor surgery. In each instance I was glad I had it, when my pain was at its worst soon after the local anesthetic wore off. I took one or at most two pills out of each prescription, leaving 18 or 19 in my medicine cabinet. I have often wondered why they don't prescribe 4 pills rather than 20. Can anyone tell me that?
6
@Ray Greenberg
Great question. Prescribers would have to require the patient to make another visit and have a separate prescription written. The physicians don't want their already overloaded schedules clogged, and many insurers would not reimburse. There would also be a delay in patients receiving pain relief. In the days where surgeries were performed on an inpatient basis, registered nurses provided the medications and transitioned patients from IV and intramuscular (injection) forms of pain medications to oral versions, and often to non-opioids before patients were discharged home. Nurses promoted coughing and deep breathing, got patient walking (mobilized), provided wound care and monitored for side effects of the anesthesia and medications, so that these were addressed in a timely manner and minimized or eliminated them altogether.
Because the patient recovery period has stripped professional nursing from the majority of patients undergoing surgery, this care and oversight has disappeared, leaving patients on their own to figure out how to best advance their recoveries. And physicians are not interested nor are they motivated to burden themselves with these factors in patient recovery.
6
@Ray Greenberg I work in vet med, not human med so take this with a grain of salt.
The cost of prescribing 4 pills may very well be the same exact cost as prescribing 20 for the insurance companies and in terms of your copays. There is a baseline in vet med for each type of medication below which the cost doesn't change. Most of the doctors (bear in mind these are vets and they have the problem of not being able to ask their patients how much it hurts, so as I said, grain of salt) just write the script for the baseline and that way the patient has a cushion if they need it. Of course, vets stick to buprenorphine and tramadol for the most part and while those are opiates they are slightly different than the kinds of painkillers given to most patients - although tramadol is becoming a standard.
2
"A recent study in JAMA estimated ...no more than about 5 percent (decrease) by 2025."
Actually that's a very optimistically skewed statement; the actual numbers from the study: "projected to result in a 3.0% to 5.3% decrease".
And; very tellingly regarding the mindset of the medical establishment; this study does not address AT ALL the simple "flip-side" of this change in prescribing practice; what is the effect on those who lose prescriptions they were correctly given for long-term pain management?
Many people hang on to their jobs, marriages, families; only because they have been able to handle chronic pain, via opioids. No, NSAIDS do not work for everything.
When they lose the drug that works- they can lose their job; their marriage, their home - and their will to live. Vehicular suicide is far more common than we admit- and also the simple bullet in the brain is never noted on the police report as "caused by lack of pain medication".
But! This nice, expensive study- modeling the effects on a lesser proportion of those affected by decreased availability of opioids - does not even MENTION - let alone study, or project - effects on the greater number. That's actually counter to long-standing scientific practice.
Anybody listening, in the medical community?
17
It is not only the fear and discomfort of withdrawal that motivates people to continue using opioids. Opioids “work” because, across a broad range of tissues, they are essentially inhibitory. The much publicized “dopamine” hypothesis exaggerated the high opioid seekers achieved.
For most, including the vast numbers on Buprenorphine through MAT programs, opioids provide a sense of relief from daily cares and aches. Buprenorphine is an opioid that is a great work force maintenance drug. People on Buprenorphine need their meds, behave to get them, , can go to work, do suffer some cognitive decline and some reduction in affect. But they are great low end service workers since the Buprenorphine reduces pains of repetitive labor.
Multiple species have endogenous opioid circuits not to “get high” but to reduce the suffering of life.
4
I’m 47, a registered nurse in critical care, and a long time (13 yrs) beneficiary of pain relief courtesy of buprenorphine. I have a congenital, degenerative, neurological condition that causes widespread chronic pain. If I didn’t take that, along with Lyrica I’d be bedbound, depressed, and likely completely nonfunctional due to a psychological dependence on euphoria-inducing opiates. Instead I recover patients from open heart surgery. I must question your assertion that the low-level service worker is reduced to a flat affect and decreased cognition (paraphrasing) if s/he is using buprenorphine. It isn’t only addicts, in recovery I might add, and reprobates who benefit from buprenorphine. There are quite a few medical professionals in recovery thriving due to the benefits of this medication. It helps a lot of different classifications of patients function. A lot of us are high functioning. The idea that buprenorphine use manifests flat affect and decreased cognition is patently false.
3
"" 80 percent by one estimate — of heroin users in the United States previously used prescription opioids. In some cases, they were directly prescribed ""
This is the kind of quote that drives me crazy.
The link provided says that heroin users "reported using prescription... " That means they said ,,and 'they said' is not evidence, it is hearsay and perhaps make-believe. besides, an addict says it's not his fault somehow is not a big surprise.
And that is the problem here ,everyone loves the sound of their own voice , no matter if the words they use are factual or relevant.
Opioid addiction will never go away . neither will pain . what we need to do is think carefully about this. It is very complicated , and scattershot regulations based on shallow thought are just going to harm legitimate uses of what really is a miracle drug.
Let's start with separating controlled and uncontrolled use in our dialog. Then we can work on disallowing the opinions of the inexperienced or those that have no medical learning.
Once we have some accurate assessments, then we can have thoughtful actions , not this crises 'du jour mentality of late .
10
It used to be heroin addicts here could only get treatment and rehab if they claimed they had been addicted by wisdom tooth extraction or something similar. The other point is that 80 percent of heroin addicts is not 80% of people prescribed pain meds - which is how half the people I’ve talked about this article with today misread it. Finally, when the pills were virtually free, every heroin addict knew you had to crush and shoot or snort or smoke them to get a heroin-like high. In other words, the addicts were already addicts. When heroin became cheaper (as it remains today), they used that. As it became more and more contaminated with fentanyl and worse, they died. Not one bit of this has anything to do with the 95% or more of all acute and chronic pain patients who never abused anything. It is apples and oranges. The last five years of hysteria about the wrong thing have killed more legitimate pain patients than will ever be counted.
9
@Anna Base ""Not one bit of this has anything to do with the 95% or more of all acute and chronic pain patients who never abused anything""
That was worth repeating .
Oxycodone is not perfect. But it does not burn holes in stomachs or trash livers like other pain medicines do.
What it can do, when used cautiously, is restore function and worth to millions.
Thoughts constructed from dubious and incomplete information have led to blanket policies against legitimate and considered prescriptions.
Easily smuggled Fentanyl should be worried about, but few 'studies' separate it from other factors in the 'Opioid crisis'.
Ideas that doubling regulation and lowering supply of oxycodone to licensed medical doctors will somehow stop Fentanyl smuggling and it's illegal abuse seem very naive.
4
I am a physician with several patient in chronic pain which could be helped by an orthopedic surgeon. Unfortunately they have Medicaid which reimburses so poorly that I cannot find a surgeon for them for their herniated discs or congenital hip problems. They live on welfare when if society would pay for their medical care or find me a compassionate surgeon they could go back to work.
14
I fear that the Upshot has been stingy with some key facts about opioids, namely:
1. Untreated chronic pain results in statistically significant increases in suicide. I prefer the 33% figure but have seen some claim as high as seven-fold.
2. The text does not make entirely clear that those who procure opioids that have NOT been prescribed to them are the vast majority most vulnerable to addiction. Few legit patient follow prescribed drugs with addiction.
3. There is indeed research documenting the benefits of longer-term opioid use for chronic pain, but it is from other countries. My favorite is an Italian study concluding that modest opiate doses have value in treating chronic pain from arthritis and other woes of old age.
4. The number one reason we have no American research on benefits of opiates for chronic pain is that the NIH does not care to fund it.
5. Doctors who hand out 60 or 90 pills for brief pains strike me as either incredibly cavalier or just plain deranged. It would be interesting to see research done on their motivations.
45
@Fiorella As to your point 2. I think the article states exactly the opposite -- 80% of addicts have been prescribed opioids in the past. Either your statement is different in a way I don't understand, or you should provide a source as the NYT does.
@Atm oht It's terminology - "prescription opioids" includes both opioids prescribed to someone else and counterfeit street drugs manufactured to resemble prescription drugs. CDC reporting does not differentiate. 75% of people with opioid addiction started with prescription drugs that were not legally prescribed to them. Source: SAMHSA National Survey on Drug Use and Health.
Plus toxicology results only show whether a commonly-prescribed substance was present. They don't show whether that substance was ever actually prescribed to that person.
8
@Atm oht
The article states that 80% have taken prescription drugs and that "in some cases" they were directly prescribed. One does not have to be prescribed prescription opioids to have taken them. It is you that is misquoting, as to your point.
Furthermore, in those cases in which they were prescribed, no data is offered as to for what they were prescribed. They may have been prescribed for an acute injury or post surgery, as opposed to chronic pain.
3
I'm a physician in West Virginia. Most doctors know next to nothing about addiction. They prescribe pain medications without an understanding of the long-term consequences.
Opioid pain medications work great, for a few months. After that, due to tolerance, their efficacious effects go away and the pills are essentially preventing withdrawal symptoms -- this feels like relief to patients. Which is why patients say they need their pain medications to continue to feel okay.
However, look at the data. People on chronic opioids report increased level of pain and we know their functional capacity decreased the longer they are on opioids.
These are essentially heroin pills -- they work the same way in our brains. Great for people post-op and in hospice. However, for chronic non-cancer pain relief, there is NO evidence that they should be used. The risks outweigh the benefits in almost every scenario.
But, when there are 15 minutes to see the doctor, it's easier to prescribe a pill than actually listen to a patient (healing in and of itself if done properly in a way to create empathy).
I'm not saying listening is going to cure chronic pain -- but explaining to a patient that a pill is not the answer to every ill is not something that many people want to hear. And, the patient satisfaction scores are so important -- never mind that the doctor might be putting the patient on a medication that they might never be able to get off of.
19
@MC That may be true for some patients, but there is a small population who do legitimately benefit, with continued high function and no increase in dose, for entire lifetimes.
You say "almost every scenario," but if you lobby government to outlaw opioid meds for *all* chronic pain except cancer, for that small subgroup you just ended their careers and prevented them from ever having families and normal lives.
I have severe refractory IC, a condition in which the immune system attacks the bladder lining. I've been through literally every alternative that exists, invasive and alternative, including a multi-modal pain rehab program. Nothing except long-term opioid medication ever gave me more than 5 minutes at a time away from a bathroom.
But with high-dose opioid meds, I get an hour or two at a time. I can teach class, sleep, parent. I've earned a doctorate and never once increased dose. Casual acquaintances have no idea anything is different about me. Prior to starting opioid therapy, I was homebound 24/7.
These severe disabilities - IC and a number of other rare conditions - get lumped under "chronic pain" as if they are weird trick knees, which might indeed benefit far more from physical therapy.
"Chronic non-cancer pain" is a huge umbrella - please don't promote across-the-board policies that don't account for individual differences.
46
@Reese Tyrell
I think both these comments point to an underlying issue that we still fail to grapple with. Opioid addiction and probably all drug addiction issues should be de-coupled from religion and from government (read criminal law enforcement) to the largest extent possible consistent with regulations that require prescribers to demonstrate their current competence with the medications in question and scrupulous prosecution of actual crimes committed while under the influence or as a result of seeking drugs. Simple possession or use of drugs should be dealt with as a medical and public health issue first and foremost, not as a sin or a crime.
7
I am one of those patients who has been taking Percocet on a regular basis for about four or five years now. I don't take excessive amounts, only 1-3 pills per day depending on my pain level, and if I'm not dealing with an injury, I usually only take this med a few times a week. My dose has barely changed in four years.
I have read the claims about how opioids lose their effectiveness and actually increase pain over time, but I'm not convinced this is true, only because when I stop for a few days, at first the pain seems far worse than it was (compated to relief!) but within a few days it settles back to where it was. This effect isn't anything to do with pain, but rather the perception of it.
I have chronic intractable pain thanks to systemic arthritis from lupus, severe stenosis and joint degeneration. I have kidney failure, so many painkillers are off-limits. This and several other meds are the only reason I'm able to keep working with my level of disability; in effect, they keep me from being homeless. Please don't protect me from someone else's demons.
26
Something not often considered when discussion opioid prescription policies is the fact that "chronic pain" diagnoses (in quotations since it encompasses a variety of different sort of diagnoses) are absurdly more frequent in the US than in other developed countries. We're not just dying more because we use opioids more, we're also dying more because we're legitimately diagnosed with chronic pain at rates two or three times that of our neighbors across the Atlantic. Why is that? Why aren't we studying what causes people to develop chronic pain? Is the answer so obvious that we've stopped discussing it entirely? Because it doesn't seem so obvious to me.
6
Well for one thing it is so difficult and expensive to get basic medical care here compared to other countries that we do not have the advantages they do. I know people with fractures who could not afford treatment, people in manual labor working double shifts with extreme spinal disc disease - why? We no choice here. It leaves you half dead at 40 and in chronic pain beyond anything the word may imply.
8
In January, I had a total knee replacement. I can't imagine what my recovery would have been like without the opioids, and yet...in my hospital room, I asked for an ice pack to replace the one the anesthesiologist had placed on my knee in the post-surgical recovery room. I was told they didn't provide ice packs on the ward--constantly refreshing the packs would take too much staff time--but I could have more dilaudid or tramadol.
Honestly? I was shocked. I know that healthcare is a business, of course, but I had not imagined that financial considerations were allowed to dictate the terms of care so completely.
32
One of the best things we can do with the least expense and the lowest cost is to make evidence based prevention part of the curriculum in all schools; starting with elementary school and continuing through high school. Our mindset is reactionary and interventionist. But primary prevention lowers disease incidence and treatment cost. In this case, it also lowers enforcement, litigation and incarceration costs; as well as emotional damage to families and quality of life damage to communities. Prevention needs a much stronger push.
7
Pain state terminology is confusing: 'chronic' has a double meaning: chronic to mean lasting > 3 months; and chronic to signal that pain has 'centralized' (embedded in the central nervous system). Furthermore, as noted by others, there is a vast difference between 1) chronic patients with mild to moderate pain who can function and respond well to a variety of non-drug and less toxic drugs; and 2) chronic patients whose pain may be better termed 'persistent' or 'intractable', many of whom have severe enough pain, often with degenerative medical conditions, to warrant more serious interventions (e.g.,surgical). There is NO research specific to benefit of opioids in these severe 'chronic' pain patients. And to complicate matters further, patients can have a combination of acute and chronic pain.
A legitimate empirical approach needs to address both the pros and cons of strong pain medicine for severe persistent pain. While the cons of opioids have been spotlighted, we may not appreciate fully the well-established research-based pros, such as prevention of pain-related cardiac symptomotology, dementia, and so on.
12
Hysteria over drug addiction often ignores the lessons from previous drug prohibitions. Nobody can predict the future, and the government has a bad track record when it comes to unintended consequences. If opioid prohibition drives people with legitimate needs to alcohol, what will the government do, reinstate alcohol prohibition? Drug policy can evolve scientifically and should be designed by experts to do the least harm, not punish non-addicts. In some cases, "addictions" are even less harmful than the alternatives.
18
"In the short term, many policies that would limit opioid prescriptions for the purpose of saving lives would cause people to turn to heroin or fentanyl."
I'm an addictions counselor. Many things I do to lessen my clients' mental anguish are ignored or manipulated by the clients, putting them in even greater mental anguish.
We are healers, and we only mean to heal. However in the face of unanticipated harm from our advice, we have to remember the nature of the population we serve, and, "We're responsible for our efforts, not the outcome."
5
Good article. I have been practicing medical and interventional pain management for over 25 years. In the end, long term opioids can be a useful option, if prescribed safely and in the right context. Like any other treatment, great harm can results from mismanagement. The current "crackdown" on opioid prescriptions will help to a degree, but is likely driven more by politics more than science. Its easy to identify regulated and liscensed providers, pharmacies, clinics, etc. and make a public show of what is being "done."
Changing the underlying environment which drives drug dependence in our society is a much harder problem to face, both privately and pubicly. Our patchwork health systems offer trivial support for mental health care and psychosocial services. Economic displacement and job insecurity are additional stressors. Finally, the manupulation of regulatory bodies (like the FDA) by corporate entities (like Purdue) weaken ability to protect the public. As with opioid dependence, these chronic illnesses of our American society have no quick fixes or cures. Just a long road of hard work ahead.
52
@Andrew Wesely, MD
I am guessing you are part of the pain medication delivery system. Interventional and all that. If your 25 years of whatever you recommend was working, why does there seem to be so much more pain, requiring opioids here in tne USA than elsewhere.
Perhaps the medication is exerbating the problem? Is it actually true that Americans are unable to curb their use of the drugs and will all head downtown to the illegal dealer? All of them? How can that be?
1
Thankfully I don't suffer from chronic pain so I don't take pain killers. But I do suffer from ADHD and take adderall so that I stay focused enough at work stay employed, so I am familiar with some of these issues. To get adderall (legally) I have to see a shrink every 3 months, missing work and taking up time that he could spend on other patients whom have mental health issues they need help with. I hate when government policies make patients feel like criminals for seeking treatment. I hate when MDs make patients jump through needless hoops to get basic treatment.
On a related issue-last week I woke up with strep throat. I was in agony but had to wait 4 hours for urgent care to open to get relief from the pain (with antibiotics, not opiods).
At a certain level I think that basically all prescription drugs should just be available over the counter. I realize this might cause other problems, but it seems like the tradeoffs might be worthwhile.
15
@Joe Public: I agree with you: many prescription drugs should be available over the counter and in Europe many are. Drugs such as mild tranquilizers, sleeping pills, pain pills and antibiotics should be available over the counter, there is no more rational for forcing people to go to a Dr., jump through hoops and made to feel like a criminal than there is for forcing the same hurdles onto those who drink alcohol and certainly less reason than those who smoke, both of which are much more harmful to both the individual and society than any prescription drugs. Let’s be clear on the subject, this is all about money for our medical professionals and the opportunity for our truly pathetic elected officials to give the appearance they are actually doing something for the greater good: both groups fall short. To add hypocrisy on top of hypocrisy the legalization of marijuana really stands out: in my generation you could be sent to prison for life for selling the stuff and for quite a while for getting high( the caveat of course is “if you were poor”). There is also the influence of Wall Street on the practice of healing, with so many medical groups, hospitals, trade schools for physical therapists etc. and their lobbyists shoving through laws that make no sense its no wonder our failing health care is double the cost with worse results than that of other advanced nations, this as the rich have concierge service and get whatever they want. Remember McCain and her 10,000 pain pills?
3
@Joe Public
What we really need is high quality primary care, and a high quality health system. We have neither.
ERs are clogged with people attending the 24/7 free Medicaid clinic, because they CAN'T get seen in less than 3 months by their "primary care provider." If you'd gone to the ER you might have gotten prompt treatment, but it would have cost you $500 and total ~$3000.
Forty years ago in Italy, I ate something that gave me terrible GI symptoms-both ends so bad I couldn't leave the bathroom and sometimes needed a bucket to barf while...
My hosts called the Italian primary care after hours emergency number, and an hour later, a doc came to the apartment at 3 am, and gave me some Belladonna/Opium suppositories, which stopped both ends within an hour. Heaven. Real health care.
They spend about a third what we do for health care (though double for social services) and get far better results. It's just choosing to have good public policy instead of policy that lets a few make a lot of money.
2
A question for the many commenters who say they need opioids to manage their chronic pain.
Perhaps you can explain to me why there are virtually no studies demonstrating opioids are effective for chronic pain. It would seem that "rapacious" drug companies like Purdue would like to get as many FDA approved indications for their opioid products as they can so they can legally promote them to doctors. Yet for some reason they don't want to do these studies.
1
@Steve I was in a major head on car collision in 2002. Since then, I have been on a regimen of oxycodone and a time release morphine sulphate, due to an inoperable torn disc, combined with stenosis and pinched nerves. I don't need a study to tell me that on a good day, the moderate doses I've been prescribed can make my usual pains tolerable. Staying busy and going to physical therapy help but on a bad day, even doubling my doses (which isn't easily done as there are no "extras" available, so that would leave me short later) doesn't completely eliminate the pain. What the opioids do is allow me a reasonably tolerable quality of life that all the tylenol or ibuprofen in the world can't give me.
56
@Steve I can explain this. Most studies on pain medication recruit patients with the most common kinds of chronic pain, so if the results are positive they can sell the *most* medication to the *most* people. Long-term opioids, by contrast, were in the mid-90s (and should have always been) reserved for *intractable* pain, which is a tiny population.
Had studies specifically recruited patients who already failed all other therapies - including rare genetic diseases where there are no other therapies, just palliation - we'd be seeing the effectiveness of opioid medication in the literature.
Not to mention, there are ethical issues (and massive dropout rates) using placebo to treat disabling pain. People still have to be able to work and parent, even when they're in a research study.
Saying "there are no studies supporting opioids for chronic pain" is like saying "there are no studies supporting wheelchairs for quadriplegia," just because no researcher ever made a control group stay in bed for years.
32
Steve, all I can say is you are a lucky guy never to have suffered chronic pain. as they say, ignorance is bliss.
5
You made no mention of the terrible opioid epidemic in our nation’s prisons and jails in which over 70% of inmates suffer from some level of opioid addiction. Corrupt corrections officers provide drugs, desperate prisoners demand them and pay for them with degrading favors. But one cares about this population. We just started worrying about the opioid crisis when the pretty blond boy in the suburbs whose daddy drives a BMW overdosed.
12
Chronic pain patients are suffering. The burden of policing patients is put on pharmacists and doctors. They are policing those who are in pain and do it by discontinuing patients' pain medication. The question I have is why? There are 278,000 million deaths in the US per year--the 15 top causes don't include 70K drug overdoses. The top two causes are heart disease and cancer. Why are pain patients suffering? Why are we withholding their medication? Who is this serving?
CDC Number of deaths for leading causes of death:
Heart disease: 635,260
Cancer: 598,038
Accidents (unintentional injuries): 161,374
Chronic lower respiratory diseases: 154,596
Stroke (cerebrovascular diseases): 142,142
Alzheimer’s disease: 116,103
Diabetes: 80,058
Influenza and Pneumonia: 51,537
Nephritis, nephrotic syndrome and nephrosis: 50,046
Intentional self-harm (suicide): 44,965
30
@Robin Wright
Deaths due to old age are inevitable. Such as my father’s death of alheizermers and cardiac/respiratory issues at 93. Putting unavoidable deaths such as my father’s in is fudging the statistics. And overdoses I believe( May be wrong) are in the accidental figures and taking an ever larger portion of those deaths.
But you can cut them out and shuffle your figuring however you choose. Your task would be to convince the CDC and other medical organizations.
2
@Robin Wright
You slipped a decimal. CDC says 2,744,248 deaths/yr in most recent data, not 278,000 million, which is 800 times more people than the total US population. Total pop of US is about 330 million.
The 73,000 drug ODs are included in the 161,000 accidental injuries, though some of the drug ODs probably should be added to the 45,000 suicides instead of calling them accidents.
@Robin Wright
Can you please supply actual evidence (and I don't mean anecdotal) that chronic pain is being undertreated because of the current opioid policies
I was prescribed OxyContin after a dental procedure. 40 pills. I took one pill. These pills should be meted out carefully.
8
@Mary A
You would not have been prescribed a long-acting opioid such as Oxycontin for an acute condition. You may have been prescribed Oxycodone but it was more likely Hydrocodone.
Your point is still valid, but it is becoming rare for dentists to prescribe opioids at al any more.
4
Unfortunately Mr. Frakt overlooks some factors that don't make what he says as clear cut as he indicates.
First of all, the idea that reducing opioid prescriptions results in increased use of illicit drugs has never been proven. In fact, the increase in opioid overdose deaths from illicit opioids far outweighs the reduction in the number of opioid prescriptions.
Also, it is true that the vast majority of people who use illicit opioids began with the use of prescription opioids. However, it is also true that a very small percentage of prescription opioid uses (less than 4%) go on to use illicit opioids.
The idea that the illicit opioid epidemic is due to untreated pain experienced by patients whose doctors have reduced or discontinued their prescription opioids is without any evidence other than anecdotal. I would challenge Amie Goodin or anyone to show actual quality studies that else that demonstrate attempts to reduce the prescription of opioids have resulted in leaving patients with untreated chronic pain.
It's also worth noting that there are essentially no studies showing that opioids are even beneficial for chronic pain.
It is true that reducing the prescription of opioids may only have a small impact on reducing opioid misuse and overdose deaths. However, this doesn't mean we should abandon these attempts especially as they are relatively recent so we have yet to see what their full impact will be.
7
@Steve 100% on point!
1
A few years ago I had minor wrist surgery and was sent home with a Rx for 30 opioids. After healing, I drove to the Sheriff's office and placed the remaining 27 pills in their drop box. I hope to NEVER need an opioid again. I am a candidate for addiction.
9
As more doctors become knowledgeable of the problems with opioids prescribing patterns have changed. Not too long ago the risks of addiction were dismissed as non-existent. I don’t think government rules are needed to change any more. We already have a database to look up patients prescriptions to prevent doctor shopping and the DEA monitors prescription numbers to prevent an unscrupulous doctor.
4
I have ongoing, intractable chronic pain that used to be managed by a low level dose of oxycodone. Since the Nanny State has taken over what used to be just between my MD and I, my quality
of life decreases each month.
I have a painless, nonviolent Goodnight Moon cocktail for when the pain has won. But I like living and I just wonder how did this happen? This used to be between my MD and me. How did the government get to make the rules? How does the pharmacist have more say about this than my doctor?
I’d get drugs from the street, like oxycodone and maybe even heroin but I’m an old straight clueless lady, and I have no idea how to buy street drugs.
92
@Annie Eliot, MD. God bless you. I also suffer from chronic pain. Simple thing....no low level dose of oxycodone and I’ll have to quit my job. My doctor..ljust the one...monitors the prescription that he gives. I don’t look for ‘extras’. So far, with a lot of paperwork, my insurance company covers things. I live in fear that at some point they will decide to ignore my doctor’s advice and my pain and say too bad to me.
There is no one right answer. I read these statistics but I’d like to know how many people that OD are those who work with their doctors and follow the instructions on the bottle. It’s those people who follow the ‘rules’ for the correct usage who are easiest to cut off. We don’t go elsewhere.
Seriously. Big government...get out of my examining room and let me and my doctor figure out a way for me to maintain some quality of life.
7
Oh I hear you. Spinal stenosis and chronic debilitating pain. Oxycontin and Percocet kept it manageable and allowed me to work. Enter the nanny state and my pain doctor cut my dosage in half. Now I can no longer work, am confined to a wheelchair because I cannot stand or walk and am totally reliant on others. Way to go America
8
Finally, a balanced approach. Now that we have scared docs into not prescribing regardless of legitimate need, you left out one point , people truly in pain are going to find a way to relieve it. Is that what we really want?
19
Some people need opioids for real pain, hopefully for a short amount of time. However, the regulations are burdensome. Sure, it's great to rely on family to run to the doctor's office every few days, then to the pharmacy and then to the patient's house to review a prescription. That is, unless that family member has to work or can't take hours to do this errand of mercy. Don't punish the non-abusers. I kvetch because my elderly mother fractured her spine, as elderly women do. The insurance would not cover a pain patch and the doctor would (or could?) only write a prescription for a few days. Shame.
49
"...many policies that would limit opioid prescriptions for the purpose of saving lives would cause people to turn to heroin or fentanyl"
That has already occurred!
I read about individuals who can't get opioids for pain who turn to street heroin which is laced with fentanyl and guess what? Overdose and maybe death.
The problem is NOT opioid prescriptions given by licensed practitioners - it's addiction!
How did the Chinese stop opium addiction after they finally rid themselves of the British opium trade in 1911 or so?
They forced treatment on opium addicts and they put opium dealers in prison (or worse).
5
The author should provide his phone number when making his case, so I can provide it to my surgical patients as they wail in pain.
32
I suffer from chronic untreatable back pain. The only thing that keeps me from being bedridden is my oxycodone prescription. Because of the knee jerk, republican “war on drugs” I must see my doctor monthly to receive my prescription, wasting his time that would be better served treating someone else.
CVS has decided to only fill two weeks of narcotics at a time, apparently their corporate board think they hold MDs now. I was once treated as a criminal in a CVS by a untrained clerk while attempting to fill a prescription, and the pharmacist said he wouldn’t fill it anyway on general principles.
I’m 63 years old and will never step foot in a CVS again. I find it disturbing they want to open clinics in their stores.
A pharmacist’s job is to fill prescriptions and insure that drugs prescribed by different doctors aren’t going to cause bad interactions. Some people, especially the elderly, do not inform doctors that they are also seeing another doctor. They are not qualified to second guess what my doctor has prescribed, if they want to do that they should have gone to medical school and obtained a MD.
63
Dr. Frakt, while you and others continue to bloviate about computer simulations and question the value of reducing opioid prescriptions in the United States, actual data has become available that obviates the need for such speculative studies.
As reported by the CDC (https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm), opioid overdose deaths peaked in 2017 and have been declining since. This almost perfectly mirrors (with an expected 4-5 year lag) the drop in opioid prescribing which began in 2012 (https://www.cdc.gov/drugoverdose/maps/rxrate-maps.html). For all practical purposes, the policy goal of reducing opioid prescriptions has already been implemented, and yet there has not been an increase in the number of opioid deaths. This is not particularly surprising.
You cite the Beauchamp 2014 article on the urgent need to reduce iatrogenic opioid addiction but don’t seem to understand its message. Only big pharma and the pain management industry think there is uncertainty about whether reducing opioid prescriptions will reduce opioid deaths. Please stop parroting their talking points.
6
There has been a massive increase in deaths from heroin and fentanyl. It is early March 2019. You have no numbers in for 2018 that could possibly be accurate so no idea where the “peaking” part comes from.
2
@Anna Base
Please take the time to look at the data. Prior to 11/2017, there had not been a single 12-month period in which opioid-related overdoses declined. Since then, there have been 8 through July 2018. The CDC lists only ~0.2% of cases as pending investigation. So yes, there are plenty of data through July 2018, and they show a small but real decline in overdoses.
I'm sorry these numbers don't fit your narrative, but the data are the data. We're not out of the woods yet, and fentanyl/heroin overdoses have spiked. But even with that increase, overall opioid overdoses are down.
This has been documented in many places, including the Washington Post: https://www.washingtonpost.com/business/2018/11/30/after-record-number-us-deaths-opioid-epidemic-may-be-receding/?noredirect=on&utm_term=.97843f42d5cf
Also not sure why you'd be unhappy about this: I'm assuming you're not in favor of ramping opioid prescriptions back up to 2011 levels?
I am not unhappy, just doubtful, especially as you base so much on that “peak”. Anyone working in public health statistics knows that a full data set is not available within two months
2
The people who advocate restricting use of narcotics for legitimate medical purposes have never seen real suffering. Once you have seen crushing pain, and seen it melt away with narcotics, there is no further argument. All the abusers in the world can die; the argument for pain control for the suffering trumps it all. For those who think otherwise, I pray that you never know how wrong you are.
92
@Doctor
I agree that opioids should be used for "legitimate medical purposes" but that would rule out chronic pain as there are no studies showing these drugs are effective for the management of this.
If you believe the practice of medicine should be based on anecdotal evidence, fine; the problem is that the history of medicine is filled with treatments people believed worked based on anecdotes but were found to be worthless or worse when actual studies were done. Remember all those ads with doctors endorsing various brands of cigarettes saying they had healthful benefits.
4
@Steve I would love to see studies. Problem is, 1) there's little funding for studies on the rare orphan diseases that most benefit from long-term opioid therapy, and 2) in 20 years I've never seen a study I could sign up for, without quitting work and hiring a nanny. My population is invisible in the literature.
I've had long-term opioid pain management my entire adult life for severe refractory IC, a condition where the immune system attacks the bladder lining, generating open wounds that don't heal. (The animal model involves catheterizing mice and inserting hydrochloric acid. You can imagine how the mice react.)
There are few studies on opioid therapy - or any therapy - for this rare condition. Yet a scientifically-validated patient survey found opioid medication reduced symptom scores more than any other therapy, for ~60% of patients.
So yes, I believe the practice of medicine should be based on anecdotal evidence, in cases lacking insufficient data to do otherwise. I want my care to be based on my doctors' experience with me individually, not studies that literally wrote me into the exclusion criteria.
20
@Reese Tyrell. Well-stated. Thank you.
5
It's actually quite simple. Shut down PurduePharma and prosecute the pushers who run it. The people who run PurduePharma are no better than El Chapo.
You don't need these drugs. Ever read The Times?
https://www.nytimes.com/2018/01/27/opinion/sunday/surgery-germany-vicodin.html
5
Amazing that people with long term pain issues that use their RXs properly are often minimized, especially when illegal use and distribution are the bigger problems. Having to care for someone with long term pain, we follow the strict expectations of her doctor. 1/ All RXs are kept under lock and key. 2/ I track and administer all meds with a log and keep detailed records, including pill counts. 3/ The patient must sign a contract twice per year on what she can and cannot do per the physician, which includes behavioral expectations. 4/ Period random blood tests are conducted to ensure compliance with parts of the contract. This patient who has a difficult quality of life, would have an unbearable quality of life if her RXs were stopped. I am quite dismayed that the needs of the people who need the medications and behave religiously responsible are being pushed aside in these discussion as though they are mere footnotes to the poor and illegal behavior of others. Unconscionable.
25
In a lot of places you can have heroin delivered to your door as easily as a pizza.
So the government had better think long and hard before they force opioid pain meds to be withdrawn from the market.
They're highly addictive, but at least with prescription meds the dose is known, and the patient is taking them under a doctor's supervision.
If you ban then, you lose the involvement of the physician and you lose the controlled dose. Lots and lots of people will die.
18
The statistics that divide opioids into "heroin" and "prescribed opioids" are simplistic and misleading. Many opioid addictions and deaths are fed by opioid pills--many with unknown substance/dose--- that have never come through our legitimate pharmacy system. Prescribed opioids have reduced significantly in the last few years (cutting off many patients that have been compliant with the "system" for years)---it's easy to put pressure on patients, doctors, and pharmacies. It's much harder to address the larger problem of drug demand, and the illegal drugs coming in to fill that demand.
12
"demand" - is it all about chemistry and personal fecklessness... or is opioid (or oblivion) demand driven by other factors in actual peoples' lives, like misery and hopelessness? difficult as the drug situation seems to be, there is no will at all to address real underlying causes in society. blaming the victims may play well in church, but in the real world it is a useless strategy.
2
My partner of 20 years has degenerative disc disease. Without his prescribed pain medication, he’d spend every day in agony, not eating, not moving from the bed. He does not abuse his meds (always prescribed for one-month/no refills) and we are grateful to his pain-management doctor, who, by the way, subject him to a rigorous and seemingly unsympathetic review process to help weed out those who just wanted the Rx (I was there). Our insurance dropped some of his meds from its formulary, and my partner and his doctor now have to request that it be added back in. That’s okay. But it seems as though these ‘guidelInes’ are, to use a cliche, throwing the baby out with the bath water.
By the way, my partner tried steroid shots, agoninizing acupuncture and back braces, physical therapy, etc. first, with no result. His meds are, literally, a lifesaver. Literally—because he’s told me he wouldn’t want to continue to live in pain. The meds don’t eliminate all his pain, but mitigate it enough so that he can drive, walk a bit, and help me around the house. We’re both senior citizens.
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My wife could write the exact same story, after 30 years of surgery, injections, therapy, and finally only opioids give me the relief I need to function every day. We are lucky to find a doctor to prescribe the necessary medication.
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As a substance abuse clinician and someone who deals with chronic pain, I see both sides of this issue. There is no question physicians need to be better about prescribing opioids in a more mindful manner, paying attention to whom they are prescribing, for what reason, and to what amount. Pharmaceutical companies need to take ownership/responsibility for pushing the drugs in the last 20 years which caused such an epidemic. We also need to be funding addiction treatment, recovery resources, and working to resolve the public perceptions around mental health and addictions as a "moral failing."
Addiction is a BRAIN DISEASE entirely related to neurotransmitters in the brain and also a set of behaviors that develop as a result of the addiction. Addiction recovery is not something that can be done alone; it must be done within a community of support. The 12 step communities of AA or NA is one means of recovery as is formalize addiction treatment through treatment providers such as inpatient an/or outpatient rehabilitation. Providing more access to Narcan will certainly help in the opioid fight. We must also remember that one cannot recover from addiction without help. Relapse is a part of the learning process of recovery.
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@Carmel Nelson, all solid points. In addition, the addict must accept that he/she is addicted and WANT to surrender. I cannot comment on each person's scale of pain and can or would not say who should continue with prescription meds or begin a plan to taper off.
This crisis has been caused by Big Pharma.
1
@Carmel Nelson
Opioid 12 step programs have about a 90% failure rate and 20% death rate over a year, about the same as treating bacterial pneumonia without antibiotics.
Medication assisted treatment has ~80% success rate and ~2% death rate over a year. Treating addiction without MAT is like treating pneumonia without antibiotics. Yet most addiction treatment centers use ONLY 12 step programs to keep the patients coming back and paying those fees. That's no excuse for malpractice.
Most opioid addicts are self-treating for psychological conditions, (TJ Cicero, MS Ellis) partly because good mental health care is hard to find, and insurance doesn't pay for it.
1
I have severe arthritis in neck and lower back, which started when I was 40 yrs old. I cannot afford massages,which probably wouldn’t help anyway,nor can I afford acupuncture,which my insurance does not pay for. I usually only need one Vicodin a day,and several Tylenol’s,to get through the day, which means walking with my dogs,housecleaning,etc. Some days,I need two pills but I rarely take two because I am allowed only 28 a month. I have been taking Vicodin for 17 years. It was the first medication that really ever helped with my pain. I am 77 years. I am not addicted to it and when I can,just take Tylenol. Every month when I go to pick up the script, because it can’t be called in to pharmacy, is humiliating. If it’s a random urine test they want,and I can’t produce a specimen,I have to stay there until I do. Nurse Ratchet makes sure of that! I have been a patient there for over 30 years, but now I feel like a criminal. To make that worse, when I take the script to the pharmacy, every time, the young man who is usually at the desk, has an attitude that I know is demeaning, as if I’m a drug addict. I know there are many thousands of people who are going through similar circumstances. I know many people abuse opioids, and that’s the fault of Pharma and some greedy doctors, and the government.
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@NMS. Thanks for your post. I can relate to it. In my experience, even some doctors shame patients who ask for pain medication for conditions like yours.
6
I had a elderly friend that practiced medicine in a small east Texas town that was reluctant to prescribe narcotics. That was until he crashed his little airplane and broke his back. After experiencing months of excruciating back pain his attitude did a 180 turn.
The problem is that these people advocating cutting off pain relief drugs to people that really need them to function have never experienced chronic excruciating pain.
My doctor friend agreed with me that part of medical school should be that potential doctors are subjected to extreme pain, I’m sure it could be done without causing a actual injury.
I am very fortunate that I have a doctor that can empathize with what chronic pain can do to someone’s life.
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Companies are in business to sell products. Today the pressure to "scale up" is very high. This is done by pushing the product into new markets whether it is appropriate or not. It seems this was done in the selling of opioids. It involved shady druggists and doctors, but it worked--they scaled up to extreme profitability.
Today many lives have been shattered by the above business model. It should serve as an example of the crying need for ethics in such lucrative trades as pharmaceuticals, bio-engineering (gene altering,) and unregulated chemicals.
It comes down to the choice of profits over the health of human beings.
10
Physicians do not "see" pain. Like everyone else, they "see" level of education, financial status, gender, social skills, race, and language skills. "Nothing" is gained by requiring a patient visit other than wallet thickness.
22
In 2011 my husband had back surgery. The procedure was an easy fix for his back issue. He was sent home with a prescription for 90 opioids. He took one pill. The rest were taken by the guy who did some work in our bathroom. He probably made a lot more money on those pills than he did on regrouting our shower.
11
@KA, we know that now.
2
@Kris Aaron
No
@Suzie130 Would you leave a stack of $100 bills lying on the bathroom counter? That's what those pills were.
2
As a member of an opioid task force, it is my opinion that any policy addressing the reduction of opioids requires consideration of the differences between acute and chronic pain. Every patient deserves an individual assessment and treatment plan. When treating patients with chronic pain the goals should be improvement of function and adequate pain control so that the patient can lead a quality life. Multiple modalities must be used to assist the patient, including assessing the patient for any underlying conditions that can be corrected and tapering opioids, if needed. I have cared for many patients who were given high dose long term opioids with no assessments. These patients reduced their pain by tapering their opioids as high dose opioids may cause pain. Many patients have transitioned to buprenorphine to control their chronic pain. I have to spend 2 clinic days per week fighting with insurance companies (instead of treating patients) in order to prescribe opioids to taper opioids safely for patients, to provide opioids to palliative patients and to prescribe buprenorphine for chronic pain patients. Insurance companies and big box retailers are in the business of practicing medicine and have no problem endangering patients by abruptly cutting them down or off opioids. This is why patients suicide or buy heroin when they cannot afford to pay cash to taper their opioids.
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@anya I have had many orthopedic surgeries over the years and was responsibly prescribed opioids to manage pain for what would now be considered an excessive length of time. I would frequently run into pharmacy personnel who were contemptuous - and this was 15 years ago. I had surgery last October to repair a severely deviated septum and was informed by a nurse that opioids would not be prescribed unless absolutely needed. So I said sure, let's just give that a try. I later learned that my blood pressure spiked dangerously high during the surgery itself and afterwards left with a prescription for hydrocodone already filled. What do policy makers and medical institutions make of people like me who used opioids responsibly over fairly long periods of time to manage pain, were kept mostly functional, and never became addicted? I think I'm the norm, not the exception, and have nothing but sympathy for people being denied appropriate medical care because someone else abuses opioids.
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@anya
The CDC guidelines on prescribing opioids very clearly differentiates not only between acute and chronic pain but also pain resulting from cancer or other potentially terminal conditions.
2
@Steve The problem is the Dr's and pharmacies are not following the CDC guidelines. They are doing the bare minimum allowed because that's how they are interpreting those guidelines. They are cutting back opioid prescriptions even for those patients with debilitating pain that will last the rest of their lives even after all the therapies, counseling, massages, surgeries, and interventional therapies, etc. have proven ineffective. My son and I both have medical reasons to use Opiods and after dna testing we found the ones that would work for us and it was not oxycotin/oxycodone. But in the three states we have lived we have had to endure being treated like addicts and criminals by CVS in particular. Our Doctors have worked with us after we have jumped through all their hoops. The insurance companies are starting to dictact to the Dr's what can and can't be done. Only our Drs know our situation, our diseases/conditions, what we have have already tried and what did/didn't work, and it should be left to them to make the best decision with us for our care. Politicians, pharmacy personnel (outside of drug interactions) and the public should stay out of people's medical care. I agree with others who have commented that if you cut off people who actually need opioids to have a life outside of being totally bedridden you will see a spike in suicides or illegal drug use as life will be unbearable for many with high pain levels without our Doctors' ability to help us.
8
When, oh when, will an article like this ask WHY so many Americans seek to bliss out on drugs?
OK, some people are being forced to search out street drugs when the War Against People in Pain cuts off access to medication while the pain persists.
But please consider the MAGA rugged individualism meme that isolates individuals in despair and self-blame while they suffer from a dearth of jobs that pay a truly living wage, unaffordable health insurance that leads to medical bankruptcy, and an ever-thinner social safety net.
When we reduce Americans' everyday misery, their need for drug-addled escape will fade away.
32
@MLChadwick Really, at 71 years old I came down with a severe case of lyme disease that resulted in 5 days in the hospital. (huge bill, no insurance). Two months later I was still weak and unable to work because of the pain. But with pain killers I was able to rally enough to work part time. I bought off the blackmarket because doctors in Maine don't or won't prescribe painkillers. You're correct about Americans suffering alone and so I took the pragmatic choice of illegal pills. At 71 and suffering I didn't have the time for the litany of ''alternative" therapies - vitamins, message, etc that don't work when opioids do work. My question is: why not simply give people with chronic pain the drugs that work? Addiction? So what. People are addicted to dozens of substances - food caffeine, tobacco, alcohol, and sugar. European policies prove that properly administered people can work and live full lives while taking opioids. Why not here? Poppy extracts, all natural, have been used for 1000s of years to relieve pain. Why are Americans forced to suffer needlessly?
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@Coffeeman
Actually, chronic pain patients who are using their drugs responsibly are not addicted. They are dependent on their medication for pain relief. Addiction occurs when an individual wants the drugs for the high and keeps increases drug doses and goes to srtonger drugs to maintain their high.
18
@MLChadwick
Please read more carefully. This article has nothing to do with people who want to "bliss out on drugs," as you say in your fanciful term. It is about denying effective pain medicine to those who need it to be able to do more than lie in bed suffering each day.
5
I think The Upshot is parsing, intellectualizing, cherry picking this issue.
Botton line, in general how to best deal with a dangerous object, vice like this issue is the following.
A policy of legality, regulation, responsibility and non promotion works best.
It proved incredibly successful with drunk driving and cig. smoking where it was used and a miserable failure with gun deaths and opioids addiction where it was not use.
11
What are people without access to the expensive treatments for pain such as physical therapy or intensive medical care to do if they don’t have access to opioids? I never understood how chronic pain is a terrible life ruining problem until I had hip arthritis. I ultimately found a way out with hip replacement and months of physical therapy but I have money, good medical insurance and a supportive family to see me through the surgery and aftermath. Millions of people are not in that position. They need opioids unfortunately.
115
@Nancy Croteau Thank you for writing some common sense and balance into the debate.
12
@Nancy CroteauThank you for writing some common sense and balance in the debate.
4
@Nancy Croteau
I've been there too. I understand why some people in chronic pain who have their pain meds cut off, commit suicide. It's not the lack of drugs. It's the constant screaming pain that blots out everything else.
Would love to see a study re: people who have addiction, did they start with prescriptions bc they had pain, or some other way for another reason? What happened when they first tried to stop? Did they get help with withdrawal symptoms? Dig deep. Don't just stop writing prescriptions.
In my case, I've been on these several times. I needed them. When I didn't need them, I stopped with no problem. What is the difference between me and these addicted folks? We need to find out.
21
The opioid crisis is a major public health problem in the U.S., one of the most serious. Multiple strategies will need to be employed to solve the opioid crisis. Widespread availability of Naloxone will help.
This crisis developed over years, and the solution will take some time.
Rather than withholding effective pain treatment in acute pain situations, change prescribe habits. A fracture or surgery, e.g., hernia repair is a legitimate indication for short-term use of opioids.
Doctors should prescribe 6-10 tablets, 2-3 days worth. Some do. Some surgeons still send patients out of same-day surgery units with a prescription for 30 tablets of opioids.
That is not supportable. Most patients do NOT discard the remaining pills, and these are open to theft/diversion.
But, acute pain needs to be relieved. I fractured my foot a few months ago. The pain was excruciating, and I don’t know how I would have made it through the first 2 days without the opioid. As soon as I could, I switched to Tylenol.
I’m also a pediatrician, so I see the practitioner side of this. Although most pediatricians generally do not have cause to prescribe opioids very often, fortunately, we do counsel parents and teens on substance abuse prevention.
21
@Adrienne
America is not in an "opioid crisis."
America is in an "addiction to drugs crisis."
That's what has to be fixed.
9
Excuse me. Hip surgeries stay one night over nite now. Six pain pills at discharge? Come on! Read your ortho books!
12
You’re absolutely right we don’t discard the rest of those 30 pain pills. Not now. We save them. For the arthritis flair up, for the sprained ankle, for any number of short term needs we oldsters experience. Or, we could spend 3 days getting a doctor’s appointment next week, show up at an Urgent Care Center, or the ER. At some cost and continuing pain.
We are not idiot children, not to be trusted home alone. Millions of us are responsible and know our pain needs, our bodies.. Stop second-guessing us. And yes, we’ve learned to keep them out of the obvious bathroom cabinet.
42
Well, it angers me that at 70 years old, having had an orthopedic surgery, and with excruciating pain afterwards, I had to worry about getting a second prescription for pain if I still had pain.
I have been a healthcare provider for years, a nurse who never prescribed. Now just happily retired from serving others in a lifetime career.
I get it, the opioid crisis. But there has to be some common sense. What about the innocent? Where are we in this big mixed up picture?
149
Agree. There needs to be pain treatment befire it becomes worse and untreatable. The brain learns pain. There are conditions with untreated pain that last forever. It’s stupid not to treat pain with screened testimony from people who suffer.
13
@MIMA People here just cite their own experience and call it "common sense". Have you seen the pain of a parent whose kid died of overdose? Is that pain second class?
@Atm oht - As a matter of fact I have witnessed such a scenario of the crushed parent losing a kid to opioid use of some type. More than once! But what has that got to do with elderly individuals suffering from consistant, non-healable pain who are under th care of their respective physician? Seriously? Are older folks supposed to live in constant pain, without relief and "take one for th team" because too many irresposible young, individuals, can't control themselves in th way they "get off"?
9
What other therapies are they specifically recommending for pain control? They love to talk about this, but seldom talk about the actual medications or thearapies they would use. I have one thought. And that would be to make patients see their doctors frequently for post-op or acute pain who may need narcotics. This way the doctor can actually see the patient and how much pain they are in. And if necessary change their dose or medication to something less strong. Eventually ending with Motrin. This means the doctor may see these patients every 4 or 5 days. This extra cost would be born by the insurance companies with the patients co-pay. Then there is the cost of getting another different prescription for pain filled. This seeing the patient could do wonders for pain managment. And also make it harder for other patients to get an apt. with their doctor. But it could help with our opioids issues.
12
@Gordon Those frequent weekly visits will required thousands of new physicians to handle the patient increase. With typical medical appointments costing up to $150 per visit, how are pain patients going to afford those weekly trips to see their doctor?
Chronic pain patients with incurable physical disorders are being driven to illegal narcotics and suicide thanks to the current opioid "hysteria". Years of never-ending pain combined with intransigent health insurers are making our lives not worth living. Why have we become collateral damage in the failed "war on drugs" when the majority of the overdose deaths are caused by heroin and illegal fentanyl?
25
@Gordon
Some people who need pain relief are not ambulatory. How is someone who can’t even walk supposed to feel about frequent doctor visits?
24
@Gordon
I suggest you read the CDC guideline on opioids for chronic pain. It speaks in detail about the other treatments available for chronic pain.
The industries that underpin opioid use and abuse need to be recognized and undermined before any long term progress is made with either large scale addiction and death.
Simply, eliminate the costs (and commerce) to both oploids and addiction treatment - as other societies have done. Remove commerce from the "medical/pharmaceutical" or illicit industries , and let's re-establish a public sanitarium model where chronic/recurrent treatment has zero barriers to the opportunities of recovery.
Unfortunately, the commerce of addiction (opioid sales and now addiction treatment) stands foursquare between those at risk of death and with needs for recovery.
8