Chronic pain patients are forgotten victims of opioid epidemic – By Elyse Morgan and Jacqueline A. Schwarz – Jan 2019
In this article, the authors explain how our screwed up opioid policies arise from 3 fundamental myths firmly embedded in the American mind and endlessly repeated by PROPaganda.
Our country’s well-intentioned efforts to stop opioid abuse and related overdoses have left a group of Americans fighting for their lives. Medications including opiates have allowed hundreds of thousands of patients with chronic pain to function for many years.
Recent media stories to the contrary, research reveals that fewer than 1 percent of patients became addicted following lengthy opioid treatment. Long-term treatment does not cause addiction rates that are higher than those in the total population.
However, chronic pain patients’ access to their medications has, in most cases, been severely limited or even eliminated. (One of the populations most in need of pain relief — our injured veterans — is now virtually barred by the VA system from accessing opioid medications.)
As a result, another “epidemic” has emerged: Many chronic pain patients have been rendered unable to function or have turned to street drugs to continue a pretense of functioning.
In some cases, the result has been death due to the side-effects of intolerable pain (e.g., heart attacks, suicide) or to the use of dangerous, illicit drugs. We must address and end the practice of overprescribing opioids, and we must provide treatment for individuals who suffer from drug dependence and abuse.
However, our current strategies to address opioid-related overdoses and drug abuse are doomed to fail because they are based on the following three myths:
Restricting doctors’ rights to prescribe opioids as medically necessary prevents overdoses from and addiction to opioids.
Reality: Only a very small percentage of those who have died from overdoses started with prescription drugs, and only a tiny percentage of those who receive prescription opioids develop problems with addiction or abuse.
A 2018 study found that fewer than 1 percent of patients who were prescribed opioids for the first time after surgery continued renewing their prescriptions for longer than 13 weeks.
Only 0.6 percent were later diagnosed with opioid abuse disorder during an 8-year follow-up period.
According to the U.S. Center for Disease Control and Prevention, prescriptions are now at a 10-year low, but overdose-related deaths continue to rise.
The best available medical evidence indicates that patients who “doctor shop” or “pharmacy shop” comprise fewer than 1 percent of all patients treated with opioid analgesics.
Because there are viable non-opioid ways to alleviate chronic pain, restricting medications does not harm patients.
Reality: Alternative treatments may help some chronic pain patients some of the time; unfortunately, such approaches can only scratch the surface of the pain suffered by individuals with certain debilitating conditions. As clinical psychologists with more than 70 years of experience between us, we desperately wish our field had come this far, but it has not.
It is possible to regulate the legal or typical maximum dose of opioids so that pain will genuinely be relieved while addiction and overdoses are prevented.
Reality: Like any medication, opioids must be prescribed based on the severity of the patient’s condition and the patient’s weight, overall physical status, pain tolerance, metabolism, genetic predispositions, and so on. It clearly makes no sense to follow the strategy enacted by some states; namely, to place the same limit on the maximum dose doctors are allowed to prescribe for everyone — whether it be a 100-pound woman or a 200-pound man.
It makes no sense to limit the ability of one group of patients to get essential medical treatment because another group of patients have been severely damaged by drugs with a similar chemical composition.
Our current state-of-the-art understanding of addiction emphasizes its roots in multiple causes; there are physical, emotional, genetic, epigenetic, and social causes of addiction.
Yet, the current simplistic approaches to the opioid epidemic largely ignore this relatively new body of scientific knowledge.
Although the opioid epidemic is extremely complex, the research is actually crystal clear: In the vast majority of cases,
prescription opioids are not the cause
of opioid addiction and overdoses.
Authors: Elyse Morgan, Ph.D., and Jacqueline A. Schwarz, Ph.D., are members of the Pain Education Project board of directors in Boulder.