It seems that no amount of data-driven information can get policymakers to reconsider the hysteria-driven pain prescription policies they continue to put in place.
For all human beings, data is far less stimulating than hysteria. That’s why movements, like the anti-opioid zealotry, use scare tactics to motivate and mobilize the populace.
I can understand lay politicians and members of the press misconstruing addiction and dependency, but there is no excuse when doctors make that error.
I used to believe that doctors knew far more about my body and its functions than I did, but what I’ve seen during this “opioid” crisis has disabused me of that quaint notion.
Yet National Public Radio reports that surgeons in 18 Upstate New York hospitals have agreed on an initiative to limit the amount of pain medicine they will prescribe to postoperative patients discharged from the hospital.
The reporter says that researchers “now know” that patients prescribed opioids for postoperative pain “can become addicted” and that “the new prescription guidelines can prevent this particular gateway to abuse.”
No, they cannot.
No number of guidelines or restrictions can “prevent” anyone from getting addicted.
Even without a single opioid, a person with certain genetic tendencies in certain environmental situations will become addicted to whatever drug is available.
One recent study published in the BMJ of more than 568,000 “opioid naïve” postsurgical patients followed for 8 years found a total “misuse” rate of 0.6 percent. (“Misuse” includes a range of non-prescribed drug use, from self-medicating with leftover pills to treat an ankle sprain on one extreme to addiction on the other.)
Broken down further, the researchers found the misuse rate was 0.15 percent in patients given just one prescription postoperatively and was 0.29 percent in patients who got a second prescription as a refill.
Multiple highly-respected Cochranesystematic analyses, the most rigorous reviews in the medical science literature, found the addiction rate in chronic noncancer pain patients on long-term opioid therapy to be around 1 percent.
These numbers are absurdly low. Without the hysteria created by anti-opioid zealots, there would be little cause for concern and we’d be focusing on the root causes of the current “overdose crisis”.
We’re arguing about milligrams of dosages instead of working to solve the real problem, which lies in the current state of our economy and society.
Addiction and dependency/tolerance are two separate entities, but policymakers and many in the media equate the two. But the doctors in Upstate New York should know better.
in 2016, Drs. Nora Volkow and Thomas McLellan of the National Institute on Drug Abuse explained,
“Unlike tolerance and physical dependence, addiction is not a predictable result of opioid prescribing. Addiction occurs in only a small percentage of persons who are exposed to opioids — even among those with preexisting vulnerabilities.”
Even though NIDA, the National Institute of Drug Abuse, is THE government agency for the study of and policies for drug abuse, this agency is one of the few that have been left out of any serious discussions.
In 2016 the Centers for Disease Control and Prevention published guidelines regarding opioid prescribing for pain. Many scholars and clinicians specializing in pain management and addiction treatment criticized the guide as lacking a basis in evidence
Complaints by academicians, clinicians, and the American Medical Association(Resolution 235) finally caused the CDC to issue a clarification in April 2019, noting, “Some policies, practices attributed to the Guideline are inconsistent with its recommendations.”
Zealots will always disregard information that does not suit their purposes, so policies will be interpreted as they prefer to interpret them, not as they were written.
Among the misapplications of the guidelines it noted were those that result in “hard limits or ‘cutting off’ opioids,” stating the “Guideline does not support abrupt tapering or sudden discontinuation of opioids.”
Yet the statutory and regulatory restrictions remain unchanged.
And, once created and instituted, these restrictions will require considerable effort to remediate.
No matter how misguided and even perverse they are, we will be stuck with these morally corrupt restrictions long after they’ve been proven ineffective and even damaging.
To date 18 states have laws limiting the amount of opioids that can be prescribed for acute and chronic pain. Many have limits on the morphine milligram equivalent daily dose (MEDD) that may be prescribed, despite evidence in the peer-review science literature that MEDD is an inaccurate and inappropriate metric
So the march continues, undeterred by the facts, toward a pre-modern approach to the understanding and treatment of pain, and a pre-modern understanding of the risks and benefits of opioids, and the subtleties that differentiate dependency from addiction.