Profit Motive as Cause of Previous Over-Prescribing

I keep reading about studies that show opioids to be no more effective for pain than non-opioid medications or other therapies. I still cannot believe that.

At first, I was convinced the studies had been corrupted, then I thought that the statistics were improperly manipulated, then I thought the patients had been poorly selected, but now I’m running out of excuses to insist those studies are wrong.

Still, it makes no sense to me that the only medication or treatment or therapy that has reliably reduced my pain for decades can be “proven” to be no better than drugstore pills (NSAIDs). 

After over two decades of pain and trying just about every possible other treatment (see My Journey through Non-Opioid Pain Treatments), it seems impossible that some “pain patients” do better (or just as well) without opioids.

I know of so many patients with pain that’s relieved by nothing other than opioids. Others achieve only minimal relief from non-opioid and non-medication therapies and thus also rely on opioids.

For me and these patients, a reduction in opioid dose simply means an increase in pain. Losing opioids completely leaves us practically crippled by pain – and fury, and fear.

Fury that our pain can be eased by a legal and widely available medication, but isn’t, due to the uninformed policies that interfere with our treatment.

Fear that we will have to live with uncontrolled pain the rest of our days, fear that we would welcome death to curtail our suffering.

This makes me wonder if many people back in the ’90s were prescribed opioids just for “aches and pains” that a doctor didn’t want to or couldn’t deal with in the 15 minutes allotted for an appointment.

Are these the people who’s condition improves when opioids are reduced? Are they the people for whom non-opioid therapies are effective?

Are there possibly many, many more of them than we realize?

Apparently there really are people who are better off without opioids, even though we who truly need opioids find that hard to believe. Just like anti-opioid zealots find it hard to believe anyone could benefit from opioids, we with intractable pain find it hard to believe someone might NOT benefit from them.

Opioid over-prescribing is said to have started in the ’90s. Pain was taken so seriously that it was instituted as one of the “vital signs”. Doctors could even be sued for not providing enough pain relief.

I don’t think it’s a coincidence that the ’90s were also when Health Management Organizations (HMOs) and Private Equity took over almost all healthcare functions in this country.

The ’90s were the beginning of the privatization and consolidation of healthcare when medical care providers (doctor practices, hospitals, labs, etc) were being bought up by giant finance corporations. This privatization led to a singular focus on profits to fill the pockets of managers and the C-suite profiteers, not doctors or any other people doing the actual work with patients.

Excessive prescribing of opioids would not have happened if the “alternative” treatments now recommended had been covered by insurance. Instead, only actual doctor visits and medications were covered, along with a very limited number of sessions of physical therapy, counseling, biofeedback (which I believe holds great promise), chiropractic, acupuncture, or any other treatment that requires ongoing care and costs.

Excessive prescribing of opioids would not have happened if doctors had been given enough flexibility and time to trial other therapies and make a realistic assessment of a pain patient’s need for opioids before prescribing them.

Such a medical investigation initially requires a long series of frequent appointments as non-medication therapies, then non-opioid medications are trialed. No one wants to pay for that.

But when it’s been done correctly, as it was for me and so many others I know, withholding the only effective relief of opioids is just cruel, and tantamount to torture.