Monthly Archives: April, 2016

Managing Chronic Pain in America – Part 2

According to the Substance Abuse and Mental Health Services Administration, there were 2.1 million people addicted to prescription opioid drugs and 467,000 people addicted to heroin in the United States as of 2012. Why are so many people taking these drugs illegally? Are they all bored teenagers wanting to experiment with drugs? Are they down-on-their-luck adults looking to escape their depressing realities? Maybe. However, I want to present another type of drug addict. It is the addict that looks like your average American – going to school, working hard, raising a family, following their dreams. And then one day pain enters their life, a pain that does not go away. A pain that refuses to heal after the injury that caused it has healed. I am talking about chronic pain.

There is a lot of debate regarding how many Americans suffer from chronic pain. The Institutes of Health’s 2012 study estimated that around 100 million people suffer from chronic pain (defined as anyone with moderate to severe pain occurring within the past four weeks). The 2011 Journal of Pain study estimated a more conservative number of 39 million people (defined as anyone with frequent or constant pain experienced most days within the preceding three months).

If we leave behind the semantics of defining chronic pain, we still face a staggering number of people with this condition. According to an article published by the National Institutes of Health, only about 5% of pain patients who take opioid painkillers as directed actually abuse them. So what does that mean? It sounds like the DEA and FDA want to throw the baby out with the bath water by decreasing access to pain medications for chronic pain sufferers. Why are we willing to punish 95% of chronic pain patients to a lower quality of life simply because the other 5% has a problem? Should we not do a better job of weeding out those 5% and getting them treatment options that do not include pain medications? It is great that health insurance plans cover pain medications and drug addiction programs. But why do they not cover more options in between these two extremes?

If pain patients had more evidence-based treatment options covered by their health insurance plans… If the National Institutes of Health allocated a greater percentage of funding to pain research… If we, as a society, did not label people in pain asking for help as drug seekers… If we would only show a little compassion to those in pain…

Managing Chronic Pain In American – Part 1

The Backstory

Once upon a time in America, pharmaceutical companies decided to get richer off of patients’ pain. They had some good intentions -like relieving pain-and they had some nefarious ones -like wanting to make stakeholders richer. They created a huge ad campaign targeting both doctors and patients to use their opioid medications. As a result, pain was better managed. However, since doctors were rarely shown the big picture of what opioids can do, millions of people became addicted to them, eventually turning to heroin after their doctors cutting off their legal supply.

Big Pharma encouraged doctors to over-prescribe opioid pain medications because the manufacturers only revealed data that supported the safety of these medications. Doctors were encouraged to treat chronic pain liberally with opioids, never knowing the very real costs to patients. Doctors treated pain patients with opioids as a first step instead of trying other pain medications and/or alternative methods (e.g., physical therapy).

In 2012, 259 million prescriptions for opioid medications were written; and since 2000, a 200% increase in overdoses by opioid medications has occurred. This may appear cut and dry on paper. If we limit the supply of opioid medication available in the U.S., then overdoses will decrease. Whenever there has been a decrease in opioid pain medications both in terms of prescription and overdose, heroin has simply moved into its place. In fact, according to Time magazine:

This rise in cheaper, purer and more readily available heroin has coincided with a law enforcement crack down on illegal prescription pill providers.

According to the American Society of Addiction Medicine, the rate of overdose deaths and the sales of opioid pain medications both grew in tandem to each other from 1999 to 2008. They also state that one in four heroin abusers started with opioid prescription pain medications. These gloomy statistics would be enough to make me jump to the conclusion that opioid medications are bad for us as a society. However, research has shown that when the supply of opioid medications decrease, abuse of its illegal counter-drug increases. See this:

2014-ADAI-page-8

And this:

4-2014-testimony-fig3

The marketplace for abused substances tends to balance itself when the availability of one decreases.

… to be continued.