By Ed Coghlan
The National Pain Report has been covering the debate over the use of opioids ever since the DEA rescheduled them.
It has become very obvious that the debate over the use of opioids to treat chronic pain has been hijacked—by the extremes on both sides.
The anti-opioid crowd—driven by government and addiction advocates—would have you believe that opioids are evil and lead to addiction, suicide and pretty much the end of the world as we know it. They have been loud and the major media of the country have been their echo chamber.
The pro-opioid crowd—driven by patients and patient advocacy groups—would have you believe that the concerns about abuse are overblown and that they are being denied access to the only thing that can help them. They are frustrated that more people aren’t hearing their side of their story.
Both sides are a little bit right and a little bit wrong.
Like most disagreements, it’s not an “either/or” argument.
There is enough room between the sides to drive a truck through.
That’s why this letter published in the New England Journal of Medicine caught our eye this past week. Dr. Daniel Alford of the Boston University School of Medicine did a great job of defining what the middle could look like in this very important argument.
For the anti-opioid crowd he says, “slow down”.
“Groups lobbying against prescribing opioids for chronic pain remind us that the effectiveness of long-term opioid therapy has been inadequately studied. I believe that this is a case of absence of evidence rather than evidence of absence. As we await scientific evidence, questions remain regarding how best to address the epidemic of prescription-opioid misuse now. Groups advocating quick fixes believe that regulations that limit opioid availability are the best plan. This strategy is well intentioned and will certainly reduce opioid prescribing, but such blunt approaches will also limit access to opioids for patients who are benefiting or may potentially benefit from them.”
For the pro-opioid crowd he says “We hear you, but you need to listen too”
“Managing chronic pain is complex. Chronic pain is subjective and can present without objective evidence of tissue injury, which results in diagnostic uncertainties despite our most thorough assessments. Patients with chronic pain are desperately seeking immediate relief from their suffering; they tend to have unrealistic expectations regarding the potential benefits of opioids and not to fully appreciate the degree of risk conferred by escalating their own doses in a desperate (yet futile) attempt to obtain pain relief.”
Common sense, better education of doctors, especially for the primary care physicians and their patients, about how to prescribe and use opioids responsibly.
“I believe that the medical profession is compassionate enough and bright enough to learn how to prescribe opioids, when they are indicated, in ways that maximize benefit and minimize harm. Though managing chronic pain is complicated and time consuming and carries risk, we owe it to our patients to ensure access to comprehensive pain management, including the medically appropriate use of opioids.”
Read the letter and let us know what you think.