There’s a lot of attention going to opioid abuse, overdose and death in the media and government circles recently. The question is, “does anyone really understand what the problem is, or even a tangible thing to address it?”
In its effort to quell the problem, the CDC has drafted guidelines for prescribing opioids for chronic pain that focuses on selection of the opioid, its dosage, its duration of use, follow-up and discontinuation of use. According to Dr. David Nagel, who wrote this in a recent article for National Pain Report, there is a problem with this simplistic view.
“There is no universal understanding of chronic pain. There is no universal solution to the problem; in fact, there is no solution. There is no universal definition of what chronic pain management actually is. A physician is judged how well his judgment follows the evidence base. What happens if there is no reliable evidence base? What happens if a problem is so complex that that it defies study? Who defines what the reliable evidence base actually is.”
The media, including a recent story by 60 Minutes, and the White House are lumping heroin use and abuse with pain management. According to a column in National Pain Report, author Kerry Smith writes, “They (the media, and the piece by 60 Minutes) focused on the over-prescription of narcotic pain meds as the reason behind the heroin epidemic.” While heroin and legal pain medicines share being labeled as opioids, their use and purpose are vastly different.
There is a strong disconnect between pain sufferers who rely on legal opioids to help manage pain and the media and government who are trying to rebound frightening statistics about abuse, overdose and death from opioids. So, what should the public focus on?
Well, many say there needs to be a decoupling of drug abuse (either of heroin or illegally obtained opioids) and the legal and necessary use of opioids in pain management in the public discourse. But, that’s not happening, as the voice of the pain sufferer who needs opioids rarely gets heard. Government says it’s a prescribing problem. Pain sufferers say it’s a drug abuse problem. The media says whatever sounds most salacious.
Even though the public discourse likely won’t decouple the good from the bad with respect to the topic of opioids, there is a campaign that recently started that makes sense for all.
It’s called “America Starts Talking,” which is an initiative created to call on anyone taking an opioid, as well as their loved ones, to learn more about safe use, potential side effects, and how to recognize and respond in an opioid emergency, such as accidental overdose.
One of the key messages from the campaign – something many people have no idea exists – is to have the antidote to opioid overdose – naloxone (Narcan®) – at the ready to rapidly intervene in the event of an opioid overdose. Naloxone can be administered by a non-medical professional, as the drug only affects people who are using opioids. The drug puts people in immediate withdrawal of opioids, but does not otherwise in danger.
AmericaStartsTalking.com is the output of a partnership between Kaleo, a privately-held pharmaceutical company, American Academy of Pain Management, American Chronic Pain Association, The Pain Community and U.S. Pain Foundation. Its goal is to empower patients and their loved ones to work together with healthcare professionals to have these potentially life-saving conversations pertaining to safe use of opioids before an accident may occur.
“Many people think an opioid emergency could never happen to them but the truth is it can happen to anyone where an opioid may be present,” said Dr. Anita Gupta, Vice Chairman and Associate Professor at Drexel University College of Medicine in the Department of Anesthesiology, Division of Pain Medicine and Regional Anesthesiology. “Recent survey data show that starting conversations on this topic is not always easy to do and therefore is sometimes avoided – on both sides. Now is the time to foster lines of communication, bring this issue out in the open and help people impacted by pain be prepared in the event of an opioid emergency.”
This message is for drug users / abusers as much as it is for those legally taking opioids. In fact, research from StopOverdoseil.org shows that drug users / abusers are willing to give naloxone to one another.
So, while the media, government and public opinion sway in different directions, and some believe they do not represent the real problems or possible solutions, one thing is clear: No one wants to have a loved one or friend overdose or die from opioids, and if everyone taking an opioid (legally or not) knew about naloxone, perhaps those very real and sad statistics from the CDC might start falling.
Editor’s Note: Doug Lynch is a former chronic pain patient who worked in the pain industry for ten years. He is a partner in the National Pain Report.