Counterpoint: “Opiophobia” is not a real thing

By Cindy Perlin, LCSW.

(Editor’s Note: A recent commentary by Dr. Jeffrey Grolig on Opioidphobia has generated lots of comment and we received a request for publication of an opposing point of view by Cindy Perlin which you can read below.)

First, let me state unequivocally that I am vehemently opposed to the practice of involuntarily terminating opioid medication for chronic pain patients with a long-term history of opioid use and no evidence of addiction. I am also vehemently opposed to license suspension and prosecution of physicians who prescribe opioids to legitimate patients, a practice that has terrorized physicians to the point that they are abandoning their pain patients. These practices have caused grave harm to pain patients. Many are experiencing significantly increased suffering as a result, with some turning to riskier street drugs and others committing suicide.

Cindy Perlin

I feel compelled, however, to address the many inaccuracies in Dr. Jeffrey Grolig’s recent article, “Opiophobia: The Irrational Fear of Opioids”. To begin with, a phobia is “an exaggerated usually inexplicable and illogical fear of a particular object, class of objects, or situation” (Merriam-Webster Dictionary). It is not illogical or inexplicable for patients, physicians and policy makers to have concerns about a class of drugs that is killing over 100 Americans a day and addicting so many more. While we may disagree about the causes or the policy response, use of opioids can be life disrupting or deadly for some users. So, fear of using opioids is not a phobia because it is not exaggerated, inexplicable or illogical.

Dr. Grolig also misrepresents data and timelines. Opioids were used with caution in the mid-to-late 20th century because thousands of years of medical and recreational use had demonstrated that these drugs were very addictive. It was only after Purdue Pharma patented an extended release opioid, Oxycontin, with the intention of making huge profits, that the reluctance of the medical community to use these powerful drugs was reversed. Purdue Pharma funded the research by Dr. Portenoy and others that Dr. Grolig mentioned. These parties then misrepresented the data in their marketing to physicians. Purdue Pharma was charged with criminal consumer fraud by the FDA in 2007 for lying about the addiction risks to pain patients of Oxycontin and fined over $600 million. Hundreds of lawsuits have been filed against the doctors and pharmaceutical companies involved in this fraud. These lawsuits, filed by states, counties, cities and individuals, are now pending in state and federal courts.

Contrary to the “less than one percent” addiction rate claimed by Purdue Pharma, the National Drug Abuse Council now estimates, based on independent research studies, that the rate of opioid addiction for pain patients is between 8 and 12 percent. Furthermore, the National Drug Abuse Council reported that it is impossible to predict which patients will succumb, and addiction can occur as soon as five days after initiation of use. So, when new pain patients are placed on opioids, we are in effect playing Russian roulette with their lives.

A meta-analysis of research studies of opioid use for chronic pain published just last month in JAMA (Journal of the American Medical Association) found that opioids provided statistically significantly better pain relief than a placebo or other available medications, however the actual amount of additional pain relief was so small that it probably wasn’t very meaningful in terms of patients’ lives.

All of this does not rule out the possibility that there are some pain patients who will not become addicted and for whom opioids provide the best pain relief. It does logically lead to the conclusion that opioids should be used with great caution and only after other less risky pain treatments have been unsuccessful.

There are many nonpharmacological treatments that have been proven safe and effective for many chronic pain conditions, including: medical marijuana, herbal treatments including kratom, mind/body approaches, acupuncture, massage, chiropractic, nutritional interventions, light therapy, electrical stimulation therapies, stem cell therapy and many others. There are significant legal and financial barriers to patient access to these therapies that need to be removed. Promoting use of these alternative prior to initiating opioid therapy is not “opiophobia”, it’s common sense.

Cindy Perlin, LCSW is a chronic pain survivor, the creator of the Alternative Pain Treatment Directory and the author of The Truth About Chronic Pain Treatments: The Best and Worst Strategies for Becoming Pain Free.