The release this month of the final version of The CDC Guideline for the Prescribing Opioids for Chronic Pain is the latest step in the painfully slow process of undoing what has been called an “epidemic of overprescribing of prescription opioids.” You can find an excellent commentary in the Journal of the American Medical Association on this document written by MAR contributor Dr. Yngvild Olsen. Having lived through the evolution of the problem, I am heartened to watch the momentum finally building toward addressing it.
In my medical training, I was taught that when prescribing opioid medication to follow the sage advice of Hippocrates from 400 BC to respect their potency and use them “sparingly.” Later I observed how the apprehension of physicians about oversight from the Drug Enforcement Administration could contribute to their seemingly overly cautious attitude about using opioids to relieve the pain of patients. At the same time, in my work at Kolmac, I also saw patients whose lives had been scarred by having become addicted to opioids after having taken them initially for legitimate medical purposes.
I was therefore unsettled in the 1990s when I would attend medical conferences on the topic of addiction and pain management and hear reassurances from notable pain experts that opioid medication was not as dangerous as we had been taught. They would say confidently that the likelihood of addiction was so low that they could safely be used for chronic pain for many conditions that were not as serious as cancer. For those of you interested in more details about this well-orchestrated campaign, I would suggest that you read an earlier post featuring a Q&A with Andrew Kolodny. I also recommend watching an excellent lecture by Dr. Reuben Strayer, who documents what he terms the “brainwashing” of a whole generation of physicians.
The dramatic increase in the number of patients who have entered the Kolmac program for addiction to opioids has been startling to watch. Painful accounts of a large number of young adults dying of opioid overdoses are all too ubiquitous. Even more, patients have taken opioid pain medication as prescribed but have had their dose increased because of the development of tolerance and are now trapped in a state of physical dependence.
This situation can and is finally being corrected – with physicians taking the lead in dealing with the problem that they helped to create. Patients who have chronic pain and whose medications are being reduced are unfortunately caught in the middle of this adjustment and are understandably unhappy with this state of affairs.
Those who will reap the greatest benefit from this change are those patients with pain who will now be directed toward alternative, less dangerous forms of relief. Physicians, meanwhile, have another reminder of the importance of thoughtful consideration of the evidence before accepting the safety reassurances of some professional colleagues and the pharmaceutical companies that support them in not always transparent ways.