Interview with Dr. Steven Passik – Question #3

Question #3: Why do you think the US and Canada use so many more opioids than other countries?


Dr. Lynn Webster [Dr. Webster]: This is Dr. Lynn Webster. Thank you for listening to the Pain Topics series of interviews on I am back with Dr. Steve Passik to ask him another question which many of us in the field hear a great deal about. Dr. Passik is a clinical psychologist and vice president of clinical research and advocacy at Millennium Health. Thank you for joining me, Dr. Passik. Today, I’d like to ask you, why do you think the US and Canada use so many more opioids than other countries?

Dr. Steve Passik [Dr. Passik]: Well, this is like, of course, a funny question because if this question had been asked years ago, the implications of the question would have been totally different because when I started out my career in Sloan Kettering and Cathy Foley was very busy those days with the World Health Organization.  And World Health Organization was always – their meetings on these issues was always putting out these bar graphs where the different countries and their per-capita morphine consumption was represented and the funny thing is, that the more civilized you are, the higher your per-capita morphine consumption was.  Now, when you ask a question about why the US and Canada has a higher morphine use or opioid use than other countries, the implication is that there’s something wrong with that.  And we have a movement afoot in the last several years, I think, to try to take pain seriously and we wanted to re-examine everything in the armamentarium.  We had the recognition that opioids, in and of themselves, are not the source of the opioid problem, it’s when opioid are given to people without safeguards, who need safeguard that becomes the problem, and so there was a sort of critical re-examination of it.  And when you are confronted with 100 million people with chronic pain and you’re de-stigmatizing the use of opioids as we did at least for a short period of time, that’s what’s going to happen.  Now, you’re going to lead the world in it because other countries haven’t necessarily gone through that exercise.  They don’t have the pharmacopaeia available that we do.  And in some instances, particularly in developing countries, they got a lot more to worry about, so much so that I think the places in the world where the suffering of the people with chronic pain has to take a backseat to this suffering of people for all kinds of other problems that they have.  And so, some people never opened up the Pandora’s Box and sat back and waited to see what this grand experiment would do in North America before they got involved.  That said, it’s interesting – we just had a little bit of a discussion about how the reimbursement system might have fueled the problem of opioid abuse but it’s interesting.  Canada and United States have very different reimbursement systems and both had expansion in opioid arguably to the benefit of at least some of the population, but then at the same time, both ended up with the abuse problem and I think they’re in – that’s where with just an education problem, that just because you free up opioids, doesn’t mean you have done what Doug Gourlay said, and you know I’ve quoted this until it’s coming out of my ears, that you’ve created what Doug Gourlay said needed to be created from day one which is talented amateurs in addiction medicine.  So, you can’t just say we’re going to re-examine opioids and do it without also preparing the medical community and the affiliated communities like the psychologists and everything to be ready to pounce on signs of addiction and know what to do about it.  Of course, we didn’t do that.  And so, we use more opioid, I think, just because philosophically, we are ready to examine using more opioid but we also didn’t do it particularly well because as you heard me say many times, I think we trivialized the risk to get people to re-examine opioids rather than saying there are risks and we’re going to train and educate everybody.

Dr. Webster: I would agree, Dr Passik. The cultural and societal attitudes towards the use of opioids has certainly changed over the last decade or longer. It seems to be a continually evolution. Thank you for participating in today’s interview, and thank you to the listeners for tuning in to Pain Topics on Please come back tomorrow for another question with Dr. Passik. If you aren’t already, please follow me on Twitter @LynnRWebsterMD. Also, stay tuned to my blog for more information about my upcoming book and documentary, titled The Painful Truth, to be released this fall. Thank you and have a great day!

Steven D. Passik, Ph.D.
Vice President of Clinical Research and Advocacy, Millennium Health

Steven D. Passik, PhD, is vice president of clinical research and advocacy at Millennium Health. Before coming to Millennium, Dr. Passik was professor of psychiatry and anesthesiology at Vanderbilt University Medical Center in Nashville, Tenn. He was section co-editor for the opioid pain and addiction section of Pain Medicine, served on the editorial board of the Journal of Pain and Symptom Management and has been a reviewer for many peer reviewed journals, including The Clinical Journal of Pain. Dr. Passik was editor in chief of the National Cancer Institute’s PDQ Supportive Care Editorial Board. He was named a fellow of Division 28 of the American Psychological Association (Psychopharmacology & Substance Abuse) and awarded a Mayday Fund Fellowship in Pain and Society. An author of more than 200 journal articles, 60 book chapters, and 59 abstracts, he speaks nationally and internationally on pain, addiction and the pain/addiction interface. Dr. Passik received his doctorate in clinical psychology from the New School for Social Research, New York, and was a chief fellow, Psychiatry Service at Memorial Sloan-Kettering Cancer Center in New York.

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