Why You See The Pendulum of Addiction Fear Swinging Again
Addiction Fear
“The data about the ability of opioids to cause addiction haven’t changed. But that ‘old’ news can’t compete with the fire-breathing, vote-getting, be-seen-to-be-doing-something mentality of our political and regulatory folks,” said Charles F. von Guenten, MD, PhD, Editor-in-Chief of the Journal of Palliative Medicine.
I couldn’t have said it better. Of course, this is not the first time in U.S. history when opioids and the people for whom they have been intended have been castigated. Early in the 20th century, as many as 10% of the American population had become addicted or were physically dependent on opioids.
History of Addiction Fear
Back then, heroin was the primary molecule they abused. Therefore, many clinicians felt morphine would be an effective cure for heroin addiction. They did not know, at the time, that heroin metabolized into morphine and had many of the same euphoric effects.
Nevertheless, the government intervened, and laws were passed to criminalize the use of opioids. Many physicians were incarcerated for prescribing or dispensing the drugs. There was an enormous chilling effect from law enforcement interdiction. The people who had legitimately needed pain relief were either ignored or told to suck it up. The pendulum of excessive opioid use swung to near total abolition except for treatment of acute pain and for some cancer patients.
Again, the fear of addiction surfaced in the middle of 21st century. I write in my book, The Painful Truth, that in 1941, Lyndon E. Lee Jr., MD, wrote an article in the Journal of the American Medical Association in which he warned against the use of opioids (narcotics) even for terminally ill cancer patients because “it would condemn the patient to a life of addiction.” Dr. Lee was prepared to condemn dying patients to spending the rest of their lives to agonizing pain. He perceived the risk of addiction to be a far worse harm than pain.
History appears to be repeating itself.
Addiction Fear Today
Today, the pendulum has swung from excessive opioid prescribing in the 90’s and early 2000’s back to the attitudes and practices that caused incredible suffering decades ago. Today, as was the case in the 1940’s, mostly physicians and regulators are well intentioned, but their narrow focus on the harms of opioids is causing many with severe pain, including people dying with cancer related pain, to needlessly suffer.
Our regulatory and policymakers are trumpeting the dangers of opioids without appropriately recognizing what this imbalance of compassion is doing to a large number of people with pain in our society. I stand with Dr. von Guenten who is calling for a “voice of reason when someone starts breathing fire about the evil opioid and the evil doctors who are maliciously ensnaring the unsuspecting.”
Let compassion lead us forward, but allow science to light the way.
Purchase my book The Painful Truth: What Chronic Pain Is Really Like and Why It Matters to Each of Us (available on Amazon) or read a free excerpt here.
Copyright 2016, Lynn Webster, MD
Thank you Lynn for your broad public education on the painful subject of opiophobia. Without you and people like you pain patients would never stand a chance. I hope to live long enough to see those politicians and law enforcers who are making their careers out of pain patients misery to be publicly exposed and named one by one. Those culprits are the only ones who don’t deserve doctors’s mercy, all others do.
Joseph Zolot, MD.
Thank you for your increasingly strong advocacy for pain patients, Dr Webster (and Dr. Zolot too). Coming from physicians, your words carry more weight and legitimacy than dozens of patient testimonials.
I wish more physicians like you would band together to form a more outspoken group to fight against this opiophobia, one with the credentials and respectability to be believed, as PROP did.
I’m stunned that the AMA isn’t outraged and protesting vehemently, as legislators are becoming so specific that they are essentially “practicing medicine without a license”. We patients certainly feel their overbearing presence in the exam room, yet only a few brave individual physicians are protesting (like you).
We need more outspoken physicians advocating for pain patients. Nobody will listen to us since the media has successfully stereotyped us as lying “druggies”.
I agree with everything you posted here! Very well said!
Yes, I agreed wholeheartedly with all ! After almost losing a grown son due to UNTREATED pain after a surgery to remove a tumor in the ribs, resulting in nerve damage that caused severe intercostal neuralgia, and then he developed Centralized Pain Syndrome from untreated pain. He tried every medical and alternative option out there and his pain just kept spreading like wildfire. ( We found out he has a genetic anomaly with metabolizing medications , so all the standard analgesics used didn’t work for him and no one believed him that they weren’t working). His system got so stressed from the intense pain that his pituitary and adrenals almost shut down. Thankfully he was able to find a compassionate doctor who understood his metabolic issues, ordered tests to confirm them, and found medications that helped his pain. He is slowly rebuilding his life and to see policy makers going after opioid medications with no medical understanding of the issues people are dealing with is truly frightening! They are ignoring the science of individualized metabolizing of medications in setting standardized limits . One size doesn’t fit all. Our family is now too well aware of the unintended consequences of not treating pain adequately when it presents, and we are very glad for your tireless advocacy and for being the steadfast voice of reason! Thank you ALL from the bottom of our hearts.
Thank you for your advocacy for the truth.
As a pastor I’ve had to witness parishioners who spent their final hours and days screaming in pain. Why? Because they were too terrified to take pills that could “make them addicts!” I’ve seen all too many post-surgical patients turn down pain meds when they were obviously in real discomfort for the same reason. I have little doubt that the effort to endure, and the exhaustion it caused, slowed their recovery.
I’m a patient as well, living with three chronic pain conditions. I’m partially retired, but the opioids prescribed for me allow me to continue pastoring. I’ve tried all alternatives to opioids by now, with damage to kidneys and digestive system. Were I not an older pastor with no alternatives left, I might find pain relief impossible. Or maybe I’d just be an old pastor trying to buy pot on the street for pain relief, since the politicians are against that, too.
Please keep up the effort to get through to the hard headed ones.
I just got your book, The Painful Truth. As I feel up to it and can focus on reading, I have begun to browse the chapters. Everyone should have to read this book as mandatory life lesson 101. I don’t know too many families that haven’t dealt with these issues. Thanks for your advocacy.