Let’s Agree to Prioritize the Needs of Patients When Treating Pain
Treating Pain — The Stats
In a recent Consumer Reports article on pain, “Prince’s Death and the Addiction Risk of Opioids,” Teresa Carr writes, “In fact, as many as one out of four taking a prescribed opioid for several months or longer becomes addicted, according to the CDC.”
Carr doesn’t provide a reference, so I’m not sure where she found this statistic. In fact, the statistic is untrue.
Nora Volkow, Director of the National Institute of Drug Abuse, cites in the New England Journal of Medicine a different statistic: approximately 8 percent of people exposed to opioids over a long term become addicted.
That 8 percent figure is consistent with the percentage of the population who become addicted to alcohol after they’re exposed to it. Of course, alcoholism and opioid addiction — or any addiction, for that matter — is a horrible disease that we should try to prevent.
Alcohol vs. Opioids
However, people gain no medicinal benefit from alcohol that they can’t derive from other means. This is not true for opioids. Many people exposed to opioids do gain a medical benefit — taking the edge off unbearable pain for awhile — when they have no alternatives for treating their pain.
Furthermore, those who are unable to obtain alcohol to sustain their addiction are not being deprived of substance that improves their life. On the other hand, when opioids are not made available to people who need them, those people can suffer needlessly.
An 8 percent addiction rate for opioid users is better than a 25 percent addiction rate. However, the fact that anyone becomes addicted to opioids is one of the many drawbacks of using opioids to treat pain.
But, still, inflating the 8 percent addiction rate to 25 percent seems to serve a political purpose. Those whose agenda prioritizes the elimination of opioids, even though there are no effective, safe alternatives for treating many people in pain, may have an incentive for using hyperbole to get their point across.
Yet — when you remove the exaggeration — their point about the addictive nature of opioids is valid. Some people, unfortunately, will become addicted when they are prescribed opioids for their pain.
Addiction is a brain disease. It is characterized by the craving for, and continued compulsive use of, a substance despite the harm that it produces.
Pain Addiction vs. Dependence
However, many people who do not become addicted to opioids do become dependent on them. This occurs with many medications, not just with opioids.
Dependence is a normal neuroadaptation of the central nervous system to an exogenous substance. In layperson’s terms, dependence means that your body adjusts to the substance and resets homeostatic thresholds. Sudden discontinuance of a drug upon which we have developed dependence will cause withdrawal. Withdrawal is a normal and expected physiologic response to a sudden drop in exposure to a drug at the receptors.
I worry about people in pain who have developed a dependence on opioids, even if they have not developed an addiction to them.
Prioritizing Treatment for Patients in Pain
In the wake of the new CDC Guidelines, it is becoming increasingly difficult for patients to receive painkillers. For those with a dependence (not an addiction) on opioids, their inability to obtain or fill prescriptions will mean they are at risk for suffering from withdrawal, in addition to their unmanaged pain.
This is something that all physicians should be concerned about. Perhaps we disagree about statistics, or approaches on the prevalence of opioid addiction, but we should all agree that people who have been on opioids should not be forced to experience unnecessary withdrawal from them.
Physicians must prioritize the needs of patients while we search for better ways to treat pain. It would seem we could agree to agree on this objective.
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.
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Copyright 2016, Lynn Webster, MD
I have taken this opportunity to share my heartbreaking story in hopes these witch hunting Opiate ill informed skeptics will read and understand that I would have no life without Medically prescribed Opiates by a physicians care and strictly monitored monthly urine and blood test. Please remember that An Opinion Before A Thorough Investigation Is The Epitome Of Ignorance! And that a little more compassion from the Medical Field and its representatives could have saved my beautiful Stepdaughters life. Let me say this! A person who has a addictive personality will abuse anything that helps them feel better. I have taken Oxycontin for 12 years , I have had 20 major surgery’s in 9 years. I have so much physical pain I can not even get out of bed with ouit pain meds and when I run out I run out and just lay in bed praying the Lord relieve me of this horrible condition and I pray God you pain med skeptics never go through what I go through everyday of my life when the only thing you have to do is threaten what help I get, Shame on you! There will always be drug abuse and as the so called war on drugs has failed all this will! All you do is stoke and aid the drug pushers business to knew heights in the Black Market of Heroin while depriving folks as me to this horrible movement! My Stepdaughter committed suicide 4 years ago because of being treated like a drug addict by her family and doctors when all along she suffered from Lupus and Fibro which I believe was brought on by a deadly car crash at 18 , she told me between that which I was being put through and what they were putting her through she was not going to live her life in such a hell brought on by people like you that are on a witch hunt to out law Opiates and pain meds that give us some sort of a life . As a retired Police officer and worked indirectly close to the DEA, you people do not have a clue how thrilled you are making the illegal opiate trade and think of my Late Stepdaughter as you continue on with this bull shit movement to outlaw opiates! Just like the slaughter of children at Sandy Hook if there would have just been gun laws , my God they were Gun Laws , the guns that murdered all those 20 children were all registered and owned by a school teacher! You fight Drug Addiction in Elementary education by teaching all children the dangers of Booze and Tobacco which if these witch hunters want for us to know the real truth but they do not. I miss my Stepdaughter a so much and some of us will continue on the fight to protect our right to feel better and function without fear of these witch hunters trying to convince us to commit suicide . And they are trying to do exactly THAT!
The under line real truth is THESE witch hunters would rather us Chronic Pain sufferers commit suicide are and DRINK all the BOOZE we can drink! The Federals legalized it ( ALCOHOL) knowing its a more deadly drug than Strychnine. And just because the DEA has miserably failed with their bullshit war on drugs why do they deprive us sick people of our Constitutional Rights to be Happy in that pursuit of with Professional Physicians to take meds that give us relief of this horrible malady of Chronic Pain ! May God have mercy on their miserable souls they that seek to destroy us Chronic Pain Sufferers only and little hope of temporary relief of this horrible sickness.
wow Wayne , you sound angry and in pain. but on target.. I believe the real problem lies with the big pharmaceutical companies and the insurance industry. because there is alternatives that they don’t talk about. http://www.multiradiance.com I am a firm believer of low light laser therapy. I have been writing blogs and doing research about pain and my findings are amazing. I, of course do not know what your situation is , but the new medical technology that has been developed with light therapy is amazingly safe, effective , affordable for home use, and cordless, making it easy to use.. I work with residents in retirement homes and it is just a shame how we have not looked into this remarkable modality of medicine for pain relief.. If you want to know more here is a link to my first blog that I tried to write in plain english for all to understand. http://moredogsmorefun.com/the-truth-about-low-laser-therapy I hope you can find some peace and relief from your pain. Light is how we are here!
I am a chronic pain suffer, as is my husband, my father in law, my daughter, and my mother. Some of us do need meds to function! If I were not being treated I would not be able ti support my family as I do now.
I pray for you friend because I understand. I also lost a close friend from suicide, she couldn’t handle the pain any longer either.
You speak up for the medicine so many of us need. I had to retire too young because of pain. Losing my work as an independent marketing communications specialist — writer, publicist and media and art director — was sad, as it was to lose participating in the sports and outdoor activities I loved.
One never fully accepts chronic illness, I believe, and it has taken many years of grieving to accept my new and uncertain life the best as I can. Opioids brought a new measure of life and capabilities for me, however, even though I still have severe pain and many difficulties. For so many years I believed I’d never write again, for the physical, social and emotional pain, a hard time concentrating, being creative, and owning the foresight and capabilities to research/study it takes to do my work. But now I am once again writing and doing lots of research, but in another arena: Chronic pain and what is happening in the U.S. with healthcare systems, medication, medical studies, insurance, government, media and patients like me.
If my meds are reduced or taken away, I will no longer walk, live in any sort of independence, have my EMS dog, write and contribute to society. In fact, I don’t know how I could even live in that much pain.