This article, in a slightly edited form, first appeared on Pain News Network on May 11, 2021.
About 30 years ago, when I opened a pain clinic, I met a patient who made a lasting impression on me. She was a middle-aged woman who sat on my examining table with an unsmiling expression, her shoulders hunched. While maintaining eye contact, she began to tell me about her experiences: living with severe, chronic pain; being passed around by hard-hearted doctors; and being ignored or misunderstood by her family members and friends.
Her words saddened me. My patient was telling me she lived in pain, but she also bore a stigma that complicated her pain management. While I was treating patients with chronic pain over the next decades, I would learn that her experience was not uncommon, but this was the first time I’d heard about it. Therefore, it was memorable to me. It reinforced my commitment to advocate for people with chronic pain who were unfairly marginalized, ignored, and dismissed.
A Narrow Perspective of Opioids
I thought about this particular patient after seeing the HBO documentary’s narrow perspective of opioids. It occurred to me that the visceral reaction from nearly any casual viewer would be, “Why are opioids even being sold?” That was unexpected and deeply disappointing to me.
In part, I agreed to be interviewed by Alex Gibney, the director of the documentary, to explain why opioids are still prescribed, despite their risks. I saw this as an opportunity to help educate the public about opioids. After months of exchanging emails and having conversations with a producer, I decided that speaking on the record would be a calculated risk. As a doctor who had prescribed opioids, and who had lost patients because of their pain, I had been confronted by tough interviewers in the past.
I believed this HBO documentary couldn’t be any worse than the other hostile interviews I’d done. I was wrong.
The interview reopened a painful episode when a patient under the care of my pain clinic died — despite the treatment we provided, not because of it. The interviewer asked me about my patient’s death. I chose not to address it during the interview out of respect for those involved, and I will refrain from doing so in the future. It seemed unnecessary to defend myself. The death was a tragedy. It has been adjudicated, and there is nothing that I can say about it at this point that would benefit anyone.
A claim that I must address, however, is this. The documentary says that I was paid hundreds of thousands of dollars in speaking fees which supposedly influenced my prescribing practices. The fact is that I was paid a relatively small amount in speaking fees. The purpose of those speaking engagements was to educate clinicians about the safest ways to treat people in pain, not to encourage them to use opioids.
Fundamental Problem With the Documentary
Beyond the erroneous claims about me, my fundamental problem with the documentary is its potential reach and influence. It is likely that, going forward, all instances of people taking any opioids for debilitating pain will be perceived through the lens of the documentary’s narrative. This, in addition to the 2016 Centers for Disease Control (CDC) opioid prescribing guideline, could have a further chilling effect on opioid prescribing — despite the fact that lowering the number of opioid prescriptions does nothing to reduce the number of opioid-related overdose deaths.
The documentary appropriately highlights how opioids can, and do, lead to addiction and deaths. But the fact is that not everyone who takes opioids gets addicted or dies; comparatively few do.
The benefits of using opioids outweigh the risks for many people with severe chronic pain. For a certain patient category, opioids can be the difference between life and death, and happiness and misery.
Having studied addiction for my entire career, I am deeply sensitive to the propensity of some people to be harmed by opioids.
I also am deeply sensitive to intractable pain for which there are no treatment options today other than the use – as judiciously as possible – of opioids. My experience with patients confirms two things: opioids kill, but so does pain.
We must resist the temptation to further restrict or ban opioids for people who desperately need them. Instead, physicians must be allowed to fulfill their professional responsibilities and uphold their oaths, evaluate patients with complicated needs, apply proper discernment, and treat their patients in accordance with the best available scientific evidence.
A CDC disease expert, DEA officer, member of Congress, activist, or documentarian should not ever attempt to practice medicine.
The Real Crime Is Letting People Suffer Needlessly
Today, one in three Americans (not including children or those with cancer) suffers from chronic pain, or pain lasting longer than 12 weeks. Chronic pain is a full-blown crisis, not unlike the opioid crisis. Yet we hear precious little about the chronic pain crisis. Most people with pain silently, if unwillingly, endure their conditions. Few of us would listen to them, even if we had the opportunity.
Thirty years ago, I waited until the patient had finished telling me about her experiences. Then I simply said: “I believe you.” Hearing those three words, she burst into tears of relief because so few people had been willing to take her at her word when she told them her life had been derailed by unremitting pain. Hers was among the millions of voices that were, and remain, unheard in this climate of opioid rage.
The documentary’s central claim about the opioid crisis is that marketing opioids is a crime and was understood as such at the time when they began to be used to treat non-cancer pain. The use of opioids was not a crime then, nor is it today. However, the failure to appropriately treat chronic pain when it is possible to do so should be a criminal offense.
You can find him on Twitter: @LynnRWebsterMD.