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Too conveniant a call here. Especially when Hospitals are being critiqued like Hotels with pt questionarres asking questions like "Was your pain adequately controlled?" We aren't ALLOWED to refuse to treat a patients pain.
Study after study shows this idea to be false. Mild pain is one thing, but strong pain isn't just miserable, it slows down healing and greatly increases the incidence of dangerous complications.
Your initial assertion is that no pain is good so there is obviously no line to be drawn.
I'm reading Dreamland right now, which details the rise of the opiate epidemic- very good read, and it highlights the letter above as one of the early justifications for the massive opiate prescription boom. The "Porter and Jick" letter referred to only their very limited experience for patients in their database, who were prescribed morphine while patients in the BU hospital. Purdue Pharma took that letter and used it as foundational proof upon which a boom was born.
Quoting a very old post here but I didn't see anyone else address it:
That does seem pretty high. And I assume that these are mostly adults (and the article claims that the number could be a low estimate), suggesting that about half of American adults suffer from chronic pain. Though between obesity and sedentary lifestyles, maybe.
Ya know, last time I checked, the emergency services in Portland are currently having this debate. People working in the community -- drug counselors, homeless advocates, rehab centers, and the like -- are strongly in support of having this drug easily accessible. Considering that prescription overdoses are more common than car crash deaths, this is increasingly an issue that affects people in the non-traditional addict lifestyle.
The fact that it is even close is alarming. And, it doesn't matter how the death is classified: if it was related to opiates, having this drug available would lead to fewer deaths.
Serious question - do you work for Purdue Pharma, another Pharma do, or a service provider for a Pharma co?
This gave me a lot to think about, but when reading this post, and in particular the article from TIme that you posted, I believe there are some serious questions that need to be raised with some of these stats you are using:Consider the following:
So we can see that chronic pain is a very serious and widespread problem that affects over 100M Americans. And we can assume from these numbers that approximately 20M Americans are prescribed opioid medications. So the need for opioid medications is extensive and real.
- In 2011, the Institute of Medicine showed that 116 million Americans suffer from chronic pain.
- From Prevalence of Chronic Pain in a Representative Sample in the United States: "Chronic pain is the most common symptom for which patients seek medical care."
- From CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016: "Opioids are commonly prescribed for pain. An estimated 20% of patients presenting to physician offices with noncancer pain symptoms or pain-related diagnoses (including acute and chronic pain) receive an opioid prescription."
Facts on drug overdose deaths:
So there are likely 15K or fewer accidental prescription opioid deaths annually. Meanwhile, more than 20M Americans use their opioid prescriptions responsibly to treat their pain. I'm sorry, but I don't see an 'epidemic' here.
- Per the American Society of Addiction Medicine, in 2014, there were 47,055 drug overdose deaths, which they break down as follows:
18,893 prescription opioid overdose deaths
- 10,574 heroin overdose deaths
- 17,588 non-opioid overdose deaths
- However:
This data is flawed. Some overdoses were counted twice and some deaths blamed on prescription medications were caused by illegal opioids.
- This metric also includes situations where individuals chose to end their lives with an overdose. Many people who suffer from chronic pain also suffer from chronic depression, and many patients on opioid medication face severely declining quality of life and/or end of life situations. Many of those people who chose to end their life with a prescription opioid overdoes would have found another method if necessary.
- Altogether, it seems likely that the number of accidental prescription opioid overdose deaths is much lower... which incidentally means they are likely not the leading accidental cause of death in America as has been reported.
Also, while overdose deaths have been increasing, as with all statistics, you have to look at context. From 1999-2010, opioid prescription sales increased 300%. So it stands to reason that prescription opioid overdose deaths would increase.
The reason for that increase in opioid prescribing over the past 15-20 years is that prescribing policies changed in the late 1990s, when pain was introduced as the "fifth vital sign." The rationale behind that change was good -- patient advocacy groups and pain specialists successfully lobbied state medical boards and state legislatures to change statutes and regulations to lift any prohibition of opioid use for non-cancer pain. There is a lot of funded cancer research and thus a lot of funded research on cancer pain, and comparatively very little funded research on non-cancer or general pain. There is no reason to believe cancer pain is by definition different or worse than non-cancer pain. So it is not appropriate to reverse these policy changes.
The bigger problem with these changes is that it led to physicians prescribing opioids without any specialty or significant education in pain management. This led to some unquantifiable amount of overprescribing. This is a hard problem to solve, since there are only an estimated 10K pain management specialists in the US... only 1 for every 11K+ Americans suffering from chronic pain. This is the primary issue that needs solving to address these deaths.
Unfortunately, the CDC has now published new opioid prescribing guidelines with questionable validity that are likely to harm tens of millions of Americans who are already suffering in the name of trying to reduce a relatively small number of accidental overdose deaths. These guidelines were developed without patient or pain expert involvement and are universally opposed by national pain organizations.
I'm all for taking steps to reduce those deaths, but those steps should be carefully designed and employed to avoid harming those who need opioids and use them responsibly. Unfortunately, the CDC has not done that. Not only that, but CDC has been exclusively focused on how to reduce these deaths for several years rather than on how to improve our understanding and standard of care for pain management, which should be their focus with regard to pain.
Serious answer: no. I do not and never have worked in any industry relating to healthcare/pharmaceuticals.
Suffering from chronic pain does not equate to suffering from a condition that requires "incredibly addictive drugs," i.e., opioids. In fact, I posted that 20% of patients presenting to physician offices with non-cancer pain symptoms or pain-related diagnoses (including acute and chronic pain) receive an opioid prescription. Meaning 80% do not.
I agree that opioids are not always the answer. Whether or not they should be the "last resort" depends upon the patient/situation.
No, this does not indicate that the number of people suffering from chronic pain has doubled. In my post that you quoted, I pointed out that in the late 1990s, prescribing policies changed to lift any prohibition of opioid use for non-cancer pain. That was a good thing, and obviously should have been expected to increase the prescribing of opioids. Prior to this policy change, there were millions of people suffering from non-cancer pain that was undertreated.
I'm not qualified to answer this. It may very well be that overprescribing opioids led to this problem in many small towns. I agree overprescribing should be stopped, since it is by definition inappropriate. However, that needs to be done without doing harm to a much larger population of Americans who have legitimate need for opioids and are using them responsibly and appropriately. The Government's current approach is doing harm to those people. IMO that is unacceptable.
I addressed this in the very next paragraph of my post you quoted and also above in this post. While I don't doubt that there is some fraud and some additional irresponsible/inappropriate prescribing, I believe the vast majority of this increase is justifiable, for the reasons I have presented.
Anecdotal evidence is not an appropriate basis for policy that will harm tens of millions of Americans who are already suffering. Any doctors who are handing out prescription opioids "like candy," i.e., inappropriately, should be stopped and punished. That does not require sweeping policy change.
No, that is a fair point. One of the articles I linked states that 1.9M people had substance use disorders associated with prescription opiates in 2014. Doing the rough math, if there are 116M Americans who suffer from chronic pain, and 20% of them are prescribed opiates, then roughly 8% of those who are prescribed opiates have substance use disorders.
I linked this article previously, and I already posted that the data in your first bullet here is flawed. Still too many deaths, but likely 15K or less, not 19K.
I have posted facts about the number of people suffering from chronic pain. Show me some facts that tell us how many people (a) fake it to seek drugs and (b) are successful in getting them. Until then, my facts trump your unsubstantiated opinions.
Legalize weed and decriminalize all other drugs except heroin and far fewer people will want to try illegal opiates.
Makes too much sense so it will be another 50 years before it happens. The war on drugs is a cash cow for the Feds and the prison system. Besides, big Pharma needs to get their mitts on weed before any legality at the federal level will happen.
Welp, that's what it is. This is really, really scary. And sadly, heroin's grip is so strong that it won't discourage many people from accepting the risk and continuing to use.
I guess this is Exhibit 1001:
That's like banning caffeine or sugar because you don't want to prime kids for meth/coke. Keeping it illegal is the real primer as they begin to see circumventing the law as not as big of a personal risk. There's no reason to group a drug that is impossible to fatally OD on in the same "schedule" as the drugs that destroy lives.
A friend and I used to say...
