T

he opioid epidemic has rapidly emerged from the shadows and is now recognized as a plague that affects hundreds of thousands of Americans regardless of age, race, or socioeconomic status. In its destructive potential, it can be compared to the AIDS and polio epidemics. But unlike AIDS and polio, the opioid epidemic continues to rage in large part because we, as a nation, have not yet resolved to attack it head on.

As highlighted in the surgeon general’s report released this week, “Facing Addiction in America,” we are now beginning to translate rhetoric into national initiatives that target community-based education, treatment centers, and interventions to stop the distribution of opioids and to implement effective treatment and prevention programs. As the report emphasizes, those afflicted need insurance coverage as well as resources for education and treatment, which will certainly lead to new federal initiatives and financial outlays.

The surgeon general’s recommendations represent a major step forward in our fight against this deadly scourge. Like most epidemics, the immediate call to arms by our federal agencies is focused on helping those who are currently affected by opioid addiction and implementing steps to minimize the risk for addiction and death in vulnerable populations.

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Yet the call to eliminate the use of opioids for chronic pain represents a major dilemma for health care providers and their patients because we are also facing an epidemic of chronic pain. As documented in the 2011 Institute of Medicine report, “Relieving Pain in America,” more than 100 million Americans suffer from chronic pain. It costs our society a staggering $600 billion a year. That is more than we spend each year on treating cancer, heart disease, and diabetes combined.

Many, but certainly not all, patients who suffer from chronic pain rely on legally prescribed opioids to live, work, and function in their daily routines. For them, opioids are among the few therapies that work.

How do we decrease addiction to opioids and still humanely and ethically treat the millions of Americans suffering from chronic pain? As a pain expert, I had hoped the surgeon general’s report would have placed a greater emphasis on the need to develop alternatives to opioids that can be used for pain management, which would eliminate a key pathway to abuse.

Although the president, Congress, and federal agencies are making substantial headway in funding educational and treatment programs, they have fallen short in funding research initiatives that will eliminate the need for opioids in medical practice. That would significantly reduce the availability of these drugs. Such an effort will require funding at the federal level for new research that will lead to new drugs, behavioral interventions, alternative medical practices, devices, and health care delivery systems to replace opioids in clinical practice.

We currently spend just 4 cents per pain patient per year on research aimed at discovering and implementing new treatment strategies and delivery systems that will reduce, and ultimately eliminate, the need for prescription opioids. At the same time, pain patients account for about 15 percent of health care costs. That’s a big imbalance.

If we are to win this fight, we must resolve two interwoven health epidemics facing our nation: opioid abuse and chronic pain. We need more federal funding to develop new drugs, procedures, and health care delivery systems that will eliminate the need for opioids in clinical practice. That would eliminate a primary contributor to opioid abuse while still providing the best possible care to patients who are suffering from chronic pain.

William Maixner, DDS, directs the Center for Translational Pain Medicine and the Innovative Pain Therapies at Brier Creek and is professor of anesthesiology at Duke University.

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  • Life without my pain medication is torture. I have gadolinium deposition disease caused by Optiscan contrast media being used in conjunction with an MRI in 1996. I had a brain aneurysm and had a craniotomy to repair it that same week. I also have a window with unhealed edges because it is over my temperomandibularmasseter muscle and so i have headaches too. But my feet and ankles were red and swollen when i went home from the hospital. That was the least of my problems at the time since I had had several small strokes also and was having a number of serious visual and motor issues. But they resolved over time. I lost my career. But mostly recovered over time. Except that my feet and lower legs got insidiously worse and worse until they resembled Nephrogenic Systemic Fibrosis. I had had severe burns to my feet and ankles as a teen but at 40 when I had the aneurysm I played tennis twice a week and was very active. Over the next few years I had terrible pain that never resolved because the capillaries and venules in my feet and lower legs were damaged enough to dechealate the Gadolinium and leave the heavy metal in my tissues causing a terrible inflammatory and fibrosing response ruining my feet and lower legs thickening my skin and making me feel as if I have a cast that is too tight that will never come off. It is torture without opioids. I can walk but i pay a dear price. My feet and legs swell terribly. With high dose opioids i could have a relatively normal quality of life though and help my family and do things around the house. There is an array of complications that greatly shorten a persons life when they are subjected to chronic intractable pain. I guess the government and medical community couldn’t care less about that. I am so very angry that mds would say chronic pain pts should just accept their pain. When the mds would be begging for opiates if they experienced a fraction of the pain i am enduring. I would hope they do experience something like what i am having to go through. Or that their children do. Fuck them all. You see how I feel about these mds. That is how most of America is going to feel about the medical community when their wives,children, parents, or siblings are treated to such sadistic , callous, lack of empathy. They may just start hunting down the responsible physicians and ending their lives too. You should think about what you are starting here. About how many people you are murdering so very casually.

  • Chronic Pain Patients are unlikely to abuse opiods. In contrast to those who use opiods recreationally to experience a “high”, those receiving opiods to manage chronic pain under a doctor’s care are seeking an ability to resume work, to socialize with friends and family, simply having life beyond the confinement of a bed.
    Let us not resort to outlandish assertions about Pharmaceutical Companies misleading doctors and patients with claims of new, abuse-free opiod drugs. Patients are not so stupid. Show me a doctor who believed opiods no longer required responsible prescribing so I can report that doctor as being unqualified to practice medicine, much less prescribe controlled substances.
    If a drug has the potential for abuse, will it be abussed? Of course it will. But the simple fact that a patient requires a drug to improve quality of life, even when that drug makes the patient “feel better”, does not indicate abuse or misuse.
    Frankly, I am surprised that any physician would not recognize that drugs with the potential for abuse are prescribed to children in every city, in every community and in every state across this country without creating life-long addicts. Doctors and parents have long recognized there can be significant benefits to children having conditions that improve and frequently resolve completely with the proper use of stimulants such as Ritalin and Adderall. Children typically require such stimulants for many years, but there is no evidence of misuse or self-medicating with illicit amphetamines later in life.
    Most Americans are aware of our Healthcare System at a far more personal level than ever before. Politicians make sport railing over the cost of delivering healthcare, and now they race towards actions to make healthcare for some difficult or even illegal. For the largest class of patients, those living with pain, I am witnessing the destruction of lives at an increasing scale. The most egregious and frightening thing to me is that our Government, both directly and indirectly, will be responsible for inflicting the lion’s share of suffering, as well as diminished benefit to patients at increased cost. There is an explosive expansion in organized crime as patients refuse to give up on life outside the confines of their bed find themselves searching for options. Mark my words, many will die trying.

    • Part of the reason MDs are taking opioids away from chronic pain patients is the irresponsible recommendations of the CDC. Their recommendations are based on bad interpretations of retrospective studies. They don’t have real studies on opioids for chronic pain, just say that it doesn’t work.

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