Point of View
In the many congressional hearings on the growing problem of prescription drug overdosing, many “experts” testify. But, rarely will a patient living with chronic pain be heard. The anxiety both patients and doctors have about using pain medications causes many patients to live with unbearable discomfort. When the Huffington Post did a series of articles on pain treatment, over 300 pain sufferers responded with stories like this one:
Faced with debilitating pain from spinal stenosis, one Indiana pain patient was told by local doctors she was displaying the drug seeking signs of an addict, and they refused to treat her. "I have never used an illegal substance, and seldom have a glass of wine- I've never had a beer in my life," she writes. She was finally able to find a pain specialist, but in California. She makes the trip every three months for the high-dose opioid therapy she says makes her life bearable. But the cost of flying to the west coast ever few months is taking a toll on her finances. "I have asked for help finding a pain management doctor closer to Indiana," she writes. "I have searched online. I cannot find any one willing, or qualified to take me. I am a Christian and I do not believe in taking my own life, but I pray for an answer before I have no way to survive. I am not alone. There are so many pain patients whose lives are a living hell -- waiting and praying to die."
R. Balko, HP, 05/09/12
The CDC stresses the value of medication-based pain management in palliative care at the end of life, but they are not the agency that controls the drugs used. It’s the DEA that directs how, when and where opioids are prescribed. So, the same governmental agency (the DEA) that controls the US supply of opioid pain medications is also charged with the mission of eradicating drug abuse. There is little or no balance in the DEA to ensure "legitimate" pain patients have access to these medications–as pain patients are not distinguished from addicts.
The Cato Institute (a libertarian think tank originally called the Charles Koch Foundation) says “The government is waging an aggressive, intemperate, unjustified war on pain doctors by demonizing physicians as drugs dealers and exaggerating the health risk of pain management.” The logic, they say, is the government, through the DEA, is trying to make physicians scapegoats of the failed drug war. They represent the extreme pole that opioids should be available to all with little government oversight, and describe their viewpoint in their pamphlet, Chronic Pain & Opioids–which we do NOT recommend handing out to patients, but is interesting reading for HCPs.
Whatever the reason, all physicians know they have to be careful in using opioids, and maintain records showing consideration of alternative treatments.
If you prescribe opioids, you should document efforts to evaluate addiction risk and that you have looked at other pain control options to make sure your patients and practices are "legitimate" as the DEA describes it. You can see how the Pain Management Evaluation and its resultant report can help.
Read on about attempts by pharmaceutical companies to reduce opioid addiction in the next section.
The Cato Institute (a libertarian think tank originally called the Charles Koch Foundation) says “The government is waging an aggressive, intemperate, unjustified war on pain doctors by demonizing physicians as drugs dealers and exaggerating the health risk of pain management.” The logic, they say, is the government, through the DEA, is trying to make physicians scapegoats of the failed drug war. They represent the extreme pole that opioids should be available to all with little government oversight, and describe their viewpoint in their pamphlet, Chronic Pain & Opioids–which we do NOT recommend handing out to patients, but is interesting reading for HCPs.
Whatever the reason, all physicians know they have to be careful in using opioids, and maintain records showing consideration of alternative treatments.
If you prescribe opioids, you should document efforts to evaluate addiction risk and that you have looked at other pain control options to make sure your patients and practices are "legitimate" as the DEA describes it. You can see how the Pain Management Evaluation and its resultant report can help.
Read on about attempts by pharmaceutical companies to reduce opioid addiction in the next section.