Chapter 23-2: Vision for the Future - Part II

“I am seeing many people who are being harmed by these sometimes, draconian actions amid this headstrong rush into finding a simple solution to this incredibly complicated problem,” said Sean Mackey, the chief of Stanford University’s Division of Pain Medicine. “I do worry about the unintended consequences.”1

After decades of growth in the prescribing of opioids, the annual volume shrank 29 percent between 2011 and 2017, even as the number of overdose deaths climbed higher. The drop in prescriptions has been greater still for patients receiving high doses, who fall way off the CDC Guidelines and most of whom have chronic pain, as happened to my husband. The correction has been so rapid, and so excruciating for some patients, that a growing number of doctors, health experts and patient advocates are expressing alarm that the race to end one crisis may be inadvertently creating another.2

Place de Vosges in blue, Paris, France 2018

Is it any wonder that suicides have been rising over the past ten years,2, 3 we de Vosges in Blue, Paris 2018ith rural areas accounting for an even higher growth, when pain patients in these areas have no choice but to drive hundreds of miles for treatment,4 and their medication is also being reduced?

Sadly, there is no consensus among the medical community as to how to treat patients with opiates. There are doctors who have been quoted in widely read magazines that opiates have no place in treating chronic pain; that there is no evidence for the long-term use of the opiates in managing this pain. Here I beg to differ, having seen the effect on the quality of my husband’s life when it was managed by opiates! The problem for many physicians is the reluctance to increase the doses to a high enough level; and so, their patient never gets to the point of saying their pain is under control. When a patient is undertreated for their pain, the doctor starts to think that “Well the pain medication is not working so we might as well stop”. And at the other end are those doctors, who have seen the benefits of increasing the doses on their patients, doctors like Forest Tennant and Jennifer Schneider.

1. McCoy, Terence, Unintended consequences. Inside the fallout of America’s crackdown on opioids, May 31, 2018 https://www.washingtonpost.com/graphics/2018/local/impact-of-americas-opioid-crackdown/?noredirect=on&utm_term=.3f322234ae6f&wpisrc=nl_evening&wpmm=1

2. Ingraham, Christopher, Mapping the chilling tide of U.S suicides, Washington Post, May 24, 2018, https://www.washingtonpost.com/news/wonk/wp/2018/05/24/mapping-the-rising-tide-of-suicide-deaths-across-the-united-states/?utm_term=.688d5e6e7002

3. Sheff, David, Clean: Clean: Overcoming Addiction and Ending America’s Greatest Tragedy, Houghton Mifflin Harcourt, New York, 2013, p. 1-374

4. https://www.cdc.gov/drugoverdose/data/overdose.html