Deb was in a near-fatal car accident. Her arms, legs, and pelvis were severely injured and would require multiple surgeries. She relied on opioids to ease the pain. Along with her other day-to-day medical challenges and constant setbacks, she suffered from constipation which her doctor attributed to her use of painkillers. But he offered no treatment or advice, nor did any other members of the hospital’s medical team. With all of Deb’s serious health problems, constipation wasn’t on the list of issues the team felt obligated to address. The medical team, therefore, allowed Deb to suffer, perhaps needlessly, from a common and potentially treatable side-effect of opioid use: constipation.
“The insurance industry appears to have played a major role in the development of a new strategy by the federal government to combat the abuse of opioid pain medication,” writes Pat Anson, editor of Pain News Network. This Orwellian act by powerful insurance companies in collaboration with the US Department of Health and Human Services (HHS) proposes to deputize pharmacists “to report suspicious activity by doctors who prescribe opioids to Medicare and Medicaid patients (see ‘Medicare Takes ‘Big Brother’ Approach to Opioid Abuse’). Individual profiles of patients, their behavior, and opioid use would also be created and shared among insurance providers.”
Are patients qualified to determine whether or not opioids help in treating their pain? Pain Medicine Advance Access published a study that was conducted at the Back and Pain Center, University of Michigan, in Ann Arbor, MI. The Back and Pain Center is an outpatient tertiary care pain clinic where patients are evaluated for a range of chronic pain conditions.
Study Asks Patients to Describe Pain
Patients were asked about key clinical factors including pain, functioning, mood, and opioid use history. The researchers wanted to evaluate patients’ beliefs about opioids. Their goal was to find out, from the perspective of patients, whether the difficulties associated with opioids (such as anxiety and depression) outweighed its benefit (that is, pain relief).
I’ve been critical of the media’s language in describing aspects of the opioid crisis. To solve the opioid crisis, we have to understand it and use terms that are factual but without spin. I believe the media could be a force in motivating people — the public as well as lawmakers — to take constructive steps to end the crisis. They can also prejudice readers and create attitudes that are not helpful to solving the problem.
A cop who arrested addicts is now experiencing life as a pain patient and has a much different perspective. You can read Nick Selby’s first-person account of “what happens when pain meets bad health policy and bad drug laws” in the Washington Post.
He tells his story well, and it’s one that’s familiar to me. I had several police officers in my practice who also received opioids. Some carried guns. None were impaired, as far as I could tell.
Officer Selby’s Journey to Changing His Perspective About Pain
Selby relays his journey from arresting drug abusers to understanding how necessary an opioid can be for someone in severe pain.
President Barack Obama wrote in the January issue of the Harvard Law Review, “As their [prescription opioids] use has increased, so has their misuse.” This is true, but blaming only overprescribing of opioids for the current opioid crisis demonstrates a lack of understanding about the complexity of the problem.
The putative argument President Obama and many others assert is that the opioid problem was created by an excess supply of painkillers flooding our communities. Excessive prescribing is part of the problem, but without demand, there would be no crisis.
Once again, I read the Intractable Pain Act (along with the section of it known as the “Pain Patient’s Bill of Rights”) which was passed by the Tennessee House and Senate in 2001 and repealed in 2015.
I did not see anything in the legislation that supports the statement made by Knox News columnist Frank Cagle that “when a patient was discharged from the hospital, they had to sign a form saying they have been issued all the pain medicine they wanted. If they didn’t get all the pain pills they wanted, the doctor could be sanctioned.”
The headline reads, “As prescription opioid addiction rises, help from doctors lags.” That belies the following statement by Washington Post reporters Scott Clement and Lenny Bernstein:
“Despite the high rate of dependence, the poll finds that a majority of long-term opioid users say the drugs have dramatically improved their lives. Opioids relieve pain that is otherwise intractable, they said in follow-up interviews, allowing them to walk, work and pursue other activities. Fully two-thirds of users surveyed said relief is well worth the risk of addiction.”
In 2012, Vanyukov et al published an article describing two separate views on the role that drugs play in initiating an addiction (Drug Alcohol Depend 2012;123:S3-S17). One is the “gateway theory” and the other is the “common liability to addiction concept.”
The gateway theory places the drug as the primary factor in initiating a substance use disorder (SUD). The belief is that exposure to a licit rewarding drug (e.g., tobacco or prescription opioid) begins a developmental process that progresses like a disease to a more serious stage, culminating in the use of an illicit drug (e.g., marijuana, heroin). Thus, in this theory, exposure to a drug initiates an SUD independent of the biology of the individual.
We are making headway in the fight against preventing, detecting, and treating cancer. You may already know that genes may someday hold the answers to treating, detecting, and even preventing cancer.
Improved Genetic Therapy for Cancer Treatment
You may also have heard that genetic therapy carries with it risks. But, according to the Genetic Literacy Project, scientists have recently found a way to make genetic therapy safer. In November 2016, the Genetic Literacy Project reported, “Scientists have developed a new safer gene therapy that may reduce the risk of cancer and can be used for many blood diseases” by altering the way in which a virus carries a beneficial gene to its target cell. This reduces the risk of cancer and can also be used for many blood diseases.