Carl Jung once remarked, “The pendulum of the mind alternates between sense and nonsense, not between right and wrong.” When I think about the nation’s patchwork quilt policy toward opioids, I’m reminded of how right he was. In my book “The Painful Truth,” I devoted some space to outline a brief history of opioids, and the sensical and nonsensical polices adopted by government and payers.
Our current path of understanding has been littered with good intentions and unintended consequences. While we’re better off with what we’ve learned about opioids today, we still have a long way to go to address the unfortunate side effects of opioid policy in America.
In 1914, the Harrison Narcotic Act, the first U.S. federal law prohibiting the use of opium products without a doctor’s prescription, was passed. The act created a black market in illicit drugs and promoted social prejudices against people who took the medication as prescribed. This was easy to do since minorities were the demographic most involved. This social stigma among the indigent, woman and disabled is not unlike the poor treatment that many patients legitimately taking opioids receive today.
This perception persisted until 1986 when Russell Portenoy and Kathleen Foley published an article in the medical journal Pain ,reviewing 38 cases in which non-cancer patients received opioids. Their conclusion, that opioids are a safe and humane way to treat patients with non-malignant pain, quickly entered the medical mainstream, leading to a dramatic increase in opioid prescriptions, with many doctors believing wrongly that they could simply prescribe ever-increasing dosages of medication to combat escalating levels of pain.
The abuse of opioids that predictably followed put patients at extreme risk and caused a severe backlash, leading effectively to a regression of attitudes and laws similar to those of the early 20th Century. New anti-opioid legislation is popping up in state legislatures across the nation. DEA investigations continue to follow a hockey stick trajectory (which means years of low rate of investigation with an almost vertical rise in rate of investigations). The result has been a deepening fear among pain clinicians of talking about opioids with their patients and, ultimately, having their patients be denied access to treatment.
The medical community is in consensus about opioids because science has advanced. I don’t want to unwind that. I believe, as do many others, that opioids need to be replaced as a treatment method. But, until that happens, thoughtless blanket restrictions on opioids ultimately end up harming the very same people they are said to help. For me, it’s not about being against opioids. Rather, it’s about being against chronic pain. It’s also about being guarded against social over-reaction, which seems to come in waves throughout history.
My book, “The Painful Truth,” was released in September 2015.
Philip Matthews says
October 27, 2015 at 5:51 pmLynn,
Thank you so much for keeping your eye on the true mission of providing pain relief in the safest and most sane manner to chronic pain patients. Your intelligence, compassion, and integrity shine through every sentence you write. Thank you for your dedicated and determined efforts to overcome the nonsense that has become epidemic in our field.
Philip Matthews, DO says
October 27, 2015 at 5:53 pmLynn,
Thank you so much for keeping your eye on the true mission of providing pain relief in the safest and most sane manner to chronic pain patients. Your intelligence, compassion, and integrity shine through every sentence you write. Thank you for your dedicated and determined efforts to overcome the nonsense that has become epidemic in our field.