In a recent well-conceived and reasonable Huffington Post blog, Dr. Steven J. Stack presents his seven ways that American physicians can reverse the opioid crisis. However, the blog’s opening line — “The medical profession must play a lead role in reversing the opioid epidemic that, far too often, has started from a prescription pad” — is the one that caught my attention.
Dr. Stack’s position that physicians can do something to solve the opioid epidemic, unfortunately, is putting the cart before the horse. Today, physicians are increasingly refusing to treat people in pain. There are probably many reasons for this, including the twin fears of causing harm from prescribing opioids and of being subjected to regulatory scrutiny for prescribing opioids.
Pain is The Number One Reason People Seek Care
The larger problem, however, is that most physicians are woefully undertrained in treating pain. There is almost no education on pain management in medical schools or residency programs, yet pain is the number one reason people seek care from physicians.
People in chronic pain usually are castigated, ignored, treated as suspected drug addicts, or told to suck it up. To appropriately treat pain requires time and expertise that most physicians simply do not have.
New Approaches Are Needed
In 2011, the Institute of Medicine recognized the need for a cultural transformation in attitudes and behaviors towards treating acute and chronic pain. In a report titled “Relieving Pain in America: A Blueprint for Transforming, Prevention, Care, Education and Research,” they recommended that the National Institutes of Health (NIH) develop a National Pain Strategy for a public health approach to pain prevention, treatment, management, and research.
On March 18, 2016, NIH issued its National Pain Strategy. Key components of the strategy include the following:
- Developing methods and metrics to monitor and improve the prevention and management of pain.
- Supporting the development of a system of patient-centered integrated pain management practices based on a biopsychosocial model of care that enables providers and patients to access the full spectrum of pain treatment options.
- Taking steps to reduce barriers to pain care and improve the quality of pain care for vulnerable, stigmatized, and underserved populations.
- Increasing public awareness of pain, increasing patient knowledge of treatment options and risks, and helping to develop a better informed health care workforce with regard to pain management.
NIH clearly understands the need for more education. If physicians are to take the lead in reversing the opioid crisis, as Dr. Stack correctly says we should, then we have to have the tools to effectively treat pain.
The Solution to the Opioid Crisis is not to Simply Reduce Prescribing
The solution to the opioid epidemic is not simply to reduce prescribing painkillers. Physicians must be equipped with the knowledge, expertise, and treatment options that will meet the needs of people in pain.
Our sense of responsibility, along with the Hippocratic Oath we take, will not allow us to abandon the needs of people in pain in an effort to reverse the opioid crisis.
Our humanity allows us no alternative.
Purchase my book The Painful Truth: What Chronic Pain Is Really Like and Why It Matters to Each of Us (available on Amazon) or read a free excerpt here.
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Copyright 2016, Lynn Webster, MD
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