It’s become very clear that prescription opioids cause significant harm to many people. Millions of pain patients and others who’ve taken diverted medication have become addicted, and hundreds of thousands have died. Individuals, families and communities have been devastated by what is being called the worst drug epidemic in U.S. history. Despite this, these dangerous drugs have not been removed from the market because many medical authorities insist that pain patients need these drugs. Do they?
The United States, with 5% of the world’s population, uses over 80% of the world’s supply of oxycodone and almost 100% of the hydrocodone, the two synthetic opioids that got us into our current predicament. The rest of the world is not clamoring to get their hands on our opioid supply. And, although chronic pain is a major problem worldwide, there have been no reports that pain patients in other countries are suffering more than pain patients here. In fact, all major industrialized countries and many developing ones have better overall health care outcomes than the U.S., according to the World Health Organization.
In addition, there is no evidence that opioids are an effective treatment for chronic pain. In fact, what evidence there is indicates that pain patients who take opioids have more pain, more disability and lower quality of life than similar patients who never took opioids. There is no evidence, according to many experts, that the benefits from opioids outweigh the harms.
It is also highly questionable whether opioids provide the best pain relief. According to the National Safety Council, ibuprofen works as well as oxycodone and a combination of ibuprofen and acetaminophen works much better than oxycodone for pain. Many pain patients who have used medical marijuana after first using opioids have reported that marijuana provides much better pain relief with fewer side effects. Marijuana is also much safer than opioids—no one has ever died of a marijuana overdose.
There are many other pain treatments that are proven safe and effective that are currently underutilized due to lack of provider and patient awareness and/or restrictions on insurance coverage. These include:
- Mind-based treatments such as psychotherapy, biofeedback and relaxation training
- Body-based therapies such as chiropractic, physical therapy and massage
- Nutritional and herbal therapies
- Energy-based therapies such as acupuncture, therapeutic touch, reiki and homeopathy
- Low level laser therapy
Research has shown that the safest and most effective pain treatment approach is multidisciplinary, using a combination of nonpharmaceutical therapies that address the complex biopsychosocial nature of chronic pain. Even pain patients who are dependent on opioids can be safely weaned off their medication when treated with a combination of therapies that address both the body and mind. These patients end up with less pain and better function than when their primary treatment was opioids.
Chronic pain patients who have been using opioids to manage their pain, sometimes for decades, are some of the loudest voices objecting to any effort to curtail opioid prescription use. This is understandable because these patients have become dependent on opioids and they have not been offered alternative treatments.
Dependency means that if the drug is stopped, withdrawal symptoms would occur. Withdrawal can be excruciating. In the first few days withdrawal can include severe agitation and anxiety, body aches, difficulty sleeping, runny nose, frequent yawning and profuse sweating. After a few days, patients might also experience painful abdominal cramping, severe nausea, diarrhea, vomiting, goose bumps, chills and shivers and dilated pupils. With severe addiction, hallucinations, severe body tremors and suicidal thoughts may be experienced. Withdrawal symptoms are the main reason most patients find it so difficult to give up opioids—taking the drug again stops the unpleasant effects.
There have been many reports from pain patients that with the implementation of drug monitoring programs to curtail opioid abuse, many doctors are becoming concerned about the legal implications of continuing to prescribe large doses of opioids to their pain patients and are abruptly cutting them off. This is unconscionable. No pain patient should be abruptly withdrawn from opioids and none should be withdrawn without a comprehensive alternative pain treatment program in place.
We can end the scourge of drug abuse and overdose death and, at the same time, do a better job of treating pain. We just need the will to do so.