Abstract: The Opioid Crisis and the Need for Compassion in Pain Management

Rothstein, M.A., Am J Publ Health 107(8):1253, August 2017

The author, from the University of Louisville School of Medicine, comments on the unintended consequences of restricting opioid prescribing. Causes and outcomes of the opioid addiction epidemic are well documented, including aggressive marketing by pharmaceutical companies without full disclosure of risk and a four-fold increase in US opioid-related deaths between 1999 and 2014 alone. Countermeasures include prescription drug monitoring programs to restrict use, legal limits on pill numbers per prescription, opioid patient “contracts,” and drug testing to ensure compliance. For fear of medicolegal risk, many physicians have decided to stop prescribing opioids for patients with chronic pain, limiting use to postoperative pain, cancer pain and terminal illness. In some cases, patients with severe pain turn to illicit drugs as the only alternative, leading to diseases such as HIV and hepatitis, as well as more overdose deaths. Eliminating opioids entirely as an option for chronic pain shows a lack of compassion and violates both standards of care and medical ethics. Many patients with severe pain due to chronic conditions legitimately need potent analgesics such as opioids, especially during acute episodes, because over-the-counter analgesics are completely ineffective. Patients who became addicted after using a lawful prescription also cannot be abandoned but need proper management. Stakeholders at all levels must address the undertreatment of pain with research, education and policy changes to acknowledge both the problem of opioid abuse and the needs of patients with chronic pain. After all, policies “should not presume that all physicians are reckless prescribers or that all patients are deceitful drug seekers.” 7 references (mark.rothstein@louisville.edu – no reprints)