Cutting Pain Prescriptions No Solution for Opioid Crisis

President Trump has tapped Chris Christie to head a task force to work on the opioid crisis. One idea on the table: curtail medical prescriptions for pain. Two experts in pharmaceuticals and biomedical science (Josh Bloom and Alex Berezow) have weighed in to say that’s a mistake. They point out that legitimate pain patients need their prescriptions and that 26 studies they reviewed show addiction occurs in less than 1% of these patients.

They make six excellent points.

1) Christie should ignore the Center for Disease Control’s stingy recommendation limiting opioid prescriptions to 3 days. The CDC idea is based on a crude analysis finding that longer prescription periods result often in long term use. Yet long term use is usually the result of unresolved pain not addiction.

2) Doctors prescribing in good faith should not be put on the defensive. The prescription drug monitoring system is available in every state, (Missouri’s governor set it up by executive order last week), and provides adequate protection against doctor shopping. Let the docs do their job.

3) Limits on prescriptions drive patients to seek illegal sources. Eighty percent of the opioid deaths are associated with illegal heroin and fentanyl according to the Miami-Herald.

4) Most prescription opioid deaths were caused by taking the drug along with a benzodiazepine, such as Valium. Regulatory focus should be on lethal combinations.

5) Christie should not even think about upping the war on drugs. Problematic drug users are in need of a compassionate response, not the punishment shown to have no beneficial effect.

6) encourage development of non-addicting pain medications.

We should applaud these guys for stepping up and telling it like it is. So few scientists seem willing to do that, though we need so much more education of the public and the politicians. It is a common myth that long term use means addiction, when all it means is, well, long term use. Short term use of opioids is almost always safe. And, according to treating specialist Sally Satel it is more common for adults to skip taking their pain meds than to abuse them.

Scientific evidence discussed by NIDA Director Nora Volkow and her colleagues in a paper last year makes it clear the reason someone uses is far more important than how for how long. Whether a person starts on opioids with a doc’s prescription or an adolescent impulse to experiment, severe substance use disorder, “addiction,” doesn’t follow from continued use, except in a small percentage of cases. Those are the psychically vulnerable people who continue to use as a crutch in relief of psychic pain they believe they can’t avoid any other way.  A normal person who uses opioids, not as a coping mechanism to deal with challenging life situations, but strictly for physical pain relief, is not headed for addiction.

What these experts might have also suggested is that when opioids are to be used medically the physician needs to pay attention to markers for potential addiction. It would not be difficult for the docs considering opioids to have their patients fill out a questionnaire that picks up clues about psychological vulnerability.  The likely vulnerable patients could be identified with a fairly high level of confidence, and monitored closely or treated with a different approach.

Still, as these scientists say, the real reason for the opioid epidemic is not doctor prescriptions, but the easy access to recreational drugs from illegal dealers. The country is awash in opioids  because of, not in spite of, our anti-drug laws.

These experts could have made the additional point that addictions form mostly among minors, because that is the age of greatest vulnerability, as Volkow and colleagues explain. We need to come to grips with the reality that only an adult- use tolerant system holds promise for killing that illegal drug trade so easily accessed by the young.

© All rights reserved to Dave Finch 7/21/2017

For my suggestion on how best to change the drug laws visit the Reform Drug Policy Project.

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