The opi­oid pen­du­lum

As gov­ern­ment guide­lines curb ac­cess, chronic pain suf­fer­ers can’t be for­got­ten

The Buffalo News - - OPINION -

The dra­matic surge in deaths con­nected to opi­oid ad­dic­tion in the past decade spurred United States health of­fi­cials to take ac­tion.

Opi­oid over­doses led to more than 42,000 deaths across the coun­try in 2016. That year, the Cen­ters for Dis­ease Con­trol and Pre­ven­tion is­sued pre­scrip­tion med­i­ca­tion guide­lines that en­cour­age al­ter­na­tives to pre­scrib­ing opi­oids and lim­it­ing dosages when fea­si­ble.

As a Buf­falo News story this week pointed out, the strat­egy led in some cases to an over-cor­rec­tion in which restric­tions on opi­oids were ap­plied to peo­ple who need them to man­age se­vere pain. For that pop­u­la­tion, the ef­fects of not hav­ing the pre­scrip­tion re­lief they need can be dev­as­tat­ing.

It’s no sim­ple task for state or fed­eral health of­fi­cials to bal­ance the needs of chronic pain pa­tients with con­cerns over peo­ple be­com­ing de­pen­dent on opi­oid anal­gesics. In some cases, doc­tors and phar­ma­cists took the CDC’s guide­lines as gospel and re­fused to pre­scribe ad­e­quate nar­cotic re­lief to those who truly needed it.

Gov­ern­ment reg­u­la­tors, health care pro­fes­sion­als and drug man­u­fac­tur­ers all have a role in find­ing so­lu­tions.

Ad­vo­cates for suf­fer­ers of chronic pain point out that those pa­tients who are de­nied nar­cotics may be­come de­spon­dent to the point of try­ing to end their own lives.

And cut­ting off the pre­scrip­tion opi­oid sup­ply from a pain pa­tient who de­pends on them doesn’t make their need for them dis­ap­pear; in­stead they may re­sort to buy­ing the drugs through il­le­gal chan­nels, of­ten heroin which is fre­quently laced with lethal doses of the syn­thetic opi­oid fen­tanyl.

The doc­tors who work with pain pa­tients need to be aware of the risks as­so­ci­ated with pre­scrib­ing opi­oids and dis­close the risks to their pa­tients.

Clin­i­cians must also be alert to which seg­ments of the pop­u­la­tion are most vul­ner­a­ble to be­com­ing ad­dicted to opi­oid painkillers, in­clud­ing those with any fam­ily his­tory of ad­dic­tion, a his­tory of men­tal health con­cerns – par­tic­u­larly from sex­ual or phys­i­cal abuse, or any­one who has been ad­mit­ted to an emer­gency room for an over­dose.

Re­searchers have been work­ing for decades to de­velop non-ad­dic­tive opi­oid painkillers. The fi­nan­cial re­wards would be con­sid­er­able for any drug com­pany that can solve that puz­zle, but there could also be a role for gov­ern­ment to play, in fund­ing re­search into “new” opi­oids as well as ef­fec­tive al­ter­na­tive pain man­age­ment meth­ods.

The well-in­ten­tioned CDC guide­lines were not meant as a one-size-fits-all so­lu­tion.

The Amer­i­can Med­i­cal As­so­ci­a­tion in No­vem­ber passed a res­o­lu­tion cit­ing “the mis­ap­pli­ca­tion of the CDC guide­line by phar­ma­cists, health in­sur­ers, phar­macy ben­e­fit man­agers, leg­is­la­tures, and gov­ern­men­tal and pri­vate reg­u­la­tory bod­ies in ways that pre­vent or limit ac­cess to opi­oid anal­ge­sia.”

Dr. Gale Burstein, Erie County health com­mis­sioner, pointed out to The News that the CDC guide­lines “are not laws.”

“Providers may have to mod­ify the rec­om­men­da­tions, or their prac­tice, on spe­cific pa­tients – based on a spe­cific pa­tient’s sit­u­a­tion,” she said.

Keep­ing treat­ments tai­lored to in­di­vid­u­als, rather than blind ad­her­ence to poli­cies, is the best medicine.

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.