The opioid pendulum
As government guidelines curb access, chronic pain sufferers can’t be forgotten
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.