Opioids for Chronic Pain (?)
I’ve written about the spectrum of medical and scientific opinion (not, unfortunately, always the same thing) over the use of opioids for treatment of chronic pain. For those who missed the earlier discussion– one that produced a heated response from readers– I invite you to review those posts.
The essence of the issue is that over many years, there has been significant effort to increase patient access to potent opioids. This effort has come in part from the pharmaceutical industry, but also from organizations that advocate for patients with a wide range of painful conditions, some with connections to pharma, and some without connections to pharma.
There has even been a push to increase opioid prescribing from Federal agencies. Back in the 1990’s, when I chaired my local hospital’s Department of Anesthesia, we were warned by agencies hired by the hospital that the Joint Commision on Accreditation was focusing on pain control one particular year, and that some hospitals had been cited for insufficient prescribing of pain medications.
Even physician groups– notably a group of physicians in my own back yard, at the University of Wisconsin– have pushed for greater prescribing of opioids, claiming in some cases that the risk of addiction was quite low, and patients, in general, were under-treated for chronic pain.
Now, of course, there exists a literal epidemic of opioid dependence. I have written about this epidemic for several years here and elsewhere, and over that time some readers, including physicians, have accused me of overstating the situation. I recently came across an old comment in a physican forum, where one doctor wrote ‘seriously, people– when was the last time you heard of a person addicted to oxycontin?!’ I suspect the writer was somewhat clueless, and hope that the writer now knows that most doctors would answer: ‘about an hour ago!’
The CDC reported on November 1, 2011 that we are deep in the midst of this epidemic, that now affects one in 20 adults in the United States. The report prompted a string of headlines about the tripling of overdose deaths across the country from prescription opioids, far exceeding deaths from ‘street drugs.’
I’ve written about a relatively new group of physicians called PROP, for Physicians for Responsible Opioid Prescribing. Their mission is to point out the facts surrounding opioid prescribing– at least for those who consider ‘facts’ to be information that is derived from clinical study and research. I am a big fan of evidenced-based medicine, as I’m old enough to remember a number of mistakes made ‘en masse’ by the medical profession. Such mistakes generally occur when everyone just knows that something is right– a dangerous condition for any organization or profession.
Instead of going through the PROP evidence bit by bit, I’m going to make this a somewhat large post, and provide the ‘Dear Colleague’ letter that the group recently sent out to physicians and medical organizations. I encourage readers to check out the links in the letter, to see videos from the true experts in the field of opioid treatment and research.
Dear Friends and Colleagues,
A couple of days ago Dr. Thomas Frieden, Director of the CDC, held a press conference paired with the release of “CDC Vital Signs: Prescription Painkiller Overdoses in the US”.
This is a call to action from the CDC. In the Vital Signs document the CDC outlines important steps that can be taken by state governments, medical boards, health insurance companies and prescribers to bring the epidemic of overdose deaths and addiction under control.
Physicians for Responsible Opioid Prescribing (PROP) wishes to thank the CDC for issuing this important report and for their strong leadership on this issue. We would also like to take this opportunity to share with you our new and revised videos on opioid prescribing.
At PROP, we believe that it’s not just pill mill operators and drug dealers that are fueling the epidemic. An even greater problem may be well-meaning prescribers who have been misled to believe that compassionate care for a person with chronic pain automatically equals an opioid prescription. We hope that these videos will permit prescribers to properly weigh the risks versus the benefits when considering long-term opioid therapy.
The CDC has demonstrated a relationship between increased overdose deaths, increased addiction rates and increased opioid prescribing. To turn this trend around, providers must understand that opioid prescribing entails serious risks for patients, their families and the community, so vigilance and caution are essential.
We urge you to carefully read the CDC Vital Signs, to watch these videos, and to assist us in distributing these materials.
Effectiveness for Chronic Pain
This video is new and features interviews with Drs. Mark Sullivan, Alex Cahana and Gilbert Fanciullo. The primary goal is to communicate that long-term opioid therapy is not an evidence-based treatment for chronic pain.
Addiction is NOT Rare in Pain Patients
This video has been revised and now features a clip of CDC Director, Dr. Thomas Frieden. It also includes interviews with Drs. Russell Portenoy*, Nathaniel Katz*, Andrew Kolodny and Thomas Kosten. The purpose of this video is to communicate that pain patients can become addicted to opioids and that misinformation on this topic played a role in causing the epidemic.
High Dose Opioid Therapy
This video has been revised and now features Dr. Lynn Webster*, President-elect of the American Academy of Pain Medicine. It also includes Betty Tully and Drs. Jane Ballantyne, and Thomas Kosten. The purpose of this video is to correct the misperception that there is no upper dose limit for opioid therapy and to communicate that high dose prescribing is a dangerous practice.
Understanding Physical Dependence
This video has been revised and now features Dr. Mark Sullivan from the University of Washington. It also includes Betty Tully and Drs. Jane Ballantyne, and Thomas Kosten. The purpose of this video is help prescribers and the public better understand the meaning of the term physical dependence and to correct the misperception that physical dependence on opioids is benign and clinically unimportant.
Asterisks (*) indicates that speaker has relationships with opioid manufacturers.
Please feel free to use and distribute these videos as you wish. If you have embedded our old videos on your website, please replace them with the new videos. If you would like to obtain a DVD (at no charge), please send an email to email@example.com .
If you are interested in joining PROP (membership is open to everyone, not just physicians), please send an email to firstname.lastname@example.org
with “Membership” in the subject line.
Andrew Kolodny, M.D.
Physicians for Responsible Opioid Prescribing
Chairman, Department of Psychiatry, Maimonides Medical Center
920 48th Street, Suite 1510, Brooklyn, New York 11219
Tel: 718 283-7557; Fax: 718 283-6540; email@example.com
Image available from Shutterstock.
Junig, J. (2011). Opioids for Chronic Pain (?). Psych Central. Retrieved on April 18, 2015, from http://blogs.psychcentral.com/epidemic-addiction/2011/11/opioids-for-chronic-pain/