A physician’s opinion on why opioids and the problem of chronic pain are here to stay.

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It is no secret that American's consume more drugs than any other country, and our health is far from the best. Unfortunately, our love for the pill has been created by our allowing big pharma to advertise on television during prime time and the fact we do not train medical doctors adequately in how to diagnose chronic pain properly but instead focus on how to medicate. Sure, professions like chiropractic have shown again and again that they accel in helping people avoid drugs while they get out of pain, however, until medical providers consistently refer these cases to chiropractors, drugs take the place of sound care for their problems and most people visit chiropractors after these methods have proven not to work. While this is not a post about chiropractic, it is a post about the dangers of opioids that are highly addictive, are overused by pain management specialists who leave in their wake the newly addicted. A medical doctor offers her perspective.

Why the American problem with opioids and chronic pain is here to stay

| Physician | February 22, 2013 America consumes 80% of the world's opioid supply (99% of the world hydrocodone supply) but has about 5% of the world's population. If you don't think America has some kind of opioid problem, then move along because this rational, evidence-based, experience-laden way in which I'm going to discuss opioid use and misuse will not interest you. To combat our opioidification the Food and Drug Administration has recommended prescribing restrictions on hydrocodone (remember, we consume 99% of the global hydrocodone supply). These obstacles do not appear derived from evidence-based guidelines and probably won't do much to reduce the vast majority of inappropriate prescribing, although they may slightly curtail physicians that run pill mills and may also help with diversion (lying to get opioids to sell them on the street).   But I want you to consider these following pain scenarios because this is how the majority of opioids are prescribed in the United States. In each scenario, there is a patient with chronic low back pain who started taking a Norco (acetaminophen and hydrocodone) every day or two for her pain, but now four years later is taking 8 Norco a day.
  • Patient A was never referred to physical therapy, never prescribed an adjuvant medication for chronic pain (adjuvant medications treat the way chronic pain is produced in the nervous system), never given a graduated exercise program, never had her anxiety or depression discussed never mind treated, and never given the option of a long-acting opioid. In short, she was only ever offered one therapy, the wrong one. Over time, her pain worsened (a natural consequence of untreated depression, anxiety, and immobility) and she needed more Norco a day.
  • Patient B was offered all the above therapies and they were well-covered by her insurance, but she found reasons to cancel physical therapy at the last minute, was intolerant of every medication except the Norco, and refused to speak with a pain psychologist despite being profoundly depressed (PHQ-9 of 24) and suffering from an anxiety disorder. Over time her pain worsened and she needed more Norco a day.
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