“They are fighting the wrong people.”
That frantic cry came as a new post on Reachout, where I connect with chronic pain patients. Not for the first time, I heard a patient cry foul over the much-publicized war against opioids. Recently, I have read quite a bit regarding this issue. The harsh reality is that about 100 million chronic pain patients are being considered collateral damage in this war. This is quite disturbing, especially when we realize most are veterans, firefighters, cancer survivors, to name but a few.
Demonizing chronic pain patients is nothing new. This practice has taken a new turn since the declaration of an emergency in the fight against opioids and drugs by President Trump a few days ago. Doctors are uncertain how to assess a patient’s honesty regarding their pain. This stems from wondering how to effectively treat them without causing complications as a result of extended opioid use. In talking with some more patients, it became apparent that there has been a renewed push to wean patients off opioid-based prescription drugs. Yet there are hardly any alternative therapies being offered to them. Without a doubt, there is pressure from all sides to reduce opioid prescription writing and opioid prescription dispensing. However, the relationship between weaning chronic pain patients off opioid medicines and the reduction of addiction-related death rates in America warrants a closer look.
As per recent CDC data, almost 90 deaths a day are attributable to opioids and heroin is certainly a cause for urgent action. Opioid misuse rate is estimated to be between 20% and 29% among chronic pain patients and addiction rates are at about 10%, per one study. The story seems like a straightforward case of over-prescribing and misuse/abuse of prescription drugs. Let’s take a closer look to see if that’s true.
What Is Misuse?
Misuse of all prescriptions drugs in adults is approximately 54%, according to this report. This number is almost double that of pain pills. On top of that, according to the large, annually repeated and representative National Survey on Drug Use and Health, 75% of all prescription opioid abuse starts with people taking pills not prescribed to them. The drugs are stolen from friends, family or acquired from the street. That leaves about 25% of people misusing the drugs prescribed to them. By all accounts, it is still a very large chunk of the population. However, before we jump to conclusions, we should shed some light on the term “misuse”.
Misuse is defined as using medications contrary to instructions, regardless of harmful or adverse effects. Hence, misuse of medications can mean that patients are either taking too much, too little or none of their medications. It is safe to assume that of the 25% of people misusing opioid prescription drugs, not all are getting addicted or dying as a result.
A Closer Look At The Stats
Perhaps the more worrisome stats would be those related to “abuse” of prescription opioids rather than misuse. The statistics indicate that over 70% of those abusing pain pills get them through illicit means rather than by getting a prescription from a doctor. Another study of 1 million patients shows that only 4.5% of those getting an opioid prescription are abusers. This suggests that although diversion of prescription medications and illicit use is real, the majority are getting high from drugs not prescribed to them.
To corroborate this, a recent study of about 136,000 ER admissions for opioid use revealed only 10% had a chronic pain condition. In effect, 90% of those admitted to ER for opioid use were not chronic pain patients abusing their prescriptions.
It certainly doesn’t seem like chronic pain patients are misusing or abusing their prescriptions and overdosing on them. Even If they are, those numbers are small when compared to the more complex issue of people getting high from drugs not acquired through their doctor. It seems that a vast majority of the population falling into opioid and heroin addiction are not legitimate patients abusing their prescriptions.
Prescription Opioid Abuse & Taking Care Of Chronic Pain Patients
How then can we understand the astounding rise in deaths per year from these drugs? In an article from the NY Times, it seems that, since 2011, deaths due to prescription opioids have leveled off, suggesting a responsible attitude towards opioid prescription drugs by the chronic pain community of late. Deaths due to non-prescription opioids and heroin are on a steep rise in recent years. However, a flat line for deaths due to prescription opioids suggests that the chronic pain community, and the doctors prescribing to this community, are perhaps not a big contributory factor to the emergency we face today.
The Needs Of Chronic Patients
In our haste to stop prescription opioid abuse and the body count, it is important to consider chronic pain/PTSD patients. Many in this group could spiral towards illicit drugs or suicide as a pain remedy if we take away their pain pills without offering any viable alternatives. We certainly don’t want to trade one opioid-related death statistic for another. We must find the right solutions, rather than continuing to focus on the seemingly obvious targets. These traditional targets are doctors/pharmacies/patients with chronic pain. Generally, they are – at best – a very small part of a much bigger problem. A lot has to be done to curb the illegal trade of drugs, check diversion, theft of prescriptions. And there has been the development of alternative and adjunct therapies for opioid prescription patients.
One thing remains clear, the problem we face today is a social problem of addiction, more than over-prescription of opioids. Perhaps, this quote from another user on this chronic pain app sums it up for chronic pain patients everywhere:
“However, I am 19 and he (pain doctor) refuses to really give them (opioid prescription drugs) to me. I see why he doesn’t. But I handed over the medications to my family and they control them. Not me. That way I can make sure not to become addicted. I take as little as absolutely possible and now I am just frustrated with my doctors.”
For greater insight into interacting with those suffering from the issues mentioned in the article or if you would like to chat with others affected, I highly recommend joining the app, Reachout.