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are deeply familiar with the tangles of public policy which surround voluntary or compelled interventions with psycho-active drugs in people who are experiencing life crisis.Some readers will also be familiar with a different kind of crisis and its policy tangles, in the difficulty which many people encounter getting medical assistance for chronic intractable pain.Unfortunately for 100 Million US chronic pain patients (estimated by the US Institute of Medicine), the document is in actuality neither voluntary nor a guideline.
Present public attitudes and assumptions toward chronic pain must change.
A fraction of the millions diagnosed with incurable pain conditions will be prescribed opioids.
But among that minority, opioids are a last resort and a necessary enabler of life.
Take them away, and you may contribute to a wave of suicides and a surge of people seeking street drugs out of desperation.
Moreover, “…in general, new addictions are uncommon among people who take opioids for pain in general.
A Cochrane review of opioid prescribing for chronic pain found that less than one percent of those who were well-screened for drug problems developed new addictions during pain care…” There is real and valid concern for the avoidable death and destruction which are wrought by illicit opioids in the US.
As recently explained in by neuroscience journalist Maia Szalavitz , “Opioid Addiction is a Huge Problem, but Pain Prescriptions Are Not the Cause.” As Szalavitz points out, “efforts to reduce opioid deaths will fail unless we acknowledge that the problem is actually driven by illicit — not medical — use.” Likewise, “…according to the large, annually repeated and representative National Survey on Drug Use and Health, 75 percent of all opioid misuse starts with people using medication that wasn’t prescribed for them—obtained from a friend, family member or dealer.” The real problem is not chronic pain patients.
Part of the solution might be securing of potentially addictive medications under lock and key when used at home.
Patients are being involuntarily taken off opioids — or outright deserted without referral by doctors who fear US Drug Enforcement Administration prosecution if they continue to prescribe the only treatments which give many people even a marginal quality of life.
None of this is to say that over-prescription or diversion of prescription opioids never happens or that prescription overdose deaths do not occur.