Pain Management Versus Opioid Addiction: A Troubling Quandary

By Michael Jorrin, "Doc Gumshoe", October 3, 2017

[ed. note: Michael Jorrin, who I dubbed “Doc Gumshoe” years ago, is a longtime medical writer (not a doctor) who writes for us a couple times a month about health issues and trends.  He does not typically focus on specific investment opportunities, but has agreed to our trading restrictions… as with all of our authors, he chooses his own topics and his words and opinions are his alone]

Here are three statements about the overall situation, which I hope are clear and accurate, and which essentially point in opposite directions:

One: Chronic pain affects more than one hundred million Americans – more than diabetes, heart disease, and cancer combined.   This is according to the National Institute of Neurological Disorders and Stroke.

Two: The most effective treatments for pain are drugs that address the μ opioid receptor.

Three: Almost one hundred million Americans used or misused prescription analgesics containing opioids, and opioid abuse killed about one hundred and seventy five of us every day in 2016.

If you are reading this in the hopes that Doc Gumshoe has any answers to this quandary – and it is a quandary, I hope you’ll agree – I’m sorry to disappoint you.   But perhaps I can point to some glimmers of light.

 To start with, let’s look at the groups of players in the mix, each with its own goals and concerns:

  • Patients who are experiencing pain want relief for their pain symptoms, to state the obvious, but they have at least heard about the perils of opioid addiction and certainly do not want to go down that path.
  • Doctors who treat these patients also want to provide pain relief for their patients, but they definitely do not want to be identified and branded as over-prescribers of opioids and thereby contributors to opioid addiction.
  • Health insurers often put themselves in the position of knowing better than everybody and sit in judgment as to what works and what doesn’t, with regard both to pain relief and also to minimizing addiction – but their eye is generally on the bottom line.
  • The authorities – police and elected officials – pay much more attention to the problems of addiction, which they have to contend with, than with the problems of people undergoing pain, which is not their affair.
  • The media focus on the new part of that quandary – pain has been around since the dawn of time, but opioid addiction is hot news.
  • And the public at large mostly goes with the media.

I left out one group – people who take opioids not for pain relief, but for their own pleasure or satisfaction of some kind.   I try to make a distinction between this group, on the one hand, and individuals who started out using opioids for pain relief, found it difficult to reduce the dose (“wean off”), and ultimately became addicted.   My focus in this piece will be on the second group.

We hear from all quarters that opioid abuse is a national crisis.   In contrast with the drug addicts of former times, who were regarded as something like common criminals, individuals who have fallen prey to opioids abuse are frequently seen as unfortunates who are in need of treatment, particularly if their initial exposure to opioids was as pain medication and not as a recreational drug.   The problems that recreational drug users present to society are not viewed sympathetically.   We know of a young woman who was seen exchanging the food stamps (on which she relies to feed her two young children) for a packet of opioid pills.   To the best of our knowledge, her introduction to opioids was not as treatment for pain, but as a party drug.   Some form of treatment is required for her, without doubt, but she is not part of our quandary.

That’s a far cry from the way the many individuals who fell into opioid abuse following severe pain episodes are currently seen.   The (fictitious) case histories below may explain why this is so.

Case history number one: Manny

Manny is a healthy, fit male of about forty years of age.   He drives a truck for a company that supplies water-softeners to homes and small businesses, and he delivers water softener salt, in forty-pound plastic bags and also in steel cylinders that weight upward of a hundred pounds.   He normally carries two bags at a time – one in his right hand and the other over his left shoulder.

One day, while making a salt delivery to a regular customer, he slipped on the stairs leading to the cellar where the wat