You may have heard about the opioid crisis in North America. Opioids are powerful pain killers that are both prescribed legally (oxycodone) and obtained illegally (such as heroin). While there is a lot of talk about the opioid crisis, there have been few comments about the cause of this crisis, which, put simply, is that North America is going through a pain crisis. It is estimated that over 110 million Americans and Canadians suffer from chronic pain, and opioids have been one of the methods for treating this pain. Yes, overdoses and deaths have occurred (the majority are a result of illegal use) and while overdoses are rapidly escalating, the total number of patients being helped by the legal medications still numbers in the tens of millions.
You probably don’t know the name Nora D. Volkow. Nora is a medical doctor, and in May, 2014, she testified before the US Senate Caucus on International Narcotics Control. Dr. Volkow is a gifted researcher, and a thoughtful individual, and in her testimony, she hit the nail on the head when she noted: “We must preserve the fundamental role played by prescription opioid pain relievers in healing and reducing human suffering. That is, scientific insight must strike the right balance between providing maximum relief from suffering while minimizing associated risks and adverse effects.”
Recently, one or more letters were sent to physicians in Alberta, letters that, at a minimum, raised apparent concerns about opioid prescriptions and provided guidance to the physicians on potentially excessive prescription levels they believe need to be discussed, and to some extent, justified. While the intent of the letter may have been no more than a caution, and an explanation to doctors that the opioid crises is for real, it appears that some doctors have hit the panic button.
I have talked to patients who have been advised by their doctors that they can no longer prescribe opioids for the patient. While this doesn’t seem to appear to be the intent of the letter(s) that went out, reality is reality. If you are in chronic pain, pain not controlled by other methods, opioids can make the difference between a life of constant agony, or a life relatively free of this agony. It is no small wonder that these patients are desperately searching for answers. We would be wise to follow the guidance of Dr. Volkow, as noted above.
There are many ways to combat pain, and I think some doctors have been too quick to reach for the prescription pad, rather than offer other alternatives. Let’s start this process by ensuring all medical personnel receive additional training on the various options available, and guidance that opioids should be the “solution of last resort.” Complex problems usually require complex solutions, and while banning opioids would be a quick and simple concept, it’s also a solution that simply will not work. Let’s create real solutions rather than just the appearance of solutions, and in the interim, let’s stop terrifying the patients who simply must have these medications.
