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http://www.bostonglobe.com/metro/2016/06/18/the-other-side-america-war-opioids/i9YYLR0bGWFdP9z1T1pwjI/story.html

As I expect nearly every reader knows, public interest in opioid abuse/overuse/overdose/death has been quite high in recent months/years. This is probably mostly because the number of people dying as a result of opioid overdose has gotten to be on a level with things like automobile related deaths. There has been a push -- at the state level, at various agency levels, etc. -- to get doctors to prescribe fewer opioids for shorter periods of time. There is a community of patients suffering from chronic pain and the doctors who serve them which has objected to this additional regulatory pressure. The article examines the problem.

"Dr. Julia H. Lindenberg, a primary care doctor at Beth Israel Deaconess Medical Center in Boston. ... But when Lindenberg’s practice stepped up urine testing, the doctors found that a few longstanding patients, who had been considered at low risk for abuse, in fact were misusing drugs. Some had cocaine or other drugs in their urine, and some were not taking the prescribed opioids, suggesting they were selling the pills."

Contrast Lindenberg's story with this primary care doctor's:

"Baratz said he, like most other primary care doctors, has long experience managing patients who take opioids for chronic pain. These people, he said, have no part in the addiction crisis. He monitors them closely and stops prescribing at the first hint of abuse."

I sort of wish the Globe had asked Baratz if his practice was also doing regular urine testing on chronic pain patients who had long-standing opioid prescriptions.

The article concludes with people making dire predictions that people unable to get legal pain meds will switch to illegal ones (indeed, some will -- that's exactly why we're trying to reduce opioid prescriptions. They have such a tendency to result in people becoming addicted and turning to illegal opioids for cost and convenience reasons) and people with chronic pain will commit suicide.

I predict we will be seeing more articles like this over the coming months. I hope more of them include details about which people being quoted are doing urine testing and which ones are not. That's a helpful detail, that lets us know who is actually committed to best practice ... and who is committed to status quo ante. Anyone committed to status quo ante who is worried about an increase in suicide has perhaps not taken seriously the increase in deaths due to opioid overdose over the last few years.

Also, if you are thinking along the lines of, those poor people, don't just take their pain medication away, I would point you at this:

https://en.wikipedia.org/wiki/Opioid-induced_hyperalgesia

In at least a few cases -- as Lindenberg pointed out -- taking away the pain medication actually helped with the pain.

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Comments

( 1 comment — Leave a comment )
rolandgo
Jun. 20th, 2016 07:57 pm (UTC)
And we are starting to see articles like this one.
Opioids for low back pain http://www.bmj.com/content/350/bmj.g6380
"For chronic back pain, systematic reviews find scant evidence of efficacy."
( 1 comment — Leave a comment )