The downside of the painkiller epidemic is rarely mentioned: patients don’t feel better
When I joined Hospice Inc., in New Haven, Connecticut, in 1975, when I was 25 years old and wanted to do something good in this world, I was challenged by Florence Wald, a former dean of the Yale School of Nursing who had organized the young organization To build the first inpatient hospice in the United States (which he managed to do five years later in neighboring Branford), we had a mission to reshape public attitudes toward pain control in America.
Florence Wald’s experience in the US healthcare system was that doctors here were far less willing to use powerful painkillers like morphine to treat the terminally ill than their British or European counterparts due to a fear outside of place to addiction. “End-stage cancer patients do not become addicted to painkillers,” Florence told me flatly, “nor do they experience euphoria from the use of painkillers. This is a totally wrong perception and we must change it. We can treat pain more effectively. and we have a duty to do so. “
In the third of a century since then, America’s burgeoning hospice movement has brought comfort and relief from pain to millions of Americans facing terminal illnesses and eased the plight of their families, who often suffer as much or more than their lives. dying relative. . Public attitudes toward pain relievers have also evolved dramatically, including the views of American physicians, who have become more willing to tolerate powerful opioids when needed to control pain.
But there may have been a downside to this shift in perception and prescription.
Barry Meier is a reporter for The New York Times who has written extensively and eloquently about the problems associated with prescription painkillers, a little-discussed epidemic that began some twenty-five years after my two-year stint in hospice ended. In June, Meier published an e-book with the “Kindle Single” program on Amazon called A World of Pain: Correcting Pain Medicine’s Biggest Mistake which explores this chapter in the history of prescription pain relievers in America, which is simply this: there is a growing body of evidence that these pain relievers, in addition to causing an epidemic of abuse, are often quite ineffective to treat. long-term pain. In reality, they may be harming patients.
Barry Meier’s first book, Analgesic: the trace of addiction and death of a ‘wonderful’ drug, centered on a more well-known story about pain relievers, namely the pandemic of abuse surrounding the powerful drug OxyContin, especially among teens looking for a new high.
Barry Meier was interviewed by his newspaper on June 23, 2013 and explained what he was trying to do with his eloquent writings on pain relievers, why doctors and patients are reluctant to quit, and some of the side effects of these drugs.
“A decade ago, pharmaceutical companies and medical experts launched a ‘War on Pain’ that promoted the widespread use of powerful narcotic pain relievers for common conditions like back pain,” Meier told the Times. “The specialists stated that a ‘clear line’ separated the benefits of drugs for patients from the dangers they suffered when young people and other people abused them on the street.”
Today, Meier says, many of those same experts who once endorsed pain relievers have changed their minds. They came to the revised conclusion that the opioid boom “ranks among the biggest mistakes in medicine.” They cite recent studies that link long-term use of these drugs, particularly in high doses, to addiction, dependence, reduced sexual desire, lethargy, and other problems. Based on stories from researchers, patients, and others, A world of pain highlights how treating pain differently can benefit both pain patients and public health. “The promise that high-powered drugs could provide a panacea, the key to winning the ‘War on Pain’, was an empty promise,” says Meier.
Critics of Meier will argue that the compelling anecdotes and stories he presents, along with references to various studies, do not make a strong enough case to deprive pain patients of the medications that allow them to control pain. No one claims that pain control is perfect, and the jury is probably not around yet when it comes to assessing the level of abuse or misuse. More work will need to be done. But today I see the pendulum swing in the opposite direction from what I saw it swing in 1975.
Which is the answer? Perhaps a better scientific understanding of the brain mechanisms of pain will help us discover new drugs that act differently from opioids? Meier will surely find fertile ground to continue writing on this subject for many years to come. In the meantime, he has made a significant contribution to public understanding of pain and pain management, and his new e-book is a marvel of clarity and concise wording. I recommend it wholeheartedly.