Rise above the 'opioid wars' to manage chronic pain
Guest columnist Myra J. Christopher argues that policymakers must move beyond the rhetoric of the "opioid wars" to find solutions to managing chronic pain. Otherwise, pain patients in Washington and elsewhere will continue to be collateral damage.
Special to The Times
THERE is a Chinese saying that we are prone to "kiss dragons and stomp gnats." When we have a big problem that we have no idea how to solve, we fixate on a lesser problem. The abuse of prescription medications, particularly by our teens and young adults, is a big problem, but not one caused by people who rely on medications to manage their pain. People living with chronic pain in Washington state have become collateral damage in an ongoing battle that has been characterized as the "opioid wars."
The compelling series written by Michael Berens and Ken Armstrong describes how new legislation intended to address prescription-drug abuse in Washington state (ESHB 2876) has further exacerbated the tension between two polarizing positions and has brought national attention to an increasingly alarming situation in Washington. ["New law leaves patients in pain," page one, Dec. 12.]
I had the privilege of serving on a committee at the Institute of Medicine charged with creating a report on the state of pain care in the United States, "Relieving Pain in America," released earlier this year. One of the foundational principles of the report is that there is a moral imperative to treat pain and that health-care professionals are ethically obligated to treat pain to the extent of their professional capacity.
To read that health-care professionals in Washington state are refusing to treat pain, citing fears of the new legislation, or simply giving up in frustration, is unconscionable.
Last fall, I was in Seattle researching the readiness and capacity of individuals and organizations to develop a national plan to improve care of those living with chronic pain, hosted by the Center for Practical Bioethics. We were encouraged by the response to our invitation to the meeting, but distressed when we realized that the angst surrounding ESHB 2876 had the potential to hijack our agenda.
Since then, I have followed activities related to this legislation more closely, and my initial concerns have only increased. The incendiary language and personal allegations have made a bad situation worse, distracting providers from truly caring for their patients and policymakers from really listening to their constituents.
The above-mentioned "Relieving Pain in America" report describes pain as the No. 1 public-health issue in the U.S., affecting at least 116 million people (more than those affected by cancer, diabetes and heart disease combined) at an annual cost of $560-625 billion. The committee calls for a comprehensive approach to treating pain that acknowledges the unique nature of how pain is experienced.
There are a number of ways to treat pain — from medicine to massage, spinal injections to surgery. Not all treatments work for all types of pain or in all individuals (who typically have other chronic health issues to manage).
Our current treatment model for pain is a failure for many who need it the most. Opioids are not a panacea, or meant to treat all pain, all of the time. In fact, opioids only reduce pain by about 30 to 35 percent in fewer than half of all patients. However, these modalities are critically important to some patients, most of the time.
Policymakers in Washington state and others should carefully review the IOM report and reconsider their current strategy. Cooler heads must rise above the rhetoric, venom, judgment and blame to develop practical solutions that do not contribute to unnecessary suffering.
Chronic pain cannot be "cured;" however, in most instances it can be managed so that people can engage in a life that they feel is worth living.Myra J. Christopher is a committee member for the Institute of Medicine "Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education and Research." She holds the Kathleen M. Foley Chair in Pain and Palliative Care at the Center for Practical Bioethics.
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