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Politicians & Pain

Whenever a new panic runs through corporate media and the grapevine — and especially when the lesson is supposed to be ‘we’ve gotta do something!’ — it is time to slow down. And look at the facts.

The opioid crisis is one of those panics.

The almost immediate reaction from politicians has been to point their quivering fingers at doctors and drug companies on the theory that doctors have been over-prescribing opiates, instigated by pharmaceutical companies.

Seems a ‘round up the usual suspects’ approach to public health.

Now there appears to be good research to back up our skepticism. According to Cato’s Jeffrey A. Singer, recent studies show “there is no correlation between opioid prescription volume and non-medical use or opioid use disorder among persons age 12 and over.” Nevertheless, Dr. Singer notes, “policymakers and law enforcement continue to pressure health care practitioners into undertreating patients in pain.” 

An under-treatment result is scarier, to me, than the desperate and dangerous self-medication problem that must lie at the core of the crisis we read about. Patients in too much pain because doctors are afraid of government harassment are pushed to unsupervised pain management . . . which looks an awful lot like a simple description of the opioid crisis itself.

Singer provides confirmation of an unintended effect: the fentanyl and heroin overdose rate “continues apace” even as the opioid prescription volume plummets.

“At a recent international breast cancer conference experts stated the under-prescribing of opioids to breast cancer patients in the U.S. is now comparable to treatment in third world countries,” warned Singer. 

One word: yikes.

I am tempted to define today’s politics itself as a kind of pain mismanagement.

This is Common Sense. I’m Paul Jacob.


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Pain Economies

Looking for a new doctor, a colleague of mine called his friend’s primary care clinic, and was told, “We are taking all patients except pain management cases.”

He was thankful his health issues were not pain-related.

After reading Leslie Kendall Dye’s Salon piece, “But what if I actually need my painkillers?” you will easily understand: America doesn’t make it easy for those who must fight constant pain.

Ms. Dye’s story is harrowing. Her chronic pain, the residue of a ballet injury, makes her personal, day-to-day experience not primarily about economizing pleasures, but economizing pains.

So she takes Tramadol. Regularly. Even with the drug, her agony too often returns. What she tries to do is carry on with as little relief as possible while living an active, normal life, always risking excruciating pain levels.

And she’s constantly harassed and inconvenienced and probed and lectured. “Each time I take my painkiller prescription to a pharmacy, I can’t help feeling suspected of a crime.”

She’s not paranoid.

The government is out to get her. And her doctors.

All to “save” the lives of people who “abuse” the drugs.

I read about cases of lost souls, overdoses, suicides, black market pills, portions of towns laid waste by narcotic abuse, and I worry. I worry for the addicts, but I also worry for those of us who would not be able to carry on without responsible pain management.

She admits to feeling “conflicted” about this.

My prescription? Feel less conflicted. Were today’s standard individual responsibility, not societal responsibility, responsible patients would suffer less.

This is Common Sense. I’m Paul Jacob.


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Pain Medicine Police