Monday, September 1, 2014

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Pain and Pain Medication Abuse: Two Epidemics in Tension

By Steve Heilig, SFMS Assistant Executive Director

The New York Times just printed a cover story titled "Tightening the Lid on Pain Prescriptions." The Wall Street Journal printed one on the same topic a week before.

Clearly, we have a serious problem -- two of them, in fact. It's long been demonstrated that pain has been widely under-treated in this country. Efforts to improve that have been underway for some time. But it's also increasingly recognized that unwise use of pain medications is a growing epidemic, with dire results: Fatal, unintentional drug overdoses occur every 19 minutes in this country, and opioid analgesics -- oxycodone, for example -- have been responsible for more of these deaths since 2003 than heroin and cocaine combined. And that's just the tip of the abuse/addiction epidemic. For every such death related to opioid analgesics, 461 people report nonmedical use of these meds, and 35 visit an emergency department. There, doctors learn to dread them -- the patients who might be "drug-seekers," or might be in real physical pain, or might be both.

These are not entirely mutually exclusive diagnoses. Addiction is painful -- it has even been likened to slavery. And many addicts started as honest people in physical pain. Medication diversion and abuse has become a major epidemic. Up to three-quarters of non-medical opioid users report their drugs were prescribed to somebody else -- in other words, they are sharing and selling them. 

April 2012 San Francisco MedicineThe April issue of San Francisco Medicine contains authoritative perspectives on some of the issues, including: An overview of the "pain problem", A review of the addiction epidemic and strategies to combat it, A review of the use of cannabinoids for pain, and How yoga can help with pain.

Clearly there is much to be done in terms of addressing both epidemics of under-treated pain and pain medication abuse and addiction. California’s official medical guidelines for managing pain are available online here.

But one important practical tool to help track the prescriptions of pain meds, the Prescription Drug Monitoring Program is going underutilized and unfunded, as noted here.

As noted therein, this "CURES" system allows doctors and pharmacists to "instantly look up the prescription histories of customers and refuse to provide medication to a patient whose drug shopping habits seemed suspicious or out of control. More than 40 states are using similar systems to help curb prescription drug abuse."

The funds needed to upgrade and operate this neglected tracking system would no doubt prevent much higher costs elsewhere. So as is so often the case, the choice is between prevention or playing catch-up, aka, penny-wise or pound-foolish. And unfortunately pinching pennies usually wins out, and then we wonder why the problem is so bad while we try to clean up the consequences. Perhaps California politicians and regulators can see their way to an exception this time, for the benefit of all concerned.

And, I can't help but add, this would seem to be a bigger problem than a few profiteering cannabis clubs, annoying to some politicians as those might be.


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