(Originally published June 28, 2014)
No one enjoys it. Not really. Even masochists don’t enjoy the pain. They enjoy the sexual excitement it engenders.
But when the pain is chronic and debilitating, it can seem like the world becomes one long, dark tunnel, filled with demons laughing at your suffering.
OK, that was purple prose. But I’ve known people, people I loved, who dealt with chronic pain every hour of every day, and the despair I have seen in their eyes and heard in their voices, made it seem like that purple prose was pretty accurate.
Sadly, the treatment of pain in the United States, or pain management and palliative care as it is called, has taken a turn down the road of opioid drugs, and this is causing massive problems both for those who take the opioids and for those around them.
For example, two reports by addiction researchers at the University of Pennsylvania School of Medicine show some startling data. These reports, published in the Journal of the American Medical Association, show an astounding increase in opioid prescriptions, while prescriptions for non-steroidal anti-inflammatory drugs or NSAIDs (i.e., ibuprofen and naproxen) have decreased. Hydrocodone and oxycodone made up about 85% of those prescriptions, and over the ten years of the study there was a 500% increase in admission to substance abuse programs for opioid addiction. According to statistics, one in four adults aged 18 to 25 will abuse prescription pain killers in their lifetime.
There were 202 MILLION (202,000,000!) prescriptions written for opioids during 2009. Of those about 12% were prescribed for adolescents and young adults.
“The scope of the problem is vast — opioid overdose is now the second leading cause of accidental death in the United States and the prevalence is second only to marijuana,” said Thomas McLellan, PhD, co-author of the studies and director of the new Center for Substance Abuse Solutions. (1)
And in December 2012, another article published in JAMA discussed how the over-prescribing of opioid drugs for pain management is having a negative impact on the health of patients who take them, but that diversion of those drugs to the street is causing social and public health issues. “More people in the U.S. die from a drug overdose than they do from motor vehicle accidents and more of those deaths are caused by prescription opioids than those attributable to cocaine and heroin combined,” said Alexander, associate professor of Epidemiology at the Bloomberg School and co-director of the new Johns Hopkins Center for Drug Safety and Effectiveness. (2)
And according to the Pain Physician Journal, there is now an “opioid epidemic” in the United States. A recent study by the Institute of Medicine stated that there are more than 116 million Americans with pain persisting from weeks to years, with financial costs ranging from $560 billion to $635 billion per year. (3) The “treatment of choice” in millions of those cases is opioids, including hydrocodone, oxycodone, and fentanyl.
Another, later study said much the same thing. In a study published in September 2013 in the online journal Medical Care. ““There is an epidemic of prescription opioid addiction and abuse in the United States,” notes G. Caleb Alexander, MD, MS, associate professor of Epidemology and Medicine and co-director of the Johns Hopkins Center for Drug Safety and Effectiveness. “We felt it was important to examine whether or not this epidemic has coincided with improved identification and treatment of pain.”(4) Essentially, what they found was that, even though all these addictive drugs were being prescribed, the actual rates of pain reduction were not improved. Plus, the use of safer alternatives (such as NSAIDS) was declining.
All right, that’s enough for the depressing information. But in a nutshell, Americans are being prescribed addictive pain medications at an astonishing rate, and this is impacting not only the patients who take them, but also public health.
Why am I telling you all this?
Because there are complementary and alternative treatments for pain, both chronic and acute pain, that are non-addictive, non-lethal, effective and available. But since the big pharmaceutical companies don’t make a dime from them, they don’t get a lot of exposure.
In a later installment, we’ll talk about some of those alternatives.
(1) Science Daily http://www.sciencedaily.com/releases/2011/04/110405161906.htm
(2) Science Daily http://www.sciencedaily.com/releases/2012/12/121204145702.htm
(3) Pain Physician http://www.painphysicianjournal.com/2012/july/2012;15;ES9-ES38.pdf
(4) Johns Hopkins School of Public Health website http://www.jhsph.edu/news/news-releases/2013/alexander-opiod-pain-use.html