Inadequate pain treatment is a public health crisis

  • Updated: April 21, 2011 - 8:55 PM

Drug war shouldn't claim new victims

The latest battle in the war on drugs must not create a new and innocent group of victims -- patients imprisoned by their own pain because doctors are unwilling or unable to prescribe the powerful pain medications that they need.

That is the risk of a well-intentioned but potentially detrimental push by the Obama administration this week to rein in abuse of prescription painkillers such as oxycodone, morphine and methadone.

Federal drug enforcement officials rightly called attention to the scourge of crime and addiction that street use of opioid drugs cause. This is a public health crisis.

But so is medicine's long history of undertreating patients' pain. Racial disparities in adequate pain treatment and access to these medications is another shameful, under-the-radar facet of this issue.

The Obama administration didn't do enough to acknowledge these critical issues as officials rolled out their initiative against drug abuse this week.

The effort will increase prescription painkiller oversight at the state and federal level, require new educational materials from drug manufacturers and promote public awareness of proper drug disposal.

These efforts are welcome. But officials need to ensure the initiative does not have an unwelcome consequence: a chilling effect on physicians' willingness to write prescriptions for these drugs or control pain with higher doses.

Many doctors are already skittish about prescribing powerful painkillers for outpatient use because of the oversight that already exists. That's only going to be exacerbated by the feds' tough talk this week.

Also troubling: officials' one-size-fits-all legislative solution. Instead of focusing on the tiny percentage of doctors who run so-called "pill mills,'' officials are eyeing a new law that would require physicians to undergo additional training before they can prescribe these drugs.

Is another hurdle really necessary for the majority of responsible providers?

The initiative "really could have a chilling effect ... and could potentially get in the way of people who do need serious pain control,'' said Art Caplan, a bioethicist at the University of Pennsylvania. "I've already heard doctors say, 'I don't want to prescribe because I don't want to attract DEA or police attention.'''

The DEA is the U.S. Drug Enforcement Administration, which regulates the dispensing and prescribing of controlled substances.

Minnesota also uses a database to monitor use of painkillers and other addictive drugs. This helps prevent abusers or drug dealers from getting multiple prescriptions from different doctors.

Dr. Miles Belgrade, medical director of Fairview's Pain Management Center, worries that the initiative will result in physicians referring chronic pain patients to specialists. He said there aren't enough such doctors to meet the need.

Conditions that can cause chronic pain include cancer, HIV/AIDS and advanced heart disease.

Using these medications for pleasure is abuse. But so is not taking advantage of them, especially the newest generation of such drugs, which help provide continuous relief to those who are suffering.

The message from the Obama administration needed to better reflect those unique risks and benefits.

Substance abuse is a real issue, but there is also a growing population of people with life-limiting pain. Federal officials need to ensure they don't focus on one health issue at the expense of the other.

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  • LIFE-ALTERING

    "For many people, these [medications] make the difference between wanting to die and wanting to live for years and years. As one of my patients said, 'It gave me back my life.'"

    Dr. R. SEAN MORRISON, professor of geriatrics and medicine, Mount Sinai School of Medicine in New York

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