Opiod addiction is horrific and widespread, and thus President Trump is to be commended for deciding that it is time to confront this social ill. However, I worry about the risks of demonizing drugs that, used properly, help sick people.
If you have ever had a friend or relative die of cancer, you already know that opiods offer merciful relief from almost unbearable pain. My oldest friend died a decade ago from cancer, and I watched her stockpile painkillers for fear that, when the end came, her doctor would be hesitant to prescribe painkillers in the amount needed.
So I worry about enacting laws that, though well-intended, harm those who suffer from severe pain. The analogy is gun control: we want laws tough enough to keep guns out of the hands of criminals but that still allow law-abiding citizens to own them.
Board-certified ob-gyn and radio host Randy Tobler made this point about cancer patients and palliative care, where addiction isn’t really a concern, in IWF’s Policy Focus on the opiod crisis. I’d like to follow up citing an article by Doctors Sally Satel and Stefan Kertesz that appeared in Slate and was headlined “Some People Still Need Opiods.”
Satel and Kertsz write:
In the face of an ever-worsening opioid crisis, physicians concerned about fueling the epidemic are increasingly heeding warnings and feeling pressured to constrain prescribing in the name of public health. As they do so, abruptly ending treatment regimens on which many chronic pain patients have come to rely, they end up leaving some patients in agonizing pain or worse.
Last month, one of us was contacted by a 66-year old orthopedic surgeon in Northern California, desperate to find a doctor for herself. Since her early 30s, Dr. R suffered from an excruciating condition called Interstitial Cystitis (IC). She described it as a “feeling like I had a lit match in my bladder and urethra.” Her doctor placed her on methadone and she continued in her medical practice on a relatively low dose, for 34 years.
As Dr. R told one of us, “Methadone has saved my life. Not to sound irrational, but I don’t think I would have survived without it.” Then a crisis: “Unfortunately for me, the feds are clamping down on docs prescribing opiates. My doctor decided that she did not want to treat me anymore, didn’t give me a last prescription, and didn’t wait until I found another pain doctor who would help me.” For the past 30 years, Dr. R has been an advocate for better treatment of IC and reports “many suicides in the IC patient population due to the severity of the pain.”
Dr. R was fortunate in finding somebody to prescribe for her. Many patients aren’t so fortunate, according to Satel and Kertsz. This points to something very worrying in the demonization of opiods: we are making doctors afraid to prescribe drugs that they sometimes know are needed but fear risking their medical licenses to make available to a patient.
A headline over a letter to the editor of the Los Angeles Times said it all: “In fighting the opiod epidemic, remember people with chronic pain.” Doctors should of course be very careful in prescribing drugs, but they should never be afraid to do their jobs.