There was an interesting article in the New York Times a few days ago, called "Tightening the Lid on Pain Prescriptions" (check it out online). A couple of things stood out to me:
“If doctors understood how hard it is to get patients off of these drugs, they would not prescribe them to begin with".
I tend to agree with that, and I've often looked at someone's first Oxycontin prescription with great trepidation (Doc, are you SURE you want to do this?). I'm not a physician and I can only imagine how hard it is to see a patient with chronic pain who answers every drug name you suggest to them with the words "doesn't work." But I also question starting someone on powerful narcotic medication without a plan. How are we going to get them off it?
"The long-term use of opioids to treat chronic pain is relatively new. Until about 15 years ago, the drugs were largely reserved for postoperative, cancer or end-of-life care. But based on their success in those areas, pain experts argued the medications could be used to treat common kinds of long-term pain with little risk of addiction."
WHAAAAAA????????? Little risk of addiction???? Here's where I'm scratching my head. Can someone explain how chronically dosing someone with a known chemically addictive substance poses little risk of addiction? It's true that many of these drugs were originally marketed for end-of-life care (OxyContin, MS Contin) or serious pain in a hospital setting (oxycodone, hydromorphone, fentanyl, etc.) Now they have leaked out into the community and into the realm of family-practice doctors who are prescribing them for neck pain, back pain, knee pain, TMJ, migraines and a bunch of other stuff for which they are not intended.
The NY Times article concludes with this:
"If the patients were taken off the medications, many would experience severe withdrawal or have to take addiction treatment drugs for years. Even avid believers in the new direction, like Dr. Ballantyne, suggest that it might be necessary to keep those patients on the opioids and to focus instead on preventing new pain patients from getting caught in the cycle.
“I think we are dealing with a lost generation of patients,” she said."