We’re People In Severe Pain.. “The prescribing of opioids has dropped every year since 2012 and is at 10 year low — and yet drug overdose deaths have skyrocketed. Meanwhile, our public policy looks backward in time, intruding on the doctor patient relationship and burdening patient care. . . . Long-term, legitimate pain patients who have relied on opioid analgesics can no longer fill their prescriptions in the many states that set maximum dosage and supply limits, often of three to seven days. Even in states that contain exceptions for long-term pain care, insurance companies and pharmacy policies use such laws as a reason to deny coverage or fills. Pain patients are being denied treatment and involuntarily tapered off of opioid medications, even if they’ve never shown any risks of abuse.”
Clinicians and researchers have long remarked on the link between opiophobia and undertreatment of pain. In a 1966 pharmacology textbook, the psychiatrist Jerome H. Jaffe, who later became Richard Nixon’s drug czar, noted that patients who take narcotics long enough develop tolerance (a need for larger doses to achieve the same effect) and physical dependence (resulting in withdrawal symptoms). But he cautioned that “such considerations should not in any way prevent the physician from fulfilling his primary obligation to ease the patient’s discomfort. The physician should not wait until the pain becomes agonizing; no patient should ever wish for death because of his physician’s reluctance to use adequate amounts of potent narcotics.”
Jaffe’s admonition suggests that undertreatment of pain was common, an impression confirmed in the early 1970s by two psychiatrists at Montefiore Hospital and Medical Center in New York. Assigned to handle “difficult” patients, Richard M. Marks and Edward J. Sachar discovered a very good reason why so many continued to complain even after being treated with narcotics: They were still in pain. “To our surprise,” they wrote in the February 1973 Annals of Internal Medicine, “instead of the primary issue being personality problems in the patient, in virtually every case it was found that the patient was not being adequately treated with analgesics and, further, the house staff for various reasons was hesitant to prescribe more.”
We need sensible prescribing, not over- and under-treatment fads.