Some painful ideas from the NY Times

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Screen Shot 2015-03-02 at 2.01.32 PMToday s New York Times editorial board addresses narcotic abuse in a piece called Painkiller Abuses and Ignorance. We wonder whose ignorance are the editors trying to discuss they seem to have enough to go around.

From the very first sentence, it is reasonable to wonder if their proposed solution to this admittedly serious problem is worse than the problem itself.

Let s start with their quote: The epidemic of deaths and addiction attributable to opioid painkillers continues unabated even as an authoritative new review of scientific studies has found no solid evidence that opioids are effective in relieving long-term chronic pain.

Right away, says ACSH s Dr. Josh Bloom, I questioned the premise of their editorial, based on the wording of the first sentence. There may not be solid evidence of the benefit of long-term use of opioid narcotics, but there is sure plenty of evidence that patients who are in dire need of pain relief will suffer mightily in the absence of these drugs.

This statement itself is disingenuous, because it implies that there is proof that long term narcotic use is not of any benefit. Yet, they admit that what is really going on is that researchers found little or no evidence that long-term opioid therapy (therapy lasting more than three months) relieves chronic pain, in part because almost all the studies are of short duration.

This is echoed by Edward Covington, MD, director of the Cleveland Clinic's Neurological Disorder Center for Pain: While opioids for cancer pain are miracle drugs, [r]esearch does not exist for using opioids to treat chronic noncancer-related pain over long periods of time, especially in high-risk patients."

There is no doubt that narcotic addiction is a very serious problem in the U.S., so it is especially important that any policy change doesn t make the problem worse. Don t think this is impossible.

The OxyContin story is a perfect example of just this. For years, Purdue Pharma s OxyContin a high dose, time release oxycodone pill was the Cadillac of drug abuse. Addicts found that by simply grinding up the pill, they could get a very high dose 8 to 16 times that of a normal pill which could then be smoked, snorted, or injected.

By 2010, Purdue finally came up with a new formula that was very close to abuse proof. When users tried to grind up the pill, it turned into a gum, which was difficult to use. OxyContin abuse dropped like a rock. Good, right? Not exactly:

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As OxyContin became very difficult to abuse, addicts turned to heroin in droves. Its use more than doubled in two years. Is this progress?

Dr. Bloom says, No, it s not. Especially because not only is heroin far more dangerous than oxycodone, but it is often boosted with a synthetic heroin called fentanyl, which is 50 to 100 times more potent than morphine. A tiny mistake in mixing can result in a deadly batch of heroin. Addicts will find a way to get drugs, no matter what it takes. This just forced them to switch to something far more dangerous.

Although the Times piece provides all the downsides of opioid use (and there are many), they fail to mention that there is no good alternative. They are not alone.

Douglas Throckmorton, MD, deputy director for regulatory programs at FDA's Center for Drug Evaluation and Research said in 2012, Increasing use [of opioids] has resulted in a clearly unacceptable increase in addiction, overdose, and death. We need to find better drugs. Let's be honest. Opioids are non perfect drugs for pain."

As if this is so easy.

Dr. Bloom says, In 1895, Bayer began marketing heroin, ironically, as a less addictive version of morphine, which was a big problem at the time. That didn t work out so well either. The hard truth is that it is now 2015, and there is still no good way to control pain. Anti-inflammatory drugs, such as ibuprofen and aspirin can cause serious gastrointestinal problems gastric bleeding, ulcers, and kidney toxicity especially when used long-term. And acetaminophen (Tylenol) is far less effective, and can cause irreversible liver damage with long term use.

He continues, We are left with a whole bunch of bad choices for the treatment of severe, chronic pain. But none of these choices is worse than denying people who are suffering from intractable pain a measure of relief. The war on drugs has been a dismal failure by any measure. Making cancer patients and others with severe pain collateral damage in this unwinnable war is inhuman.