O'Malley discusses ways to fight opiate crisis.

[Moral Compass]

33. Opiate crisis?

This is just another facet of the war on drugs.

Are there people that over prescribe? Are there people that become addicted? Yes to both.

Is it a crisis? No.

We are now going through one of these cycles where due to an increase in overdose deaths and an overall failure in identifying problem patients and helping them get help there is a now a strong impetus to throwing the baby out with the bath water.

Pain is a something that is subjective, not always obvious to a 3rd party observer--and can completely eliminate all quality of life. Access to opiates when you have chronic, constant pain is essential. The truth of the matter is that over 95% of those prescribed opiate pain medication will not become addicted regardless of how liberal the doctor prescribing is. Between 2-5% of this population will misuse, abuse, and end up habituated.

This post seems to favor draconian restriction in pain medication prescription.

I think that is an extreme and absurd position.

There already has been significant restriction is pain medication prescription reported anecdotally and there has been reported a corresponding increase is heroin overdose deaths as these patients (addicts) seek their fix any way they can find it.

What is not being reported is that all those patients who are in pain not deemed sufficient for opiate prescription are simply not getting the pain relief they need.

Pain should be relieved with opiates when it is present.

I've had back problems off and on since I injured my back when I was 29. I've found that opiates often allow the healing to begin. In other words, they're not just masking the pain but they enable my body to enter into a state of healing relaxation. Once this happens my problem quickly resolves itself--usually. I've had one bout of prolonged pain that was only ultimately resolved with spinal steroid injections.

I'd been taking larger and larger doses of opiates over a 6 month period. Once I received the injection and the pain went away I stopped taking the opiates and within a few days found that I was experiencing withdrawal symptoms. I looked it up online and found that the symptoms would abate in about 72 hours. I never once had the urge to call my doctor and try to get more. I was heartily sick of taking hydrocodone and oxycodone by that time. I would argue that I'm more the norm rather than some sort of strange exception.

Today I would have probably been cut off and would have just had to suffer. That might have led to an inability to work and led to full disability eventually. As it was, I missed only a couple of days of work during this period and never had to leave a job.

Pain when it exists needs to be relieved. To force doctors and patients to worry about potential addiction rather than addressing the problem of pain immediately at hand is a warping of the doctor patient relationship--especially when it is well documented that only a small minority of patients are actually at risk of developing addiction.

I think there is little compelling evidence that there is an opiate problem in this country. I believe there is very compelling evidence that opiate addiction hot spots in this country are being caused by a lack of economic hope and opportunity.

Indeed there is emerging research that is showing that addiction (all drugs) seems to emerge in populations that live in hopeless stressful environments. Remove the stress and addiction often self corrects except in the most intractable individuals. For example, the local hot spot for opiate abuse and addiction in my area is in south Dallas--an area known for rampant high unemployment, grinding poverty, failing schools, and low quality dilapidated housing.

The sick and elderly in this particular neighborhood show a high rate of opiate addiction and this is where you'll also find a concentration of shady "pain management" centers--some of which keep getting busted.

So which came first? The chicken or the egg? Was it the poverty, unemployment, lousy schools, and dismal outlook for the future? Or was it the opiates?

Opiate addiction, where it actually exists, is the symptom of a systemic societal problem. It is not the problem itself.

O'Malley should look at how to relieve the endemic poverty that drives the addiction rather than targeting just the addiction.

Anyone who supports the current DEA campaign to limit opiate prescription advocates an extreme solution to a problem that really doesn't fully exist.