Why You See The Pendulum of Addiction Fear Swinging Again
“The data about the ability of opioids to cause addiction haven’t changed. But that ‘old’ news can’t compete with the fire-breathing, vote-getting, be-seen-to-be-doing-something mentality of our political and regulatory folks,” said Charles F. von Guenten, MD, PhD, Editor-in-Chief of the Journal of Palliative Medicine.
I couldn’t have said it better. Of course, this is not the first time in U.S. history when opioids and the people for whom they have been intended have been castigated. Early in the 20th century, as many as 10% of the American population had become addicted or were physically dependent on opioids.
History of Addiction Fear
Back then, heroin was the primary molecule they abused. Therefore, many clinicians felt morphine would be an effective cure for heroin addiction. They did not know, at the time, that heroin metabolized into morphine and had many of the same euphoric effects.
Nevertheless, the government intervened, and laws were passed to criminalize the use of opioids. Many physicians were incarcerated for prescribing or dispensing the drugs. There was an enormous chilling effect from law enforcement interdiction. The people who had legitimately needed pain relief were either ignored or told to suck it up. The pendulum of excessive opioid use swung to near total abolition except for treatment of acute pain and for some cancer patients.
Again, the fear of addiction surfaced in the middle of 21st century. I write in my book, The Painful Truth, that in 1941, Lyndon E. Lee Jr., MD, wrote an article in the Journal of the American Medical Association in which he warned against the use of opioids (narcotics) even for terminally ill cancer patients because “it would condemn the patient to a life of addiction.” Dr. Lee was prepared to condemn dying patients to spending the rest of their lives to agonizing pain. He perceived the risk of addiction to be a far worse harm than pain.
History appears to be repeating itself.
Addiction Fear Today
Today, the pendulum has swung from excessive opioid prescribing in the 90’s and early 2000’s back to the attitudes and practices that caused incredible suffering decades ago. Today, as was the case in the 1940’s, mostly physicians and regulators are well intentioned, but their narrow focus on the harms of opioids is causing many with severe pain, including people dying with cancer related pain, to needlessly suffer.
Our regulatory and policymakers are trumpeting the dangers of opioids without appropriately recognizing what this imbalance of compassion is doing to a large number of people with pain in our society. I stand with Dr. von Guenten who is calling for a “voice of reason when someone starts breathing fire about the evil opioid and the evil doctors who are maliciously ensnaring the unsuspecting.”
Let compassion lead us forward, but allow science to light the way.
Copyright 2016, Lynn Webster, MD
Originally published at thepainfultruthbook.com on March 24, 2016.