The focus of both was triage — trying to stop a nightmare situation from spiraling even more out of control — and included ideas like providing support for people who are already addicted to opioids, doing a better job at preventing overdoses, and better tracking patients who are drug seekers.
All are great ideas. When your house is on fire, your first step should be to run outside and find a bucket of water.
However, then what?
America’s “house fire” didn’t accidentally start on its own. There was a spark at its center. Unless we talk about that spark too, new fires are going to erupt.
Our pain epidemic
The pharmaceutical industry and health care professionals didn’t create the opioid epidemic by producing and prescribing medications for allergies or heartburn. They created it by producing and prescribing medications for pain.
Those medications weren’t given to a few thousand people, but to hundreds of thousands who were (and still are) showing up in doctor’s offices in so much pain they’re unable to live their lives.
That is where this problem started.
One of the reasons why we have an opioid epidemic in the United Sates is because we have a pain one…and no one wants to talk about it.
I recently wrote a book about chronic pain and how to recover from it without relying on opioids. The response from the media was, “Meh. Maybe we’ll cover it when someone famous ODs.”
Apparently, dying from opioids is hot news. The pain that compels you to take those opioids? Not so much.
That’s a shame. Because our pain problem isn’t getting any better, mostly because people in positions of power either aren’t addressing it or are only addressing it in relation to the opioids used to treat it.
For example, here’s Secretary of Health and Human Services, Tom Price’s big plan for treating pain from a press briefing earlier this month…
And then, finally, how do we treat pain in this nation? As a formerly practicing physician — orthopedic surgeon — I know that physicians and other providers have oftentimes sensed that there is an incentive to provide narcotic medication. And we need to do all that we can to make certain that, yes, people are provided appropriate narcotic medication when necessary, but no more than necessary.
Apparently the way to treat pain is with medication, (which is, in reality, only part of the solution) but not too much medication, (whatever that means).
If that means reducing a patient’s current medication, then what? What kind of support do we offer them for the pain that remains? (You know, when “not too much” ends up being “not quite enough?”)
No one wants to talk about that either.
There is no other safety net
There is an assumption that, in the absence of opioids, people in pain can use “other stuff” to get better. What no one ever mentions is that this “other stuff” doesn’t really exist.
As it says in the opioid commission’s report, “this crisis began in our nation’s health care system.” We used to have more clinics in the United States that took a multidisciplinary approach to pain management, but we closed many of them after opioids hit the market. We also stopped educating doctors on how to treat pain without the use of these drugs.
Basically, over the past few decades, we dismantled much of our infrastructure for treating pain, thereby creating a system in which opioids were people’s only safety net.
If we take that safety net away, we need to be clear that there is currently nothing with which to replace it.
- Medical marijuana remains illegal or ridiculously hard to obtain in most states.
- Insurance often does not cover non-drug therapies like acupuncture, chiropractic, or massage.
- Doctors often lack the training and expertise to give advice on non-traditional treatment options like hypnosis, biofeedback, EMDR, or meditation. When they do, there’s usually no guidance on how, when, where, how much, or how often to do these things.
- People with chronic pain/injuries/conditions often require special attention or accommodations for pain-relieving exercise programs like yoga, Pilates, water therapy, or strength training. As a result, the classes they attend are often harder to find and/or afford.
Replacing the pain safety net won’t require us to fix one of these options, but ALL of them. Because alone, none of these options are as powerful as opioids, but combined (and also incorporating mental health care and support) they are even more effective in recovering from chronic pain than opioids alone.
The problem is, that kind of multidisciplinary approach to pain management takes a ton of resilience and resources, both of which people in pain have in short supply. They’ll need help to pull it off.
The National Pain Strategy
Thankfully help is out there.
In 2010 the National Institutes of Health (NIH) contracted with the Institute of Medicine (IOM) to study pain and come up with ideas to help people recover from it. The result was the creation of a National Pain Strategy.
The strategy was a good first step. However, it’s one we haven’t finished taking.
The National Pain Strategy is going to take time to implement and some of its recommendations are currently getting more attention than others. (Why address complex long term changes to our health care system when you can just declare war on opioids and win votes and headlines instead?)
Whether we are able to follow through on all of the strategy’s recommendations or not, at the very least we must start talking more about the needs of people with pain. Because just focusing on stopping the flow of drugs without addressing why people needed those drugs in the first place is punishing people in pain.
Eliminating opioids may help us put out a fire, but it’s also going to leave hundreds of thousands of people burned.