Everyone by now realizes there is an opioid crisis in this country. It has become a political football kicked around by politicians trying to win votes from those Americans whose families have been impacted by this crisis. Naturally, it is easier to find people to blame than solutions to the problem.
Doctors are to blame because they just insist on giving patients opioids. That’s the opinion of at least one journalist. Keith Humphries, writing in The Washington Post says there are many other drugs besides opioids that could be used for pain relief except for the ignorance of doctors.
Humphries blames doctors for not using opioid alternatives on the following:
- Opioid manufacturers’ “ruthless” marketing
- Inadequate training in pain management
- Insufficient referrals to a pain psychologist
- Insufficient insurance coverage for pain management and physical therapy
Humphries says doctors get only an average of seven hours of pain management training in medical school. He says the solution is “enhancing insurance benefits (Medicaid and Medicare) for psychological and behavioral pain care services provided by interdisciplinary pain management clinics as well as funding training on pain management in medical schools and continuing education programs serving physicians and other health professionals.”
Who knew it was so easy to solve the problem?
This is typical journalistic pabulum we’ve come to expect from mainstream media like The Washington Post. The solution is always government funding of more insurance benefits, more education and more government control.
In reality, doctors continue to educate themselves long after medical school. I am required to have 40 hours of continuing medical education (CME) every two years just to maintain my medical license – and more to retain specialty board certification. Last month I attended the American Academy of Orthopaedic Surgeons (AAOS) meeting and spent three full days in CME classes. About five hours of that time I spent in learning modern methods of pain management after surgery.
Here are a few observations that Mr. Humphries should consider:
- Opioids are more effective in managing pain than the alternatives
- Patients expect (demand) opioids for serious pain
- Alternatives are generally available OTC and have been previously tried
- Experience rather than training has proven opioids effective
- Pharmaceutical marketing to physicians is practically non-existent for opioids in the last twenty plus years (in my experience)
- Medicaid expansion under ObamaCare has contributed to the opioid crisis – not relieved it (see Medicaid and The Killer Drugs)
Doctors would prefer to prescribe non-opioids except for the following:
- Patients have been programmed to believe non-opioids are ineffective
- Non-opioids can be prescribed over the phone – but patients in real pain will usually refuse them
- Non-opioids usually have fewer side effects, like constipation and addiction – yet patient acceptance is poor
- Opioids are generally less expensive than non-opioids
Most doctors would be ecstatic if there were truly effective non-opioid alternatives to prescribe for their patients in pain. The last of these was Vioxx, a non-steroid anti-inflammatory drug that was very effective in pain relief. Unfortunately, it was taken off the market in 2004 for dubious claims of cardiac toxicity. I’m still waiting for its replacement.