This week, an excellent article on the American Pain Foundation (APF) was brought to my attention. In it, the APF’s stance that “the risk of [opioid] addiction is overblown” is examined in light of the fact that the APF receives a great deal of its funding from companies that produce addictive painkillers. I highly recommend you click that link; the article is thorough and well-researched, and provides a valuable perspective on the kind of misinformation that can harm patients when medical issues become overly profit-driven. The companies producing and promoting the use of addictive painkillers clearly have financial motives to conceal their potentially harmful effects, and they also have clear motives for funding institutions such as the APF, which can lend credibility to research that might otherwise appear “scant or disputed”. Whether or not the people working at APF believe what they say about the “low risk” of opiate addiction — and despite the real good that APF may have done in the realm of patient advocacy — maintaining that prescription of opiates should be uncontrolled is severely irresponsible.
Will Rowe, the chief executive of the APF, is quoted in the linked article as saying that “The problem isn’t opioids… It’s poorly trained doctors who prescribe them too easily or in excess.” That is certainly true. No drug in and of itself is “good” or “bad”; all treatments are appropriate in some situations while being inappropriate in others. But Rowe and others similarly associated with the foundation also express fears that regulation of physicians will “scare them away” from prescribing opiates, and induce “opiophobia” that will harm patients.
Even if the fear of “opiophobia” is legitimate, I have a hard time believing that encouraging doctors to be more conservative in prescribing highly addictive drugs will cause more harm than it will prevent. What pain management doctors don’t seem to realize is that addiction is a distinct disease, and that some symptoms of what they think is “chronic pain” are, in fact, symptoms of addiction. Some patients absolutely do have chronic pain that requires long-term opiate treatment, but I would argue that many more patients have “chronic pain” which is actually chronic withdrawal. I have had more patients than I can count who, after a few days on buprenorphine, tell me that the underlying cause of their opiate use (back pain, joint pain, or other common pain conditions) has disappeared. In these patients, the initial problem that caused them to seek treatment for pain probably cleared up long ago, and that the pain they had been self-medicating was in fact withdrawal.
Patients who are addicted without knowing it, and who self-medicate for withdrawal, are among those most harmed by the APF’s insistence that opioids have “low risk” and must be protected from regulation. These substances are absolutely, unequivocally addictive, and downplaying that risk is an appalling betrayal of trust on the part of the APF and all similar institutions. Whether patients are willing to take that risk is a matter to be decided with their physicians, but that decision cannot be made well if both physicians and patients are assured that there is no risk.
I’ve written before about how more regulation on the prescription of pain pills could very easily decrease addiction (and its associated costs), choke off the supply of narcotics being sold illegally, and improve pain management by not compounding pain with further addiction-related problems. The APF’s stance against such regulation seems to me to be blatantly self-serving, which undercuts their claim to be focused entirely on patient welfare.