common painkiller

The Politics Of Pain

/ Thomas Cohn, MD

Politics PainkillerThe problems with opioids have been all over the news. Now it is the political season, and the politics of pain have occasionally been making news. It’s generally about how awful the pharmaceutical companies have been and how they have been behind the current problems. Whenever we try to point blame, it is worth remembering that both the problems and solutions are complex. Drug companies may have recognized the market for pain medications but without a demand for the product, even with the best sales, the problems would not have developed. Further, doctors have also been blamed, always over prescribing pain medications.

The treatments for pain are as varied as the causes, as there is not a single treatment that works for all. Unfortunately, the culture in the U.S. often wants a quick fix, and if a pill helps, most want that solution. The harder solutions of modifying activity and exercise often have few takers. The easy solution is taking an opioid medication, and when people started to realize that it helps temporarily, many people have insisted on being prescribed these medications.

Patient rights and quality care have also been an issue in prescribing medications. Countless times patients have said it is their right to take certain medications and that if a patient has pain, it is the obligation of a healthcare provider to prescribe opioids to control their symptoms. Now with multiple sites providing online evaluations and ratings of care providers, patients dissatisfied with not being prescribed certain medications will rate a provider badly.

Prescribing Opioids

The politically correct position currently, at least for healthcare managers, politicians, and lawmakers, is to say opioids are always bad and doctors should not be prescribing these medications since they only cause addiction and death. The truth is obviously more complex, but these medications are appropriate for certain people, especially when all other treatments for pain have failed.

Years ago, the pharmaceutical companies were notably behind the push to have opioids more widely prescribed. Today, we have a better understanding of the problem with these medications, and we have some alternatives in management of pain. As cynical as it was for drug companies to push for prescribing medications, now the push for more addiction management due to opioid problems. One of the most important solutions to reducing opioid usage is to fund research for better treatment alternatives and to discover more about what causes ongoing pain.

The opioid crisis is real and it affects an alarming number. Yes, there is a need for stemming the crisis, but most of the money being proposed is to go for addiction treatment, and often people who directly profit are behind the treatment programs. Another group is pushing for legalizing marijuana for the treatment of pain, and many of those pushing the hardest will again directly profit if this is legalized. Those in the trenches trying to appropriately diagnose and treat pain, and those who are suffering from pain currently have little financial support. Even though a third of the population struggles with pain, very few resources are being targeted towards a better understanding of the mechanisms behind pain and new treatment alternatives. Pain is not glamorous, and there is no high profile celebrity pushing the cause for better treatments. Unfortunately, there are many people pushing causes related to pain for personal profit, from addiction treatment centers, pharmaceutical companies, to disingenuous entrepreneurs pushing for legalizing marijuana. When looking for solutions, they need to be based in the best interest of those in pain.

Why A Medical Breakthrough May Be Bad For Society

/ Thomas Cohn, MD

Hydrocodone in the Twin CitiesAn article in today’s newspaper touts the discovery by Stanford University and their development of yeast that can produce hydrocodone. This is a synthetic opioid also known by the trade names Vicodin, Norco, or Lortab. It is a moderately powerful oral pain medication and has been one of the most highly prescribed pain drugs in the United States. Of all the hydrocodone produced worldwide, 90 percent or more is used in this country. Unfortunately, this makes it one of the most abused drugs in the country.

Stanford University has found a yeast that when mixed with sugar will produce hydrocodone as a byproduct. Most of us are familiar with yeast that is used to make bread or mixing a yeast with sugar and that will produce alcohol. Now a type of yeast has been produced that when mixed with sugar will produce an opioid. The benefit is that maybe it will lower the production cost of the drug and make this painkiller more available worldwide, especially where there is a lack of medication.

Pros Versus Cons

The larger question beyond the medical breakthrough is whether this is a good development. In the United States, we currently have an epidemic of opioid abuse and significant over-prescribing with misuse. Pain can be treated with multiple different strategies; medication is only one of the possible methods. Unfortunately, it has become the quick and easy solution for physicians. For patients, more effective strategies often require the patient to do more work, such as exercise, strengthen and stretch muscles, lose weight, eat differently, and take more control of their lives. In the rest of the world, often people have more realistic view of life and their bodies, and do not resort necessarily to a pill for pain relief. Readily available pain medications have already been shown to be a problem in the United States.

The other major issue is if Stanford University has been able to develop a yeast to cheaply and quickly manufacture an opioid, how long will it be before this technology gets into the hands of illegal drug manufacturers? We know that illegal drug use is a multi-billion dollar business. It is likely that someone is already trying to either steal a copy of the yeast, or develop their own yeast for the same purpose. The illegal drug trade and opioid addiction in the United States is a major problem. Finding an easy way to home brew opioids appears to be just around the corner. As a pain physician, this is likely to just be another problem and will be a boon for drug addiction centers and criminals. The cost to society may be much worse than making a drug cheaper and more available. Despite its potential, this may be the next societal disaster.