The epidemic of opioid abuse has been flooding the news media, and the CDC has recently published new guidelines for prescribing opioids. Advocates associated with addiction wrote the guidelines without input by those providing primary care or pain management. This has led to a very unbalanced set of recommendations. The press has also been publishing countless articles blaming medical doctors for causing the addiction crisis by overprescribing pain medication.

Unfortunately, managing pain is quite complex. In medical school, doctors are taught basic concepts of how opioids work and how long they last in the body. Beyond understanding how opioids are used to treat pain, very little else is taught in medical school or specialty training about treatment of pain. Addiction education also gets very little time in the overall training of doctors. Furthermore, it is drilled into physician’s head that one must relieve pain and suffering. Then, most medical providers naturally tend to prescribe the easiest solution, opioids.

The Blame Game

One of the largest medical problems affecting all patients is chronic pain, afflicting over a third of the population worldwide. The problem of pain far exceeds medical problems like cancer, heart disease, and diabetes. In the United States, barely 2 percent of the research dollars in medicine go to the study of pain, and there is no coordinated center in the National Institute of Health or other government agency to sponsor further investigations.

The problem of providing pain management for those suffering from chronic pain and those with expertise in this field is clear. There are millions of people, a third of the population who suffer from chronic pain. The field of pain management is very small with only a few thousand experienced providers. The tools to provide pain management are somewhat limited. One of the most effective tools for pain has been the main tool for several hundred years – opioids. It is often not the best drug for pain in many patients and situations. However there is no money available for many better treatments and research with regards to new and better tools is limited.

Insurance companies also severely limit the options. Drugs that are not addictive are often denied since the use is outside the original approval guideline set by the FDA. Other times the insurance companies will only approve drugs that are not approved FDA treatments because there is similar generic drug. Non-drug treatments like additional or long-term physical therapy, massage, or comprehensive pain management programs are also denied due to upfront costs. Thus physicians are forced into prescribing pain medications that may be addictive since better treatments are not covered by insurance.

The physician and the chronic pain patient did not cause the opioid epidemic. It is a complex problem. To solve the issues associated with pain, there needs to be better education of doctors as well as patients about management strategies. Money needs to be spent on more than treatment of addicts, but on solving the complex facets surrounding pain. Allowing pain experts to prescribe appropriate treatments including medications and comprehensive programs is a start. Research on the mechanisms of pain and how these might better be managed whether with new medications and strategies also needs to be performed. The guidelines likely will only educate people that there is an opioid problem. The solutions are much more complex than the new guidelines proposed by the CDC and written by addiction specialists who run a multi-million dollar string of treatment centers.