Pubdate: Sun, 15 May 2016
Source: San Francisco Chronicle (CA)
Copyright: 2016 Hearst Communications Inc.
Contact: http://www.sfgate.com/chronicle/submissions/#1
Website: http://www.sfgate.com/chronicle/
Details: http://www.mapinc.org/media/388
Author: Debra J. Saunders

AMERICA'S OTHER EPIDEMIC: CHRONIC UNTREATED PAIN

The death of Prince, who apparently had a Percocet problem, and a 
2016 presidential primary peppered with New England town halls that 
delved into increased heroin overdoses and prescription drug abuse 
have converged to create what CNN's Dr. Sanjay Gupta calls "a public 
health epidemic." Drug addiction is 2016's big nonpolitical story. 
CNN aired a special, "Prescription Addiction: Dead in the USA." The 
Senate passed the Comprehensive Addiction and Recovery Act to provide 
grants for treatment and improved monitoring. The House also is 
working on legislation , with funding expected later in the year.

Grant Smith, deputy director of national affairs for the Drug Policy 
Alliance, sees Washington moving in the right direction by "treating 
drugs as a health issue" and "addressing head on some of the harms 
associated with opioid use." Some 78 Americans die from opioid 
overdoses every day, CNN reports. Its special "Prescription 
Addiction" related some horror stories - the football star who was 
popping 1,400 opioid pills a month; the teen who suffered 
irreversible brain damage after he started experimenting with 
friends; the teen who died of an accidental overdose after he got 
hooked on drugs prescribed to treat a football injury. Gupta 
cautioned that there is "legitimate pain that warrants" a 
prescription, but for a short period of time. Given the rise in 
overdose deaths, the media should warn the public about the risk that 
comes with painkillers.

I see a downside to coverage that has turned painkiller addiction 
into a media chew toy. This narrative focuses on doctors who for a 
variety of reasons seem to have overprescribed medication, and on 
patients who at their own peril try to game the system to get drugs 
to feed their addiction. There is little room in this narrative for 
the many individuals who do not get the pain control they need. I am 
talking about older people who need better end-of-life care. Many 
start phobic about painkillers, as they fear being drugged and 
listless. They may not realize that good palliative care can make 
them more able to cope in their remaining time. (As for those few who 
might overuse medication, who cares? They're not going to take up 
robbing banks.)

I called Eric Chevlen - a friend, Ohio pain medicine specialist and 
medical oncologist - to get his take on the new big story. Chevlen 
sees another problem in America - untreated pain. Poor people and 
uninsured individuals are less likely to get the relief they need. 
Also, people who have hard-to-diagnose ailments (like fibromyalgia, 
which mostly afflicts women) may go years before receiving available treatment.

Because they're debilitated, people who don't get the pain control 
they need may not feel like speaking up, so you don't hear their 
stories. You hear of addicts who go to the emergency room in search 
of a fix, but not about those who suffer in silence.

When it comes to pain control, Chevlen told me, "hardly anybody gets 
the right amount."

Chevlen has two concerns about the new approach in Washington. First, 
new Centers for Disease Control and Prevention guidelines are labeled 
guidelines, "but they're going to be interpreted as mandates, you 
know that." Second, Chevlen also believes that pushing patients away 
from opioids and toward anti-inflammatory meds carries a different 
risk - toxicity. Some patients will die from long-term organ damage, 
a side effect of pharmaceuticals, but their deaths won't be counted 
as overdoses.

I know that this column will spur readers to write about the horrible 
tragedy of a child, or other loved one, who got sucked into opioid 
addiction and into a downward spiral that ended in death. Too many 
families can point to a doctor who didn't keep a careful eye on what 
he prescribed. Or maybe the doctor was careful, but opioids had taken 
an ineffable hold and street trade made other drugs too available. 
Their stories are powerful, and serve as a warning. But there are 
other stories too - tales of people racked with pain that robs them 
of the joy of living. As Chevlen warned, "When we're treating pain 
inadequately, fewer people die of opioid deaths."

[sidebar]

Medical marijuana, safe alternative to opioids

As Congress puts money into fighting opioid abuses, Sen. Elizabeth 
Warren, D-Mass., sent a letter to Centers for Disease Control and 
PreventionDirector Tom Frieden that asked the CDC to look into "the 
impact of the legalization of medical and recreational marijuana on 
opioid overdose deaths."

No one ever has died from a medical marijuana overdose. You can't say 
that for opioids.

The Washington Post reports that a Journal of the American Medical 
Association meta-analysis of 79 studies found marijuana is effective 
at treating chronic pain. Researchers found "30 percent or greater 
improvement in pain with cannabinoid compared with placebo." A study 
published in JAMA Internal Medicine found that states with medical 
marijuana laws saw a 25 percent reduction in opioid overdose deaths, 
compared with states without such laws. That worked out to about 
1,700 fewer deaths in 2010 alone.

If Washington wants people to say no to opioids, Congress should say 
yes to medical marijuana.
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MAP posted-by: Jay Bergstrom