Tags: pain management

New Opiate-Based Medication Prescribing Guidelines?

05/27/12 | by the professor [mail] | Categories: Drug-Regulation Policy

Link: http://AddictionScience.net

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The U.S. Food and Drug Administration (FDA) is currently revising their guidelines for prescribing opiate-based and related medications. These medicines are used daily by millions of people for the relief of moderate to severe pain. The FDA's concern is that therapeutic opiate use may lead many to addiction and therefore these medications should be more tightly controlled. The guidelines most likely would further restrict who gets opiate-based medications and under what conditions. Although we strongly support closing Internet drug companies that promote various psychoactive drugs including opiate-based medications and we further entertain the idea of a national registry to avoid duplicate prescription writing through physician shopping, we also believe that too many people now are discouraged from receiving (i.e, patients) or prescribing (i.e., physicians) medications necessary to dramatically improve the quality of life for those experiencing chronic pain.

The United States already has conservative views on the use of narcotic analgesics. Of course there is a lot of variation on opinion and on prescription-writing practices, but overall the U.S. remains rather conservative leaving millions of people under medicated for very painful conditions. Perhaps physicians should have to undergo a one-week intensive experience-pain-as-a-patient training module whereby they would be subjected to moderate but unrelenting pain for a short period of 7 days. Maybe then they would better understand the need and urgency for prescribing proper pain medication. And while we're making up the rules for the rule makers, let's add the policy makers (physician and layman alike) to our special training program. Want to see just how fast the laws and prescribing practices can change?

Patients deserve to receive their pain-relieving medication without everyone being looked upon as a potential addict. The unfounded hysteria and sensationalistic 'scientific' papers published from time-to-time need to quit exaggerating the problem for the sake of another publication and to quit marginalizing these patients who are already suffering considerably.

Very few people who receive opiate-based medication for the relief of pain become opiate addicts. Those that do are written up in reports which eventually find their way as 'scientific' articles, but the millions who don't aren't interesting and don't even make mention in such articles. The problem of addiction to prescription medication needs to be kept in perspective. Yes, many do but most don't become addicted. And of those who do progress on to addiction, the 'scientific' literature fails to note that they first entered a phase of drug abuse whereby they misused the drug by taking it outside the prescribed directions. That is, they didn't really become addicted as a consequence of their therapeutic opiate use, but rather, they abused the drug that was therapeutically made available and later became addicted. The intervening phase of drug abuse is critically important for understanding this progression. Unfortunately, it is usually ignored by those doing 'research' in this area.

(This is another instance where the distinction between drug "abuse" and drug "addiction" is critically important for conceptualizing an important issue. Better training in addiction science as part of the regular medical curriculum would be a giant step forward.) It's impossible to even discuss this topic intelligently without the requisite concepts behind the vocabulary.

Congratulations to me, "The Professor" XX(. This commentary, drafted in September of last year (2011), was never completed or even posted in its preliminary form--another victim of "Bozarth's Law of Procrastination!" Now it's damage control time as the federal government and individual states have scared many physicians into needlessly restricting their prescriptions of opioid medications even further. Stay tuned (and subscribe to the RSS feeds) as this forum category gets shifted into high gear. Ouch that hurt :( .

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