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January 15, 2020

Pain Treatment has Painful Consequences for Some

Painkillers have improved the quality of life for millions of people with chronic pain. In the decades since highly effective opioid painkillers came into common use, the dark side became evident with overdose deaths in the tens of thousands each year. As the death toll rose, the pressure on the medical community increased. More powerful drugs, such as fentanyl, treated the most intractable pain but added to the increase in drug overdose deaths. It became apparent that people treated for pain became addicted to the medications, and sought to continue them even when the cause of their pain subsided. Both physical dependence and addiction drove otherwise law abiding citizens in search of cheap street drugs adding to what rapidly was becoming an epidemic of inappropriate drug use.

In 2016, the Center for Disease Control released a report with guidelines for prescribing opioids for chronic pain. In the following year 17 states passed laws governing the prescription of opioid medication based on these guidelines. These federal guidelines and state laws achieved the desired effect of reducing the prescription of opioid medications. There were, however, unintended consequences for a vast number of people. According to an article in the American Journal of Public Health:

  • Many physicians reduced or discontinued opioid prescriptions for patients with documented chronic pain
  • In some instances, the changes were made “literally overnight”
  • Pharmacies and insurance providers began refusing refills and payments for prescriptions that were outside the CDC guidelines
  • Many patients with chronic pain had no effective alternatives for pain relief
  • Many patients suffered withdrawal symptoms with little or no medical support or assistance
  • Many chronic pain patients turned to black market opioids with increased rates of addiction and added the risks of shared needles from IV drug use

The American Medical Association reacted two years later with a resolution that took exception to the CDE guidelines and argued against one size fits all numerical prescription limits. They further clarified that the CDC guidelines should not be considered as limits by physicians, pharmacies, insurance companies, and government bodies. It advocated that physicians should not be prosecuted for prescribing opioids above the levels stated by the CDC.

The 2018 AMA resolution was a good first step in recognizing the unintended consequences of attempting to use opioid medication in such a manner as to achieve optimal pain control with minimal side effects. Medical and legislative initiatives have lowered barriers to treatment and encouraged the development of effective treatment options for the physical and psychological addictions which can occur.

One such treatment method is the use of Buprenorphine as part of a medication assisted treatment program. The person taking buprenorphine feels normal, not high, while the brain is fooled into thinking it’s receiving an opioid. As a result withdrawal symptoms are avoiding. There are relatively few physicians approved to prescribe this as part of a treatment plan. Centrec Care Center, in St. Louis, Missouri is one such program approved to use this along with other forms of treatment to assist people emerging from painful periods in their lives and seeking to return to healthy, drug free living.

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