Strong Pain Medications
Pain is among the worst of human experiences. Since the beginning of human existence we have sought its relief. Various cultures have tried prayer, magic, herbs, torture, surgery, death, and pharmaceuticals to treat pain. Sometimes pain can lead to suicide.
In all of recorded time, nothing has proven as effective as the opium poppy and its derivatives; opiates (natural derivatives, like morphine or codeine) and opioids (synthetic derivatives, like hydrocodone or oxycodone). Yet, because of their potentially addictive qualities, none has engendered more controversy.
Modern concepts have led to major changes, but regulations and laws are too often based on knee-jerk reactions to media frenzy, instead of being based on science and medicine. Old-fashioned ideas about addiction are based on faulty studies done in the early part of the twentieth century. For example, one of the major studies, sanctioned by the AMA in the late forties, used multiple choice surveys of street addicts to ask how their problems began. Modern concepts of study design would consider this type of retrospective review to be subjective, skewed, biased by selection, and unlikely to produce objective results. Unfortunately, most “common knowledge” and regulatory action about opioids is based on Internet speculation and repetition, rather than on hard science.
It is now accepted that opioids used for legitimate medical problems rarely cause addiction. We now feel that addiction is a psychiatric disorder that occurs independently of whether an opioid has been prescribed, rather than that the prescription has caused the problem. The use of opioids for the treatment of chronic nonmalignant pain went from "unacceptable", to "acceptable", to "standard" in the early part of the 21st-century. In 2015, however, the pendulum began to swing the other way and society and regulators began to frown upon the use of these agents, even when necessary. Undoubtedly, the pendulum will swing the other way in 10 or 15 years.
Unfortunately, many physicians trained in the old school are still reluctant to use these valuable medications, which can ease human suffering immeasurably. Unfortunately, realistic fears of regulatory oversight fuel this problem. Even though the prescription of opioids for medical indications is not supposed to be subject to regulatory oversight at all, zealous enforcement agencies can and do create a “chilling” atmosphere for physicians who are otherwise desirous of treating their patients’ pain.
Misinformation in the lay public also interferes with legitimate medical use, as many people do not want to become "hooked", or feel pressure from family members who do not understand the depth of their pain. The pressure on physicians to avoid prescribing opioids is intensified by the fear of frivolous lawsuits.
When used in a controlled and competent setting by a physician certified in pain management, and in conjunction with other medications that increase their efficacy (“co-analgesics”), these substances can change lives and put people back to work.
Because opioid analgesics are potentially addictive and are regulated by law, patients who use them regularly must agree to respect certain guidelines. For example, they must take their medications only as prescribed without increasing the dose unless authorized by the medical practitioner. Lost or stolen medications will generally not be replaced. Sometimes urine drug tests will be required. These guidelines are necessary to protect the patient and the practitioner. The improper use or diversion of opioid analgesics can lead to serious physical or legal consequences.