The good Opioids: Seven years back, unable to bear the excruciating pain after a C-section surgery, I pushed the nurse call button on my hospital bed. She came in with a “pain chart”. I just had to choose the severity of my pain on the chart and she would hook me up with a prescription opioid painkiller. In my case, it turned out to be about 500 mg of Percocet. I popped one in and it worked like magic.Unfortunately, these magic pills have a dark side which is manifesting itself in the prescription opioid and heroin addiction epidemic sweeping through the US.
The pain I underwent after surgery is of the acute variety – short term and usually following trauma. Opioid painkillers are great for this (as popularized by the many tough guy movie characters who take a shot of morphine to blunt the pain after an intense action sequence.)
Unfortunately for pharma companies that make these pills, not many patients suffer from acute pain and the market is unreliable. So in the 80s and 90s, they started a concerted marketing effort to encourage doctors to prescribe opioids for chronic pain (the “pain chart” that I was shown was a result of this campaign). Chronic pain is long term and can be a result of some of the most common conditions. Back pain, arthritic pain, migraine – you name it. Suddenly the market for these drugs exploded and became one of the most reliable revenue streams for drug companies. The campaign has been so successful in fact, that every year physicians churn out about 250 million opioid prescriptions (one for every man and woman in America).
There is very little evidence that prescription opioids work as a sustainable treatment for chronic pain. There is plenty of evidence however, that they are highly addictive. Many patients abuse their prescription opioids. And when it runs out, they move on to the more available (and much more deadly) alternative opioid – heroin.
In 2014 alone, over 29,000 people overdosed on opioids in the US – a veritable public health crises. Unlike previous drug epidemics that were mostly concentrated in urban centers, the opioid crises exists in suburban and rural populations as well. The one demographic that seems to have been particularly hit is middle-age white Americans. So startling is the crises in this group that researchers recently made the discovery that the OVERALL death-rates of this group is rising (in a reversal of decades long trend). Just think about it, the opioid epidemic has the scope to create large scale changes in population makeup – by itself.
It is time for the pharma industry to be a part of the solution to this problem it helped create. We could start by acknowledging that there is no magic pill for chronic pain.