Managing Pain and Opioid Addiction

http://www.nytimes.com/2016/05/16/opinion/managing-pain-and-opioid-addiction.html

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To the Editor:

Re “Training Is Weighed for Opioid Prescribers” (Business Day, May 3):

As a physician who specializes in pain management, I find it sad that calls for mandated physician education on prescribing opioids are primarily couched in terms of preventing opioid abuse rather than in improving care for patients with pain.

It is also unfortunate but not surprising that many medical schools that should be trying to improve physician education should stand in the way of this training.

In 2004 a bill was introduced in the New York Legislature requiring medical schools in the state to include education on pain management in their curriculum. A major reason the bill went nowhere was the opposition of these medical schools.

Dr. Darrell G. Kirch, president of the Association of American Medical Colleges, indicates that schools should be given an opportunity to develop their own guidelines on teaching about the use of opioids.

As we have been aware of the inadequate education most American physicians receive in pain management for at least 30 years, one can ask how many more patients must suffer needless pain before medical schools finally get around to doing something about this.

STEVEN A. KING

Philadelphia

To the Editor:

Re “The Epidemic We Failed to Foresee” (Op-Ed, May 7):

By now we all know about the opioid addiction epidemic that is shattering millions of families across our country. Dr. David A. Kessler’s article provides a good description of what caused it and what we have learned about it.

The cause is clear: The number of prescriptions written has quadrupled over 15 years, while the number of overdose deaths has also quadrupled.

All the experts agree on two common-sense solutions. Prescribers must check their state’s database to see what else a patient has been prescribed before considering prescribing a controlled substance. And prescribers must be trained on the Prescribing Guidelines recently released by the Centers for Disease Control and Prevention.

For the sake of our loved ones, we are counting on our policy makers to ensure that these two actions take place in all states in the coming months.

GARY MENDELL

Easton, Conn.

The writer is the founder and chief executive of Shatterproof, a national nonprofit focused on ending addiction.

To the Editor:

Dr. David A. Kessler’s way of thinking reminds me of my grade-school teachers who wouldn’t permit excuses from the classroom to use the toilet. That left many of us in embarrassing and tearful situations.

Now, because of the medical community’s terror alert regarding opioids, I find myself having to endure severe pain due to interstitial cystitis. Under hospital palliative care, after more than a dozen trial medications and methods of pain control, methadone worked. It is no longer available to me. Physicians I’ve consulted for nearly 40 years refuse to prescribe even a minimal dose.

I never became addicted to opioids, unless Dr. Kessler considers the awful pain I experience from this truly disabling condition a symptom of withdrawal. Attention must be paid.

JUDY GRAUBART

New York

To the Editor:

Re “The Epidemic We Failed to Foresee”: Who is “we”?

Those of us on the front lines of medicine have known for two decades that opiates were a problem and addictive, and that we were giving out way too many narcotic prescriptions. And we weren’t being told that it was O.K. to prescribe them by drug companies but by our teachers and mentors.

With the expectation that patients be made completely pain-free, and with the decreasing amount of time to spend with our patients and the increasing emphasis on patient satisfaction, though, it was (and is) very difficult not to prescribe narcotics. I hope that things will change.

MIMI BLAUROCK

Los Altos, Calif.

The writer is an internist.

To the Editor:

As a clinical addiction therapist whose clients have struggled with opioid dependence, I see one important factor omitted from the discussion: the effect of opioids upon a person’s cognition, mood and awareness.

To quote one of my clients, “Oxy(codone) didn’t just make me feel better, it made me feel good, and changed my thinking.”

Similarly, many have told me that opioid medications cast a benign glow on their overall outlook. This is important because in such cases patient dependency is not just about pain relief but also about a seductive sense of “well-being” that these drugs promote.

In the end, their reality-enhancing properties are as potent as their analgesic effects, and to varying degrees, psychologically addictive as well.

GARY GOLIO

Ossining, N.Y.

To the Editor:

I was made aware of the dangers of opioids by my nurses. In 2002, I was hospitalized after surgery for a femur fracture. My surgeon prescribed an opioid for me. Every time my private-duty nurse gave it to me, she issued a warning: The medication was highly addictive, and I should be careful about taking it. This warning scared me, and I was determined to get off the medication as soon as I could.

On my first post-operative visit to my surgeon’s office, I was asked by his nurse if I was still talking the medication. I told her that I was not. She said she was glad to hear it, noting that too many patients become addicted to this medication.

I applaud the nursing profession for its help to me.

DIANA KLEBANOW

Forest Hills, Queens