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Opioids Provide Patients Short-Term Relief | Featured Letter

While I applaud the Tennessean’s efforts in bringing the increasingly complex truth about the opioid crisis to light, I think there needs to be some balance.

First, the current crisis is not the result of a single event, drug or manufacturer. This also means that the solution will be more difficult than passing a single piece of legislation or going after a lone drug maker.

Second, Physicians for Responsible Opioid Prescribing (PROP) does not speak for the majority of pain physicians. Their core belief that there is no “scientific” proof that opioids work for chronic pain is like saying that there is no “proof” that parachutes save lives jumping from burning airplanes. That study has never been done.

In the meantime, the best evidence that we have is that there is good evidence that opioids work for short-term pain relief, and limited evidence that they work for long-term pain relief. But chronic pain is real, and doesn’t always go away in 90 days.

Long-term studies are costly, and again that study is not likely to be done. In the meantime we offer our patients the best treatment we have, based on the evidence available.

Third, while physicians, drug makers and distributors and the Food and Drug Administration all share responsibility for the current situation, another problem is with insurance companies. They routinely deny non-narcotic options including injections and procedures, citing complex and often maddening “medical policy”. This can be as bizarre as requiring physical therapy for six weeks before trying injections, or insisting that patients be actively involved in a home exercise program. In the meantime, they are prescribed narcotics.

Finally, the current trend is that those seeking opioids for less than legitimate reasons are turning away from prescribed pharmaceuticals and towards illicit opioids such as fentanyl and heroin. While the “pill mills” have been largely shut down by recent legislative efforts, it is much harder to stop individuals who operate outside of the law.

Don’t expect the death rate from opioids to come down in the immediate future, as illegal drugs are almost by definition more dangerous than legally prescribed medication. It will require a combination of public education and readily-accessible treatment programs to curb this massive problem.

Graf Hilgenhurst, MD, is the past president of the Tennessee Society of Interventional Pain Physicians, Smyrna 37167.

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