The morning of Aug. 27, 2010 is a vivid one for me. On that day, nine men and women — some with guns in their holsters and all wearing black jackets emblazoned with "DEA" or "POLICE" — trooped into the Salt Lake City pain clinic where I served as medical director.
They quickly took up positions in offices and at clinic exits. All the patients in the waiting room and the other providers and staff of Lifetree Pain Clinic could do was stare in intimidated silence.
One of the officers handed me a subpoena. The DEA wanted medical records for about two dozen former patients to determine whether the prescribing of opioids (narcotic pain medications) by the providers in our clinic had been appropriate and legal.
Of the more than 20,000 patients we treated over 20 years, some had been discharged from our care for using their medications inappropriately; others were being actively treated or had died.
After four long years of reviewing the facts, the U.S. Attorney declined the case, citing insufficient evidence to proceed with any allegations or charges. The finality of the investigation is a great relief to my family and me. Even so, I still feel uneasy. People suffering from debilitating pain see no relief in sight, only hopelessness. For their sake, we need to find a better way.
Being intimately familiar with the horrific public health crisis of opioid abuse, addiction and overdose deaths in Utah and the country, I know aggressive enforcement is necessary in some instances. But it can never be the sole — or best — answer to any severe public health crisis. We need better education, alternative therapies and more investment in new and safer therapies.
If we ultimately are to replace opioids as a treatment method — and I believe we must — the real issue is what to do for patients with chronic pain if current medications are not available?
Professionals at my former clinic treated patients whose pain persisted despite conservative therapies. Often, their pain was complicated by additional medical conditions. When pain becomes a chronic illness, a disease in itself of a misfiring nervous system, it is fraught with challenges and adverse outcomes, as are all chronic illnesses.
The only real solution is to find safer and more effective therapies than opioids. Unfortunately, most insurers don’t cover the few alternatives that are available.
If reducing the number of opioids prescribed is the best short-term strategy, then interdisciplinary and alternative therapies must be made available to patients and covered by insurance. Until they can be fully replaced, opioids will be necessary for a subset of the population who do not have any hope of leading pain-free lives. This requires more than regulatory oversight and prescribing prohibition. It also requires an ongoing discussion about safe and appropriate use.
The long-term strategy requires a major investment in research to find better and safer therapies for patients in chronic, debilitating pain. Increased investment — whether by industry or government agencies such as the National Institutes of Health, which currently spends less than one percent of its budget on pain research — is indispensable.
Above all, our society’s misunderstanding and stigmatizing of people with the worst types of chronic pain must stop. In today’s climate of aggressive crackdowns and limited treatment options, the complex needs of people are too easily relegated and forgotten. With a problem affecting so many — as many as one in three Americans, according to the Institute of Medicine — and with solutions too few in number, we can’t expect different outcomes by doing the same thing. To curb and end the prescription drug abuse epidemic, we need to find a better way.
Lynn Webster is immediate past president of the American Academy of Pain Medicine. He lives in Salt Lake City.
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