Extreme Pain Care with Addictive Analgesics: A National Crisis

State governments and physicians are very concerned about the alarming numbers of negative outcomes resulting from use of opiates. Not since the Civil War have so many patients become addicted to or suffered terminal events from use of opiates. It is an epic crisis.

Deaths due to accidental overdoses with oxycodone are second only to terminal motor vehicle accidents as the primary cause of accidental death. In many states oxycodone overdose is the number one cause of accidental death. One state in the far northwest will soon require patients failing to adequately respond to normal opiate regimens to be referred for specialty pain clinic evaluations.

Although all are concerned, the FDA, clinicians and patients each have different perspectives and obligations.
• The FDA is obligated to assess the effectiveness and safety of opiate products entering the market. It must offer recommendations to the government for creation of legal regulations regarding these products.
• Clinicians want to offer safe, effective medications without the burden of special training, certification, and documentation of product use. Moreover, physicians do not wish for the burden of special scrutiny or oversight regarding use of these products.
• Patients wish to be pain free, without side effects, especially death.

Drug companies have not yet produced opiates that are both effective and truly safe without euphoria, development of tolerance, or impairment including respiratory suppression with death. As such, they do not yet offer any solutions to these challenges.

Hopefully, much safer products will emerge soon. Otherwise, new legislation, certification requirements and legal enforcement or practices will diminish the number of clinicians willing and able to prescribe these products and address the legitimate needs of patients. In the interim, when visiting with your doctor discuss alternative products and complementary interventions that may eliminate the need for use of opiates or at least lessen the volume of use, decreasing the probability of related adverse outcomes.