RISE ABOVE THE 'OPIOID WARS' TO MANAGE CHRONIC PAIN

Guest Columnist Myra J. Christopher Argues That Policymakers Must Move
Beyond the Rhetoric of the "Opioid Wars" to Find Solutions to Managing
Chronic Pain. Otherwise, Pain Patients in Washington and Elsewhere
Will Continue to Be Collateral Damage.

THERE is a Chinese saying that we are prone to "kiss dragons and stomp
gnats." When we have a big problem that we have no idea how to solve,
we fixate on a lesser problem. The abuse of prescription medications,
particularly by our teens and young adults, is a big problem, but not
one caused by people who rely on medications to manage their pain.
People living with chronic pain in Washington state have become
collateral damage in an ongoing battle that has been characterized as
the "opioid wars."

The compelling series written by Michael Berens and Ken Armstrong
describes how new legislation intended to address prescription-drug
abuse in Washington state (ESHB 2876) has further exacerbated the
tension between two polarizing positions and has brought national
attention to an increasingly alarming situation in Washington. ["New
law leaves patients in pain," page one, Dec. 12.]

I had the privilege of serving on a committee at the Institute of
Medicine charged with creating a report on the state of pain care in
the United States, "Relieving Pain in America," released earlier this
year. One of the foundational principles of the report is that there
is a moral imperative to treat pain and that health-care professionals
are ethically obligated to treat pain to the extent of their
professional capacity.

To read that health-care professionals in Washington state are
refusing to treat pain, citing fears of the new legislation, or simply
giving up in frustration, is unconscionable.

Last fall, I was in Seattle researching the readiness and capacity of
individuals and organizations to develop a national plan to improve
care of those living with chronic pain, hosted by the Center for
Practical Bioethics. We were encouraged by the response to our
invitation to the meeting, but distressed when we realized that the
angst surrounding ESHB 2876 had the potential to hijack our agenda.

Since then, I have followed activities related to this legislation
more closely, and my initial concerns have only increased. The
incendiary language and personal allegations have made a bad situation
worse, distracting providers from truly caring for their patients and
policymakers from really listening to their constituents.

The above-mentioned "Relieving Pain in America" report describes pain
as the No. 1 public-health issue in the U.S., affecting at least 116
million people (more than those affected by cancer, diabetes and heart
disease combined) at an annual cost of $560-625 billion. The committee
calls for a comprehensive approach to treating pain that acknowledges
the unique nature of how pain is experienced.

There are a number of ways to treat pain - from medicine to massage,
spinal injections to surgery. Not all treatments work for all types of
pain or in all individuals (who typically have other chronic health
issues to manage).

Our current treatment model for pain is a failure for many who need it
the most. Opioids are not a panacea, or meant to treat all pain, all
of the time. In fact, opioids only reduce pain by about 30 to 35
percent in fewer than half of all patients. However, these modalities
are critically important to some patients, most of the time.

Policymakers in Washington state and others should carefully review
the IOM report and reconsider their current strategy. Cooler heads
must rise above the rhetoric, venom, judgment and blame to develop
practical solutions that do not contribute to unnecessary suffering.

Chronic pain cannot be "cured;" however, in most instances it can be
managed so that people can engage in a life that they feel is worth
living.