NEGATIVE SIDE EFFECT

Drug Abuse Series Could Hurt People in Real Pain

I commend the Herald-Leader's exhaustive efforts examining Eastern
Kentucky's drug-abuse problems. The recent "Prescription for Pain" series
reminded readers of the severity and seriousness of the region's cultural
and societal characteristics that fuel this public health crisis.

Despite that good work, however, the Herald-Leader's coverage -- like other
media reports across the country -- can have unintended and unfortunate
consequences.

Such coverage elsewhere has negatively affected thousands of unseen chronic
pain patients whose heroic stories of physical and mental struggle,
treatment, recovery and rehabilitation too often go untold.

According to the American Pain Foundation, 50 million Americans, including
thousands of Kentuckians, live with chronic, debilitating pain from severe
muscular or skeletal conditions, cancer, automobile accidents, fires and
work or sports injuries.

Unfortunately, these pain sufferers must also endure an ongoing drumbeat of
one-sided news coverage that demonizes the legitimate, legal and regulated
medicines that many patients say have given them back their lives. Reports
that focus on the world of drug abusers who misuse medications and on drug
dealers who divert medications from their proper use do an unintended
injustice to tpain sufferers and those who treat them.

Just as chronic pain and its ramifications began to be understood and
properly treated by the medical community, repeated news stories of
prescription drug abuse changed the playing field. Instead of feeling a
part of the pain-treatment revolution of recent years, medical
professionals have feelings of siege, danger and uncertainty. Many doctors
feel pressure not to prescribe the treatment they know is best for their
patients.

Do we have new data to suggest that such opioid medications are not safe
and effective when taken as prescribed? No. Has one-sided journalism caused
a degree of paranoia? Definitely.

A rational understanding of Eastern Kentucky's prescription drug abuse
problem requires an exploration of the remarkable coming together of
distinct forces at a particular time and place. The medical revolution in
diagnosing and treating chronic pain converged simultaneously in Eastern
Kentucky with the arrival of more effective pain medications.

At the same time, Eastern Kentucky is an area largely without access to
illegal drugs that are more readily available in other parts of the nation.
The region is riddled with poverty and 20 percent unemployment -- a
population largely comprised of former hard laborers prone to suffer from
chronic pain.

Prescription drug abuse and diversion was a reflection of self-medicating,
loss of hope, feeding one's family and escape-seeking run amok. Thirty
years ago it was Dilaudid; 20 years ago it was Vicodin; 10 years ago it was
Percocet. Today it is OxyContin. In 10 years another controlled substance
will take its place.

Stories that oversimplify the risk of addiction can scare legitimate pain
patients. If a homecoming queen can become addicted just by being exposed
to a drug for pain from an accident, anyone can, right?

Stories that speak of lives devastated by mere exposure to a drug make it
sound as if addiction is simply the result of that exposure rather than the
complicated interaction of taking certain substances and that person's
genetic, psychological, spiritual, social and familial circumstances.
People without specific risk factors do not usually get addicted through
mere exposure to pain medications.

It appears that the media attention to this problem and the resulting
societal and regulatory pressures are causing the pendulum to swing away
from the legitimate and appropriate use of opioid medicines.

This, however, is not always visible in the number of prescriptions written
or in the sales of the products. Pain specialists write the overwhelming
percentage of opioid prescriptions, so when primary care and other doctors
stop prescribing, the impact of the change is not always obvious.

It is, however, obvious to their patients.

When these patients are forced to visit pain clinics so someone will
prescribe opioids for them, they take up precious slots that are better
reserved for patients who truly need specialist-level care -- and everyone
suffers.

What can we in the pain-treatment community do?

First, we must stay the course. Medical professionals must not take steps
backward from the progress made in diagnosing, managing and treating pain.
Doctors must continue to respect the self-reporting of pain. Patients must
demand proper pain care.

There are positive developments on the horizon. Pharmaceutical companies --
such as Purdue Pharma, the manufacturer of OxyContin -- are exploring
innovative new medicines that will treat pain, but not be attractive to
abusers.

Kentucky government is looking to enhance our innovative
prescription-monitoring program, KASPER; and surrounding states are looking
to our state as a model to develop similar programs within their borders.
New resources and efforts in medical education are capitalizing on new
technology and the Internet to expand pain-management education.

We have learned that creating a major change in medicine, law and society
is a long process to which we must be committed for the long term. We can't
let media reports and paranoia curb the tremendous gains and progress we
have made in the ongoing pain-treatment revolution.