Guilt by Association, But Not Without Hope

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By R Carter

Guilt by Association

As I research how opiate overdose death data is collected and reported the more impressed I am at how biased the rhetoric is. CPP’s are lumped into all research done on the opiate crisis for only one reason; they are prescribed opiates for a medical condition. Thus making the default assumption, prescription opiates are a major contributing factor to the opiate crisis. The data doesn’t support this conclusion, and the CDC says the data they have for chronic pain is also inconclusive. More importantly, a good deal of the data contradicts this conclusion, but it appears no one in policy making positions is listening, nor do they want us to hear this.

Data collected by the State Mental Health Organization of Ohio shows a steady drop in prescription opiate overdoses since 2012 and a marked drop since 2015, with a corresponding rise in opiate overdose deaths between 2015 and 2017 from illegal opiates of more than 600%. Yet even in Ohio, you will not see this fact in the headlines of press releases by state agencies which monitor the opiate crisis.

Drug Overdose Rate by Opioid Category 1999-2017-img
Source CDC

While monitoring meetings of the State Medical Board of Ohio I am aware of this agency’s efforts to cobble together a set of prescribing guidelines for chronic pain management, to date that effort has failed to produce anything. Worse still, of those proposed guidelines I have read, most fall in line with the CDC’s position on chronic pain management, signaling a mindset which remains blind to the data collected by other agencies in the state of Ohio.

For the moment, the status quo seems to suffice and that position is simply this. Opiates are bad and need to be eliminated. This prevailing point of view has now spilled over into prescribing guidelines for opiate naïve patients who undergo elective surgery, with some hospitals advocating the elimination of 80 percent of the opiates used in treating elective surgery patients.

Not Without Hope

While 80% reductions in opiates seems outside the realm of common sense, after thinking about it, it may in fact present a blessing in disguise. Common sense says, no one wants to endure weeks of pain after having an elective surgical procedure. So with an average of 130,000 surgical procedures performed each day in the U.S. how long before those, unhappy with their pain management, simply remain silent on these issues?

For this reason, I believe we are beginning to see the end of this insanity, or at least the seeds of its undoing. The radical fringe, who have advocated for solving the opiate crisis by taking opiates away from everyone, will eat their own words when they too become a member of the no opiate policy. Or until they too have had a hysterectomy, hip replacement or whatever.

I have no doubts anymore that this will all come to a head in the next five years or so. Joe American will speak up and the tide will turn. From that we should see the NIH’s return to funding research into the long term effects for the use of opiates in treating chronic pain. And I believe that research will tell us what we’ve known for the last one hundred years, that opiates have a beneficial role in returning some individuals to healthy and productive lives.

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