Reduce Opioids Deaths — and Chronic Pain

By: David Leonhardt Associated Press

Chronic pain exacts a terrible toll on human well-being. More than 10 percent of Americans suffer from pain every day, according to the National Institutes of Health, and many more suffer from it sporadically. Academic research has found that pain is one of the biggest sources of unhappiness. Pain sufferers, as the economist Alan Krueger told me, “typically lead more isolated lives, work less, and have lower life satisfaction.”

The high cost of chronic pain makes opioid use a much more complicated issue than the headlines often suggest. It’s certainly true that opioids have become a public-health crisis, playing a role in some 50,000 overdose deaths in the United States last year. But opioids also do a lot of good. For many pain sufferers, opioids are more effective at treating pain than any other treatment.

So how can this country take aggressive action to reduce opioid deaths without also denying medication to people who benefit from it? German Lopez of Vox has written the best overview of the topic that I’ve yet read. The article is billed as a guide for “how to fix America’s painkiller problem — without leaving pain patients behind.” It inspired me to do some of my own reporting on the topic yesterday. My main takeaways:

  • Strict limits on opioids — such as on how long a doctor can prescribe them — are a really bad idea. (Oregon has even considered cutting off Medicaid patients from opioids, which would be especially cruel given that chronic pain is more common among the poor than the rich.) Advocates for such limits like to point to research showing that opioids are often or even usually no more effective than other treatment. But “usually” is very different from “always.” As Lopez writes, “Pain is highly individualized.” For many patients, opioids are indeed the most effective treatment.

  • But there are many other ways to reduce opioid use. Nudges can work — for example, informing doctors that one of their patients has died from overdose seems to affect doctor behavior. (Margot Sanger-Katz of The Times has more on this.) So can changes to default practices — such as giving surgery patients only three days of pills.

  • And our medical system could do much more to encourage other forms of treatment — be it exercise, physical therapy, other therapy or many other possibilities. “The problem is, there is no money to be made from these nonpharmacological interventions,” Arthur Stone of the University of Southern California told me. And there is no powerful industry — like the pharmaceutical industry — lobbying for insurance coverage of these treatments. Employers and policymakers would likely need to intervene.

If you’re interested in the topic, I recommend reading Lopez’s full piece. I realize that opioids aren’t the biggest news story this week. But there aren’t many issues that have a bigger effect on Americans’ daily lives than the intersection of opioid overuse and chronic pain.

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