No Relief in Sight – Jacob Sullum, Reason, 1997
Opiophobia and the Chilling Effect
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With the specter of prescription drug abuse looming large, health care workers stressed Friday that untreated pain in Montana is a public health crisis commensurate to that of addiction.
The message rang loud and clear as the American Cancer Society commenced its second annual Montana Pain Initiative Conference at Missoula’s downtown Holiday Inn, where more than 150 physicians, pharmacists, pain patients, lawyers, law enforcement officials, social workers and nurses gathered to discuss how to responsibly improve Montana’s pain treatment policies.
“Our goal is to achieve a state of ideal pain management,” said Kaye Norris, program director for the Montana Pain Initiative and an organizer of this year’s conference, called Pain Management Policy and Practice: A Balanced Approach. “Opioids are essential to pain management, but they can’t be the only aspect. We must incorporate physical therapy, massage, psychology, all in addition to pharmacology.” Rose, a 70-year-old Missoula woman and a pain patient for two decades, said she’s concerned pain treatment has been stigmatized by reports of addiction and fatal overdoses.
“I am not a patient who abuses my medications,” said Rose, who spoke to the Missoulian on the condition that her full name not be published, lest she be targeted for her painkillers. “I am very careful. But I feel guilty for even being a pain patient. You have to prove yourself at every doctor’s visit.”
Rose was diagnosed with rheumatoid arthritis in 1988, and works with a pain management team to effectively treat her chronic pain. Rose incorporates a variety of pain treatments into her life, and emphasized the benefits of nutrition, physical therapy, cycle therapy and education in addition to her opioid therapy.
While Friday’s speakers mainly focused on the best practices in pain management, both in Montana and nationwide, Saturday’s guests will discuss the legal challenges of responsibly prescribing painkillers while keeping the drugs out of the hands of addicts and dealers looking to turn a profit.
Montana Attorney General Mike McGrath, whose office co-sponsored the conference, touched on those issues Friday in his luncheon speech.
“Prescription drug abuse is a reality we must address,” McGrath said. “But as we consider implementing programs or strategies to reduce the abuse of prescription pain medication, we must ensure that those programs are designed with a full understanding of their potential impact on the legitimate use of prescription drugs.”
In an interview with the Missoulian, McGrath said prescription drug abuse presents a unique challenge as federal law enforcement agencies make it their highest priority.
“In terms of drug enforcement, it is like nothing we’ve ever seen,” he said. “It’s important for law enforcement to understand the legitimate concerns for pain management, and for providers to understand that abuse is prevalent.”
McGrath said he would like to see a better line of communication between the law enforcement and health care communities, and is committed to curbing the illegal diversion of prescription pain medications.
Statistics reported to the Montana State Crime Lab indicate that from from 2004 to 2007, there were:
187 deaths associated with Hydocodone,
202 related to Oxycodone,
175 from Methadone, and,
51 from Fentanyl
Mark Long, the head of the Department of Justice’s Narcotics Bureau, is scheduled to speak at the conference on Saturday, and will deliver an overview of the drug trends his agency sees in Montana.
Larry Riley, a Missoula attorney with the law firm Garlington, Lohn and Robinson, said he attended the two-day pain conference because he frequently defends physicians in medical malpractice cases and wanted to learn more about the challenges that physicians and patients face.
Dr. Randale Sechrest, medical director of the Montana Spine and Pain Center, said the number of primary care physicians in Missoula willing to treat pain patients has plummeted in recent years because doctors fear criminalization.
“The biggest challenge we face is legitimacy,” he told Friday’s audience, whose collective goal is to strike a balance by providing compassion and adequate drug therapy for patients with legitimate pain issues, while limiting the potential for abuse and misuse.
Even Dr. Nathan Rudin, a nationally recognized figure for his work and research in pain treatment, noted the potential for opiate abuse while promoting responsible pain management.
Alluding to patients who lie about missing medication in order to get refills, Rudin said: “Do you ever notice how dogs only eat opioids?”