In order to understand this dilemma, we must understand some history behind the use of opioids. For centuries, pain was treated with various tinctures of opium. Morphine was developed in 1803 and, when the hypodermic needle was invented, it became widely used to treat soldiers with traumatic injuries. With increased availability, opioid addiction became more prevalent. In the 1890s, heroin was developed by Bayer (yes, Bayer, the aspirin manufacturer) and briefly promoted as a “less addictive” medication until it was found to be highly addictive and subsequently banned.
For over 50 years, addiction concerns led to under-treatment of painful conditions such as cancer, end-of-life pain and even acute pain. Then in the 1960s, a movement was sparked by cancer patients to increase access to pain medications. That sentiment continued through the 1990s as the pharmaceutical industry churned out multiple synthetic medications with different pharmacologic profiles.
Sales of opioids quadrupled between 1999 and 2010 as physicians began using them more abundantly in chronic non-cancer pain patients. OxyContin became a household name. The rise in catastrophes associated with these medications followed suit, and Nevada exhibited no immunity to this siege. In response to this, many physicians are now fearful of prescribing opioid medications to patients in severe pain.
History tells us that accessibility to these medications leads to improved treatment of pain and suffering but at a social cost of increased abuse and addiction. Pain medications are used appropriately by a majority of patients. They, at least anecdotally, help ease pain and suffering in patients who have already tried and failed conservative and surgical treatments.
So how do we move forward from here?
To alter the course of this epidemic, it will require a combination of affordable, non-opioid alternatives, abuse-deterrent opioid formulations, rigorous patient screening and strict monitoring of both doctors and patients.
Hopefully, as the science of pain advances, we will have more objective information to help guide our treatments. We must continue to work toward a middle ground where prescription opioids are available when needed but are safely kept out of the hands of those who might succumb to them.