Painful truth about opioid abuse

Congress and the administration are acting quickly – as they should – to address America’s prescription opioid crisis. But unless policymakers expand their approach, a lasting solution will fall short. 

Bills now moving through Congress focus on opioid misuse, prescription practices and treatments for people after they have become addicted. Indeed, these are serious problems that deserve immediate attention. But almost no one is asking why there is a need for people with chronic pain to take opioids in the first place. This is a shortsighted but hugely consequential omission. Until the nation tackles the underlying challenge of chronic pain, we will never end the scourge of opioid abuse.

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Research has shown that pain lasting more than six months can become a neurological disease in itself, like multiple sclerosis, causing measurable changes in the brain, spinal cord and peripheral nervous system. Chronic pain is also a pervasive -- and expensive -- public health crisis. The 2011 Institute of Medicine study, Relieving Pain in America, found that 4 in 10 American adults live with some level of chronic pain, at a cost of over $1.6 billion per day. Our nation's veterans know this all too well; a Department of Veterans Affairs study found that 80 percent of veterans returning from Operation Iraqi Freedom and Operation Enduring Freedom suffer from chronic pain.  

Despite this enormous human and economic toll, our federal health agencies spent a mere 4 cents per patient last year on chronic pain research. As a result, the field of chronic pain treatment is “strikingly deficient” in high-quality scientific evidence to assess risks and benefits, according to the Food and Drug Administration in its special report to the New England Journal of Medicine. We have almost no idea which chronic pain treatments work for whom, at what cost and at what risk, leaving clinicians and patients to grope in the dark. Most patients spend years consulting multiple clinicians and experimenting with a myriad of treatments until, if fortunate, they stumble upon a therapy that provides some relief without intolerable side effects. 

Pervasive, disabling chronic pain plus inadequate treatments plus scarce evidence – this is the recipe for the opioid crisis that now confronts us. 

Eliminating the inappropriate use of opioids will help. So will providing better treatments for addiction. But until high-quality evidence is available to help clinicians and patients make informed decisions about how to manage chronic pain safely and effectively with non-habit-forming therapies, reducing the supply of opioids will not, by itself, end this crisis. We must also reduce the demand for them. And that can only happen with a robust basic and clinical research effort that will help us to better understand the causes and mechanisms of chronic pain and to develop safe, effective, non-addictive therapies.  

If Congress and the administration want to put an end to this crisis, funding for critical chronic pain research has to be part of the solution. Incorporating this into current legislative proposals on opioid abuse is the comprehensive preventive and treatment approach that will yield a lasting result.     

Veasley and Cowley are co-founders of the Chronic Pain Research Alliance – the nation’s first collaborative advocacy initiative to advance a strategic pain research effort. Veasley has had chronic pain since surviving a car accident in her teens and Cowley developed chronic pain following a temporomandibular joint implant surgery.

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