The U.S. is in the midst of a pressing public health epidemic with broad reaching negative ramifications; an epidemic of such significant proportions that it is one of the worst in U.S. history. Per recent data from the National Institutes of Health (NIH), this epidemic affects millions with approximately 9.4 million using opioids for the management of long term pain with 2.1 million addicted. It is also noted that some reports estimate over 100 million people in the U.S. suffer from some form of chronic pain, which makes them even more prone to developing an addiction to these powerful painkillers. Despite our not having concrete scientific data to substantiate utilizing them for the management and treatment of chronic pain, we still continue to prescribe at alarming rates e.g. per recent IMS data as of the year ending September 30, 2014 in the U.S., we prescribed 123.3 million prescriptions for hydrocodone/acetaminophen (generic vicodin). If we are in the middle of one of the worst epidemics in U.S., history how can we possibly justify continuing to write prescriptions for one of the primary offenders, especially at these alarming numbers?
Per the recent July 4, 2015 Times Magazine article: “Part of the problem, according to the NIH, is that doctors have no scientific certainty over when and whether it’s safe to use opioids to treat long-term pain. “There is insufficient evidence for every clinical decision that a provider needs to make regarding use of opioids for chronic pain,” a NIH panel on opioids concluded earlier this year. The American Academy of Neurology last year concluded that the risks of long-term opioid treatment for headaches and chronic low-back pain likely outweigh the benefits.” “There were no reliable studies proving opioids worked safely against chronic pain, because it would be unethical to require pain patients in a control group to go months on end without medication.
Given the extent of this problem and the havoc it is causing millions, their families, our healthcare system, Military and Government, these justifications are no longer acceptable. As clinicians and scientists, we are obligated to protect the interest of the public and provide them with the best chance for optimal health. We are also obligated to provide safe, effective treatment options, and in this case, we are failing miserably.