Jacob Sullum at Reason calls out the NYT for a staff editorial yesterday. The editorial calls, in part, for stronger regulations on prescribing opioids:
To stem the number of new opioid users, lawmakers and regulators need to stop pharmaceutical companies from marketing drugs like OxyContin and establish stronger guidelines about how and when doctors can prescribe them. These drugs are often the last resort for people with cancer and other terminal conditions who experience excruciating pain. But they pose a great risk when used to treat the kinds of pain for which there are numerous nonaddictive therapies available. Doctors have been writing fewer opioid prescriptions in recent years, but even the new level is too high.
According to the Times, opioids “pose a great risk when used to treat the kinds of pain for which there are numerous nonaddictive therapies available.” Apparently it does not matter whether those “nonaddictive therapies” are equally effective, as long as they are “available.” This cruel prescription is based on an analysis of the “opioid crisis” that ignores important distinctions and grossly exaggerates the dangers to people who use narcotics for pain relief.
The Times is wrong when it asserts that opioids prescribed for pain “pose a great risk” to patients. The research indicates that the risk of addiction in people who take opioids for acute pain is quite low, something like 1 percent. Addiction rates are higher but still modest, according to most studies, among people who take opioids for chronic pain. The risk of a fatal overdose among patients with opioid prescriptions is even smaller—on the order of 0.02 percent a year, judging from a 2015 study of opioid-related deaths in North Carolina.
Here’s why this caught my eye today.
Regular readers will recall that in December 2016, I was involved in a relatively minor auto accident that resulted in a diagnosis of whiplash. After an MRI confirmed damage to particular vertebrae, I received extensive therapy and other treatment, including two injections directly into the inflamed discs in my neck. Nothing much helped. Doctors told me that I was just going to have to live with the pain.
Not a day goes by that I don’t feel the pain to some degree, though it is easy to manage when it gets to be too much. Why? Because my doc prescribes Vicodin for when it gets impossible to manage with over-the-counter pain meds. Because I keep my head buried all day long in the media, I’m hyper-aware of the problem with addiction to these substances. I talk to my doc about it regularly. I am a worry wart about addiction. I have been told on multiple occasions by both my doc and a nurse-practitioner working with the sports medicine guy who gave me therapy that I’m doing fine. I believe them, but I am also going to keep in close touch with them on it. I am lucky. I have never felt any kind of pleasure from Vicodin. What I have felt is relief from pain.
Last night, as I was brushing my teeth, I looked slightly to the left as I was talking to my wife, and felt a hot jagged knife slash from my neck to my shoulder blade. This was the nerve that was injured in the whiplash accident. I went to bed last night in significant pain, — ibuprofen was useless — and have been in significant pain all day. The only relief I get is from the Vicodin — and it’s not total relief, but enough relief so that I can function. If I didn’t have it, I would probably have to be in the bed all day, keeping very still. This pill makes it possible for me to do my job today, and it will for as long as the pain is so severe.
I have no doubt that this stuff is overprescribed, and that we as a society can do better. But I agree with Jacob Sullum: most people prescribed this stuff can handle it without becoming addicted. I would be very happy if I never had to use it another day in my life, but that’s not likely to happen. I texted my doc earlier today, told him about what happened last night, and suggested to him that the next time I get all angsty and neurotic with him about using Vicodin for neck pain, that he remind me of how bad the hot jagged knife to my neck felt that day in April, and how the only thing that gave me any relief was Vicodin.
How does the Times (or the Drug Enforcement Administration) know what level of opioid prescriptions is just right? It doesn’t, and therein lies the problem for patients who suffer from severe pain but are not lucky enough to be dying from cancer.