Millions in chronic pain get relief from opioids

The Feb. 17 front-page article, “Heroin use spikes as painkillers get scarce,” quoted John Coppola, executive director of the New York Association of Alcoholism and Substance Abuse Providers, “If you are legally prescribed an opiate, there is no way that over a period of time you won’t become addicted to it … It’s a logical sequence.” I would like to believe he was misquoted, but I suspect he wasn’t. I also suspect that he meant to say “opioid” rather than “opiate.” The former are the manufactured derivatives (e.g., oxycodone and hydrocodone) widely prescribed for chronic pain and the subject of the article and common agents of abuse; the latter are the natural extracts of the opium poppy (e.g., codeine and morphine) and are not commonly prescribed long term.

Certainly “recreational” opiate/opioid users have a high potential for addiction and often move on to more dangerous drugs. But there are literally millions of people, including many seniors, who depend on opioids to manage serious chronic pain and never develop dependence or addiction to their medications. The new prescription monitoring system (I-STOP) will serve principally to inconvenience those chronic pain sufferers. There is an enormous body of research literature that shows that the risk of addiction in this mostly senior population is minimal and greatly exaggerated. But many seniors and their physicians are being needlessly frightened by these exaggerations and the laws inspired by them.

Jennifer Potter, PhD, MPH, of the Psychiatry and Anesthesiology Departments in the School of Medicine at the University of Texas in San Antonio, says: “The vast majority of people with chronic pain do not go on to develop an opioid addiction, so it’s important for patients to understand that if this medication benefits you, it’s not necessarily a concern. We can’t let our response to the rise in prescription drug abuse deny access to all people in pain who can benefit from opioids.”

Kevin A. Fox