What all the opioid epidemic coverage leaves out

The design of the human spinal column makes the Hindenburg look safe.  Picture 23 small dog biscuits stacked on each other with a little orange Jell-O between each pair.  What could go wrong?

Back pain is the leading cause of disability in the world.  But chronic, severe, intractable pain arises from many different illnesses and injuries.  I have evaluated dozens of chronic pain patients seeking advanced pain treatment.  The people I have evaluated are not addicts or drug-seekers.  They are not to blame for relentless pain, and a change of "lifestyle" will not cure it.  They are stigmatized medical patients, often forced to take management classes that don't help.  They know that their families are sick of hearing about their pain, so they try not to talk about it.  They wake up each morning hoping today will be a good day and fight having to admit that it is not.  They cannot talk, pray, or meditate their way free from the ogre that tortures them.

If there is a human right to medical care, surely that right applies first and foremost to alleviation of pain.  Anecdotally, the people who really need opioids are less likely to demand them than are the opioid abusers.  The patients who need them the most also most fervently wish they didn't have to take them and are most willing to take as little as needed to live as normally as possible.

"LGBT" demands are often presented under the banner of suicide prevention.  There is no political category or condition that compares to the rates of depression and suicide among people with severe chronic pain.  Most pain patients develop depression.  Research indicates that the rate of suicide increases anywhere from 30% to 80% in chronic pain patients.

There is a general principle of justice of the presumption of innocence.  As applied, it means that ten guilty people may walk free so that one innocent person is not unjustly punished.  The scientific and medical professions have to find ways to apply that principle of justice on behalf of people who need to take opioids to function in their daily lives.  Again, anecdotally, most skilled clinicians can tell the difference between patients who need to take opioids for severe pain and those who are just trying to soften the rough edges in their lives.  Unfortunately, drug companies profit most from mass distribution and over-prescription of these relatively inexpensive medicines.

If science and medicine rose to the challenge of pain care as it did in previous decades to the challenges of HIV, safer medications could be developed, as well as reliable protocols to identify patients who need opioids in the meantime.  But pain patients have no group identity or political voice.  They must not be deprived of vitally necessary treatment because other people abuse the medicine they need.

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