The Invisible Victims
Many official sources, including the National Institute of Health and the American Medical Association, estimate that 26% of the population suffers from chronic pain. The causes are as many as the number of chronic illnesses. This amounts to over 75 million people. Yet no one seems concerned that the vast majority of those who suffer, often bed-ridden from pain, cannot find a doctor who is willing to provide medical management for them. Tens of thousands of doctors are glad to try invasive procedures -- blocks, epidural steroid injections, trigger point injections, nerve ablations, even implanted opioid pumps and spinal cord stimulators, but few are willing to consistently prescribe the pain medications that can give quality of life back to these patients - and even fewer doctors are willing to titrate those pain medications high enough to be effective.
These millions of patients are invisible victims. They do not have a distinctive ethnic appearance. They have no loud voice in the media defending them. No Congressional investigation has recognized them. Instead they are lumped into the pejorative "drug-seekers" and treated as criminals when they seek help.
Physicians ignore them either because they, themselves, suffer from "opiophobia" - a kind of pharmacological racism, in which opioid medications are perceived as evil, bad, addictive, inducing abuse, diversion and cognitive impairment. While none of these things are true (in fact opioids are probably the safest medications doctors can prescribe), like racial prejudices, these beliefs stem from irrational beliefs, and defy factual education.
Doctors who are not blinded by Opiophobia, still avoid prescribing for pain patients. They fear condemnation, or the impairment or loss of their medical licenses (state medical boards continue to be the prime source of perpetuating Opiophobia). They also fear criminal prosecution in the on-going War on Drugs War on Doctors. Even though the evidence reveals that the vast majority of illicitly used drugs are diverted from manufacturers by theft or pilfering from shipping, the media promotes the myth that doctors are the prime source. Drug Warriors, in turn, use this myth to promote the propaganda that today's crisis is "the abuse of prescription medication" and the villains are the doctors who write the prescriptions!
All this lacks an iota of common sense. Common sense would tell us that there are a billion prescriptions written, filled and safely used, each year, and only 8,000 overdose deaths from half-witted kids consuming their parent's medications (with alcohol, cocaine, marijuana, benzos, and anything else they can get their hands on.) Common sense would tell us that demonizing doctors and legitimate prescription is insane and mindless. What doctor writes prescriptions that aren't medically indicated? Further, since when does limiting the number of prescriptions written deter adolescent and adult craziness? They simply turn to alcohol instead, (the most dangerous and toxic of ALL drugs) just increasing the volume? Is that going to reduce the number of alcohol-related deaths in teens and young adults? Sure it will.
So what about all the invisible victims? All of us will someday be one of them. So what about us? It's time to stop being stupid. The way we treat the invisible victims is the way we will be treated when the pain is ours. Throw out the pharmacological racism behind Opiophobia. Replace it with common sense and traditional pharmacological principles. Titrate to effectiveness and restore millions to a reasonable quality of life. Cease the demonization of the invisible victims. Teach the kids about drugs, so that ignorance doesn't kill them. Cease sticking our heads in the sand with the wishful thinking that drugs can be made unavailable. Hasn't the trillion dollars wasted on the "War On Drugs" for the last 30 years taught us anything? Wake up. We don't have to be stupid and gullible forever. Where did that trillion dollars go? And who wants it to keep flowing?
J.S. Hochman MD
Executive Director
The National Foundation for the Treatment of Pain
www.paincare.org
