I am glad Andrew Sullivan gave more than one perspective (see here and here) on how to balance pain relief and overdose risk in public policies surrounding opioids. (Even though he keeps using the destructive war metaphor, which can drive substandard thinking in policymaking).
I gave a plenary address at the American Academy of Pain Medicine about opioid-related public policies that might promote pain relief while minimising addiction and overdoses. I suggested five approaches that seem promising (if I had had time, I would have added a sixth, which is increasing access to naloxone).
What I was most struck by in spending a few days with pain medicine experts is that hardly any of them were at the screaming extremes of the policy debate. Lots of them are worried that their field has over-prescribed opioids. Rarely was this worry based in fear of the DEA; rather as doctors should be, they were worried that patients have been harmed.
Many were struggling with an dysfunctional regulatory environment in which it is almost impossible to get rid of excess opioids. A number told me they engaged regularly in illegal behavior, for example taking back opioids returned by patients who had had a relative die in hospice and who understandably didn’t want all the remaining pills lying around in a house full of teenagers (Yes, it is stupid that it should be illegal for the doctor to take the pain pills back in such a situation, but that’s where we are).
The seriousness and decency of the pain medicine professionals was impressive, which makes some of the more oversimplified media discussions of the issue all the more disappointing. Pain medicine professionals are looking for guidance in handling a tough problem. They are seeking thoughtful, rational advice from each other, from their patients and from those who follow public policy. I hope people who write about and analyze the issue in the media will respond with equal seriousness and balance.