There is a growing national debate about two important life and death issues: the abuse of powerful pain medications and the treatment of chronic pain. The Centers for Disease Control and Prevention has classified prescription drug abuse as a deadly epidemic and the White House Office on National Drug Policy has declared the crisis to be a top public health priority. Meanwhile, a landmark 2011 Institute of Medicine report highlighted the challenges of pain in our aging society — a problem affecting 100 million people at a cost to the U.S. economy of about $600 billion a year.
To address these twin crises, it is critical that Congress fund programs within the Affordable Care Act that provide powerful opportunities to improve care of persons with pain and with substance abuse disorders. These two challenges intersect because many powerful pain medications, such as morphine and oxycodone (known as opioids), that are used to relieve pain for millions of Americans are also misused by others trying to get high or relieve distress. Such misuse can result in addiction or death.
But what has been missing from the public discussion so far is the fundamental reality that better pain treatment will reduce abuse of prescription opioids. To better treat pain, Congress must maintain funding for medical research despite budget proposals that would put it on the chopping block. If we do not find new ways to improve treatment of chronic pain, prescription drug abuse will continue to rise.
The simple equation is this: More pills used to treat pain equals more pills available for misuse. There is certainly room to improve opioid prescribing practices by doctors, and we can work to reduce diversion of opioid medications by raising public awareness and encouraging people to lock up their medications and destroy leftover pills. But until we as a society work to advance pain treatment options and support payment for more comprehensive pain management, doctors will use opioids to relieve suffering, and we will be challenged by prescription opioid abuse.
Federal agencies are scrambling to address prescription drug abuse and earlier this month a bipartisan group of eight senators called for a Government Accountability Office report to better coordinate interagency efforts. Drug Enforcement Agency-sponsored drug take-back days have made thousands of tons of unused drugs unavailable for abuse. The Substance Abuse and Mental Health Services Administration, the National Institute on Drug Abuse, and the Food and Drug Administration have all launched innovative education initiatives to improve prescribing. This month, an FDA panel recommended increased restrictions on one opioid drug and another panel heard testimony on a controversial proposal to re-label all opioids to limit their use in chronic pain.
A critical piece of the solution to reducing prescription opioid abuse, however, lies in improving options for treatment of both pain and addiction disorders.