When I signed on board Hospice Inc., in New Haven, Connecticut, in 1975 as a bright 25-year-old who wanted to do some good in this world, the challenge put to me by Florence Wald, a former dean of the Yale School of Nursing who had organized the young organization to build the very first inpatient hospice in the United States (which she succeeded in doing five years later in neighboring Branford), was that we had a mission to reshape public attitudes toward the control of pain in America.
Florence Wald’s experience in the U.S. healthcare establishment was that physicians here were much less willing to use powerful painkillers like morphine in treating the terminally ill than their British or European counterparts because of a misplaced fear of addiction. “Terminal cancer patients don’t get addicted to painkillers,” Florence told me flatly, “nor do they experience euphoria from the use of painkillers. This is a perception that is just dead wrong, and we need to change it. We can treat pain more effectively, and we have a duty to do so.”
In the third of a century since then, the burgeoning hospice movement in America has brought comfort and freedom from pain to millions of Americans facing terminal disease, and eased the predicament of their families, who often suffer as much if not more than their dying relatives. Public attitudes toward painkillers have also evolved dramatically, including the views held by America’s physicians, who have become more willing to condone powerful opioids when they are needed to control pain.
But there may have been a downside to this change in perception and prescription.
Barry Meier is a reporter for The New York Times who has written extensively and eloquently on problems associated with prescription painkillers, a little-discussed epidemic that began about twenty-five years after I concluded my two-year stint with hospice. In June, Meier published an ebook with the “Kindle Single” program at Amazon called A World of Hurt: Fixing Pain Medicine’s Biggest Mistake which explores this chapter of the American prescription painkiller story, which is simply this: There is a growing body of evidence that these pain-numbing drugs, along with causing an epidemic of abuse, are often quite ineffective in treating long-term pain. They may actually be harming patients.
Barry Meier’s first book, Pain Killer: A ‘Wonder’ Drug’s Trail of Addiction and Death, focused on a better-known story about painkillers, namely the pandemic of abuse that occurred surrounding the powerful drug OxyContin, especially by teenagers seeking a new high.
Barry Meier was interviewed by his paper on June 23, 2013, and elaborated on what he was trying to do with his eloquent writings on painkillers, why doctors and patients resist giving them up, and some of the side effects of these drugs.
“A decade ago, drug companies and medical experts launched a ‘War on Pain’ that promoted the widespread use of powerful narcotic painkillers for common conditions such as back pain,” Meier told the Times. “Specialists claimed that a ‘bright line’ separated the drugs’ benefits for patients from their dangers when abused on the street by young people and others.”
Today, Meier says, many of those same experts who once endorsed painkilling drugs have had a change of heart. They have reached the revised conclusion that the opioid boom “ranks among medicine’s biggest mistakes.” They cite recent studies that tie long-term use of these drugs, particularly at high doses, to addiction, dependence, reduced sexual drive, lethargy and other problems. Based on stories of researchers, patients and others, A World of Hurt highlights how treating pain differently can benefit both pain patients and the public’s health. “The promise that high-powered drugs could provide a cure-all, the key to winning the ‘War on Pain,’ was an empty one,” Meier asserts.
Meier’s critics will argue that the compelling anecdotes and stories he puts forward, along with references to various studies, don’t make a case strong enough to deprive patients who suffer from pain from the medications that allow them to manage it. No one claims pain control is perfect, and the jury is probably not in yet when it comes to assessing the level of abuse or misuse. More work will need to be done. But I see the pendulum swinging the other way today than I saw it moving in 1975.
What is the answer? Perhaps a better scientific understanding of the brain mechanisms of pain will help us uncover new medications that act differently than opioids? Meier will surely find fertile ground for continued writing on this subject for many more years. In the meantime, he has made a significant contribution to public understanding of pain and pain control, and his new ebook is a marvel of clarity and concise writing. I heartily recommend it.