Sep 12, 2016
Opioids are indispensible for the treatment of pain. Despite centuries of philosophical debate about whether or not to use opioids to relieve suffering, and a more recently accelerated search to find alternatives, nothing has changed this central tenet.
IASP’s leadership in opioid-related policy, ethics, research, and clinical practice has never been more important than now, when the over-prescribing of opioids for pain has produced an “epidemic” of abuse and misuse in the United States and a trajectory towards similar problems in other developed nations. What can we learn from the overuse seen in developed countries? And how can we rectify underuse and unnecessary suffering in developing nations?
At a special session at the 2016 World Congress on Pain, several experts will describe the experience of their own countries, and a panel will discuss how to make opioids accessible for those in need, while protecting pain patients and the general public from the well-known opioid harms.
Now is the time to challenge the idea that opioids must be made freely and widely available, or people will suffer. The past few decades of widespread prescribing of opioids for pain in the United States and other countries has presented us with an unprecedented level of data from which we can begin to understand which pain conditions are helped and which are not, which patients benefit and which are harmed. Recent scientific advances help us understand why opioids do not always relieve pain, why and how tolerance and dependence interfere with the ability of opioids to continue providing relief over time, and what makes it hard to give up opioids even when they are not providing pain relief.
Advances in pharmacology have provided us with new classes and formulations of opioids that promise to cause less harm. With careful patient selection and a better understanding of opioid mechanisms, opioids can be used to the benefit of those in need, while avoiding the situation of the past few decades when prescribers who knew no better were guided by uncritical proselytizers.
Nobody is pretending opioid issues are easy; they are not. Humans have long grappled with moral issues regarding the use of addictive substances to relieve pain and suffering – soul-searching that will likely continue. Likewise, governments have long grappled with protecting their communities from misuse of opioids while maintaining access for the treatment of pain.
But our knowledge is now vastly improved. Increased production of both licit and illicit opioids has come hand-in-hand with better information at many levels. What has been learned should enable us to come up with more nuanced solutions based on proper patient and drug selection, better education of prescribers and patients, and a more open and effective exchange of ideas.
The special session on opioids is perfectly timed to revisit an old issue in light of new events and new knowledge. It is intended to produce a lively, thought-provoking discussion that triggers country-specific initiatives to make opioid treatment of pain safe and effective – a necessary basis for their availability.
Anything you would like to see happen in your country? If you plan to attend the session, please submit your questions so that we can present the most common concerns and ideas to the panel.
-- Jane C. Ballantyne is professor of Anesthesiology and Pain Medicine at the University of Washington in Seattle.