“Chronic pain is a common and complex condition characterised by persistent pain experienced on most days of the week. It affects 1 in 5 Australians aged 45 and over.” And there is a smaller extremely disadvantaged cohort who suffer severe daily, disabling & intractable pain requiring long term pharmaceutical therapy or pain relief, i.e. as part of an overall holistic pain management plan. [SEE REFERENCE BELOW]
https://www.aihw.gov.au/reports/chronic-disease/chronic-pain-in-australia/summary
WHY are chronic pain patients being told in recent years that opioids DO NOT work for chronic pain?
WHY are chronic pain patients being told they must be tapered from their mobility-restoring opioids?
WHY are many chronic pain patients being told opioids cause “hyperalgesia?”
WHY are chronic pain patients being told they will experience “minimal” or no adverse side effects when tapered? [This is NOT true in many cases…I am one of these people!]
WHY are chronic pain patients, especially LEGACY patients who have been stable on their current dose for years, being force-tapered against their will in ever-increasing numbers?
ANSWER:
- In my opinion, part of this is due to ignorance & irresponsible media reporting;
- Is a result of “new age” Pain Neuroscience theories & anti-opioid policies introduced to Australian pain management policy & practice since at least June 2020;
- AND MORE DIRECTLY because of fear of opioids or “opiophobia”, a flow-on effect of the mishandled “War Against Drugs” in America, where MEDICAL USE of opioids has been incorrectly targeted by their Federal Authorities, even though it is now known 84% of “opioid” overdose deaths are due to illicit Chinese fentanyl. [1. SEE REFERENCE BELOW]
“Unsupported or simply false conclusions have been so widely and repeatedly reported as fact that they have become generally accepted as scientific truth by scientists, politicians and the general public. Among the more flagrant mythologies:
• There is no evidence that opioids are of benefit for chronic pain;
• The dangers of opioids are too high for these drugs to be used in the routine practice of medicine;
• One dose fits all (and the sanctification of MMED);
• There exist many safer and better alternatives to opioids in the treatment of chronic pain;
• There is a very high probability that someone who take opioids for however short a time will develop opioid use disorder;
• Most heroin addicts started their lives of illicit opioid use with prescription opioids;
• The opioid crisis, since 2012 related almost exclusively to the use of illicit opioids that today account for 84% of opioid-associated mortality, can be addressed solely by constraining the use of prescription opioids.”
While we DO NOT have an issue with illicit fentanyl in Australia [YET!], contrary to deliberate reductions in opioid prescribing to new patients, & the de-prescribing mantra being pushed in legacy patients, opioids DO work for chronic pain. As per the WHO “Pain Ladder”, utilised for the last 30 years, the pharmaceutical protocol for the treatment of severe chronic pain, is as follows: “first try non-opioids (primarily NSAIDS, sometimes anti-seizure meds for neuropathy); then to try relatively weak opioids like tramadol; and finally to try stronger opioids like hydrocodone or fentanyl patches.”
FURTHERMORE, “It is now widely understood that forced tapering of patients to lower opioid doses or “cold turkey” withdrawal can be a direct cause of medical crises and sometimes patient suicide. Patient desertion is never ethically or medically justifiable. Used with appropriate oversight by a licensed physician, opioids are both safe and effective. Addiction or substance abuse are rare in medically managed patients.” [2. SEE REFERENCE BELOW]
https://www.futuremedicine.com/doi/10.2217/pmt-2022-0017
Our Policy Makers in Australia MUST have a good, hard look at the disastrous State of Affairs in America, where chronic pain patients in many States have been systematically under-treated or, worse still, untreated. AND even though overall opioid prescription rates have decreased drastically over there in the last decade [a decline of 60% from its peak in 2011], their National “opioid” overdose statistics continue to rise.
IN FACT, “another year of double-digit declines in prescription opioid use in 2020 is expected to further reduce use in the United States to levels not seen since the early 2000’s.” Many pain management clinics have also been forcibly shut, leading to tens of thousands of chronic pain patients being abandoned en masse, i.e. in reality, there is now an EPIDEMIC of untreated chronic pain! [SEE REFERENCE BELOW]
IF we are not careful, by incrementally adopting these harsh anti-opioid policies in Australia, our chronic pain patients will suffer the same devastating fate. To be crystal clear, we DO NOT have a “prescription” opioid crisis either, as our most recent Penington Report [2022] indicates our largest statistically significant problem is overdoses from POLYPHARMACY, i.e. NOT OPIOIDS ALONE.
IN SUMMARY, we are not about to lapse into an uncontrolled “opioid crisis” in Australia. We have a far greater hospitalisation rate & massive Health Burden due to alcohol & tobacco abuse. Our medical use of opioids is one of the most highly monitored in the world already, & is not in question. Comparing any false “opioid” crisis to our National Road Toll is disingenuous & unhelpful. Surely mental health & the risk of suicide is a far more urgent issue to address, as “More than 3,000 Australians died by suicide in 2020”, according to the Australian Institute of Health and Welfare’s (AIHW) latest report. It would be a tragedy if chronic pain patients were to increasingly become part of this statistical demographic, due to lack of appropriate pain relief. [SEE REFERENCE BELOW]
WHY do our Australian Medical Authorities have this blind fixation on prescription opioids, & continue to persecute severely disabled chronic pain patients??
Author: Kevin R James
Chronic Pan Patient Advocate and Writer. Medically Retired RN [B.Nurs.]
If only they would listen to pain patients who have a life due to opioid treatment and look at the history of these people and the resultant harm caused by forces tapering. Hyperalgesia is not a common thing certainly not in my case! Talk to those who experience this not people who have read things!! Great article Kev. 😊