If Not Opioids, Then What?

New opportunities: looking for nonopioids. Some make a lot of sense. Some are uninspiring: when I think about the world relying on them, and them alone, as opioids become harder and harder to get. That’s the world we presently live in. However, prescribing is going down, and the death rate is going up. We’re not doing it right. We need more clinical sense in what we’re doing in our opioid policy.

Personal experiences:

• Some opioids got tied to patient satisfaction scores. As the person in a clinic who often had to tell a patient, “We’re not going to abandon you, but we are abandoning opioid therapy because you’re losing control and it’s getting dangerous. And I don’t want you to wake up dead.” Even expressing as much concern as I can muster, patients would get irate.
• One of my favorite things to say was, “I don’t care if you sue me, threaten me, or how irate you get with me, you’ll never convince me to do something that I think is harmful to you.” That often took some of the steam out of it, but it didn’t help my patient satisfaction rating.
• What’s often forgotten is the beneficence of the opioid movement. People were suffering. Multimodal pain clinics were getting shut down by payers and for other reasons. One of the most viable models of treating pain was disappearing. Lots of other drugs existed. It’s not like pain patients were fairing so well.
• The beneficence idea is it grew out of hospice…
  • Take pain seriously
  • Communicate about it
  • Ask about it
  • Try your best to apply your skill and do something about it
  • If everything doesn’t work, don’t blame the patient, keep trying. Call in an expert. People shouldn’t suffer.
• That’s often forgotten now, when people just want to tell stories equating every drug company with a drug cartel, and want to highlight the evil, they miss the beneficence.