US opioid epidemic: it’s harder to get the painkillers I legitimately needBMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j784 (Published 15 February 2017) Cite this as: BMJ 2017;356:j784
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The crackdown on the use of pain medications for people with legitimate needs contrasts with the citizen’s right not to suffer unnecessary pain. Electronic prescription and the proper use of analgesic drugs, in accordance with approved indications, are necessary measures that should not hinder the patient’s course of treatment but only eliminate the risk. Institutions should encourage physicians to use the medications properly, and doctors should agree with patients (or caregivers) the proper medication management (1).
A patient with chronic pain which does not respond to first-line drugs (NSAIDs, acetaminophen, etc.) and requires an opioid, should not be labeled as an illegal. The best therapeutic strategy involves a partnership between specialist, family doctor and patient. When these three actors agree on opioid-based therapy, no institution should stand in the fight against pain with effective drugs. Patients with severe osteo-articular chronic pain, or chronic cancer pain, very rarely are involved in misuse or abuse, so they should not suffer because of others who use drugs for non-therapeutic purposes.
In the general practice setting it is relatively easy to identify patients at risk of abuse and the medical skills are sufficient to educate the patient on the correct use of medicines (2). The wave of fear with regard to opioids coming from the US should not affect the good practice of other countries. The institutions should ensure the proper use of drugs (not only opiates), doctors must comply with the approved indications, patients must follow the doctor’s orders, industries facilitate abuse deterrent formulations.
The pain caused by the difficulty in obtaining an existing and effective therapy could be called "bureaucratic pain." Unfortunately for this kind of pain also an effective pankiller is useless.
1) Maremmmani I, Gerra G, Ripamonti IC, Mugelli A, Allegri M, Vigano’ R, Romualdi P, Pinto C, Raffaeli W, Coluzzi F, Gatti RC, Mammucari M, Fanelli G. The prevention of analgesic opioids abuse: expert opinion. Eur Rev Med Pharmacol Sci. 2015 Nov;19(21):4203-6
2) Leonardi C, Vellucci R, Mammucari M, Fanelli G. Opioid risk addiction in the management of chronic pain in primary care: the addition risk questionnaire. Eur Rev Med Pharmacol Sci. 2015; 19(24):4898-905
Competing interests: No competing interests