The editorial in this month’s Journal of Palliative Medicine: The Pendulum Swings for Opioid Prescribing by Charles F. von Gunten, Editor-in-Chief
I am about to turn 60 years of age. During my professional life as a physician, I have seen the pendulum of attitudes about the role of opioids for treating pain swing its full arc and back again. I only graduated from medical school in 1988! Why does the pendulum need to swing from one extreme to the other? Why can’t it settle in the middle, at rest, where it belongs?
It’s a good editorial and helps point out the capriciousness of how we prescribe based on the fears generated by junk science media (and political opportunism).
I particularly liked this point about the math – we see this kind of thing all the time in drug policy.
It’s a numerator and denominator issue. If you put the number of opioid addicts who were first introduced to opioids as prescription drugs before taking heroin in the numerator, and put all opioid addicts in the denominator you get a very large number. That large number (anywhere from 60% to 100% depending on the population studied) frightened everyone. But it’s the wrong math.
If you put all people with pain who are treated with an opioid and become an addict in the numerator, and all people treated with pain and an opioid in the denominator, you come up with a very small number, somewhere between 0.01% and 4% depending on the kind of pain you are looking at.