Pain Care Advocacy in an Era of Opioid Abuse (Part 1)
By Jennifer Van Pelt, MA Social Work Today Vol. 12 No. 5 P. 16
Pain medication abuse is affecting individuals with legitimate needs to manage chronic pain. Learn how social workers can advocate for them.
Prescription drugs now rank second after marijuana as the drug of choice for substance abuse, surpassing cocaine, heroin, and other illegal street drugs. Media headlines, celebrity doctors, and popular TV shows regularly denounce the “painkiller epidemic,” “prescription drug trade,” and “war on prescription painkillers.” Lost in these negative media messages, however, is the fact that the majority of these abusers were not prescribed opioids themselves but rather buy or steal them from others who were prescribed opioids for a medical condition (Manchikanti, Fellows, Ailinani, & Pampati, 2010).
Prescription pain medication addiction has been referred to as a public health crisis in the media. Statistics from the National Institute on Drug Abuse (NIDA) indicate that prescription drug abuse has increased dramatically, and opioid pain medications are now abused by more than 5 million Americans, making this drug class more likely to be abused than prescription antidepressants, sedatives, or stimulants. According to NIDA statistics, 15,600 deaths in 2009 were attributable to prescription pain medications.
But for individuals who legitimately require and benefit from opioids, the undertreatment of chronic long-term pain is a problem unrecognized even by those in healthcare due to the focus on opioid abuse. “The media generally does not report the issues around opioid use with accuracy, neutrality, and critical thinking. The tide has shifted from demonizing pain medication to demonizing people with pain, continuing the suffering of millions with untreated or undertreated pain,” says Yvette Colón, PhD, MSW, a psychosocial specialist at The MetaCancer Foundation.
Opioids typically have been more accepted in cancer care, especially for pain in the terminally ill, and prior to the 1990s they were rarely prescribed for chronic noncancer pain, even when pain was severe and long-term. After some cancer pain research studies showed that most patients did not experience addiction issues and the American Academy of Pain Medicine and the American Pain Society endorsed opioid use for chronic noncancer pain, opioids began to be more commonly prescribed (Schug, Zech, Grond, Jung, Meuser, & Stobbe, 1992; Manchikanti et al., 2010; Fauber, 2012). (See sidebar on page 20 for more information.)
“Unfortunately, this research coincided with increased rates of prescription pain medication abuse and media attention to it,” says Deborah Barrett, PhD, MSW, LCSW, a clinical associate professor at the University of North Carolina at Chapel Hill School of Social Work, a private practice psychotherapist, and the author of Paintracking: Your Personal Guide to Living Well With Chronic Pain. Barrett sees the issue from both the social worker and the patient perspective: She has lived with the chronic pain of fibromyalgia for almost 20 years.
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