Monday, June 30, 2008
Pain Patients Sue State of Washington
Do doctors suffer from "opiophobia?"
The opium family of painkillers has always been a bane and a boon to the human race, as evidenced by nurses injecting morphine into agonizingly wounded soldiers, and street junkies selling the clothes off their back for another fix.
However, as I wrote in an earlier post, "The Morphine Scandal," the ironies fly thick and fast: In many cases, pain relief is the one thing doctors can offer their patients, and the one thing they withhold. Studies show that 70 per cent of patients present with painful conditions. Typically, non-addicted patients take morphine therapeutically for pain at doses in the 5 to 10 mg. range. But experienced morphine addicts regularly take several hundred milligrams a day—a huge difference.
Now, a lawyer for a pain relief advocacy group has filed suit against the state of Washington, claiming that overly stringent guidelines on prescription pain medications have had a negative effect on pain management across the country. Attorney Laura D. Cooper, who filed the suit on behalf of a group of Washington residents being treated for pain, said in an Associated Press article by Donna Gordon Blankinship that the state's regulations were comparable to setting a limit on the amount of insulin a doctor could prescribe for diabetic patients. Cooper alleged that the Washington standards have been used as guidelines by insurance companies and workman's compensation boards.
The AP article also quoted Siobhan Reynolds of the Internet-based Pain Relief Network: "The ramifications are enormous. You never see on a death certificate that people died of pain, but people die of pain all the time."
The lawsuit features an excerpt from a University of Wisconsin textbook on pain medicine, Bonica's Management of Pain, 3rd edition:
"Opiophobia is the syndrome of failure to administer adequate opioid analgesics because of the fear of producing addiction or toxicity. The etiology of opiophobia is multifactorial: Peer pressure (provider and patient), regulatory agency pressure (real or perceived), and lack of education on opioids and the fundamentals of pain management all contribute to its persistence.... All of these factors contribute to the underuse of these relatively simple and very effective medications, due to no fault of the patients. "
According to Drug Law Blog, the complaint "asks the court to declare that the state guidelines 'do not constitute enforceable law of any kind and should be stricken and removed from all state publications of every variety,' and seeks other additional relief, including an injunction against enforcement."
As for concerns about addiction, recent evidence for the heritability of opiate addiction looks strong. “Harvard did some really superb studies using a huge cohort of military recruits in the U.S. Army,” according to Mary Jeanne Kreek, a specialist in opiate addiction at Rockefeller University in New York. “Heroin addiction has even a larger heritable component than any of the other addictions, so that up to 54% of heroin addictions seem to be on a genetic basis or a heritable basis.”
Photo Credit: Opioid.org