Michelle
Decennial ME/CFS patient
- Messages
- 172
- Location
- Portland, OR
The relevance to opioids is that anyone who has been on either side of this issue: either pain sufferers or pain medicine physicians has observed the unequivocal fact that opioids relieve pain. This has been known for millennia! Of course there are special cases where opioids don't help much, and there are people who cannot tolerate them for various reasons, and there is a subset of people who find the effects of opioids addicting. But to argue that we don't know if opioids work for pain in the long term because of lack of studies is absurd. Just ask a patient that has used them successfully for decades - like me. Or ask a pain medicine doctor (I also am fellowship trained in pain management), who has observed hundreds of patients successfully managed for years with opioids, with little adverse result.
No substitute for opioids has come close in efficacy or safety.
I've been absolutely dumbfounded to hear so many reasonably intelligent people (including a certain ME/CFS writer and former PR member who I otherwise very much respect) repeat such ridiculous nonsense as "opioids don't work." bang-head: Emperor. Naked.) For some people, sure they don't. But for so many others -- including people with FMS -- they very much do. It's the reason so many doctors so quickly prescribe them! And as you correctly point out, NSAIDS have very serious side-effects, as does acetaminophen, and anti-seizure meds (suicidal ideation), and yes, even the tricyclics. And, of course, what do you do for people on Coumadin? We can't take NSAIDS...
Without useful alternatives to opioids there is no basis for making changes. Like prohibition, I suspect this is primarily ideologically driven, and indeed is a modern continuation of prohibition thinking.
I keep trying to figure out what's behind this sudden spasm of pearl-clutching about opioids. To be sure, many state Medicaid programs required methadone be the first drug of choice when initiating long-acting opioid therapy (including mine) and there followed a spike in OD deaths as a result because methadone has such a long half-life. Prescribing benzos and opioids has not helped matters any either. Add in the historically low price of heroin on the streets (thanks, Taliban!) and systemic economic blight (thanks, neoliberalism!) and an increase in OD deaths follows (though you are very much correct that heroin is indeed being used as a pain treatment modality by many).
But it does appear that certain groups have viewed these unfortunate turn of events as an opportunity to hijack any sane or rational discussion about opioids and CDC is letting itself be among the hijacked. The DEA certainly uses it to push its prohibitionist thinking. But the role of the BPS folks in all of this, imho, has not received enough attention. They are pushing a "CBT not opioids" agenda. Why it can't be both is beyond me. While I have certainly found CBT helpful in coping with pain, I have certainly found Mindfulness Meditation also helpful in mitigating some of my pain, I certainly believe that psychosocial approaches to pain treatment have an important adjunctive role to play, BUT they will never be able to replace opioids or pharmacological treatments. I get the sense that the BPS folks see this as a golden opportunity to convince insurers to replace opioids with CBT programs (though how effective they will be with insurers remains to be seen). And that they perpetually have a chip on their shoulder in which they are trying desperately convince the rest of medicine that they do real medicine too. The sad thing is, they do but are never satisfied with the limitations of that medicine.