My writing style can be harsh at times so I apologize ahead of time and would love a back and forth conversation on the subject with someone who has been in the field. . Patients are asking for more and more of these drugs partly because opioids eventually cause an increased pain sensation as the mu receptors become sensitized to being bombarded by opioid drugs. On top of this, the mu receptor which opioids target primarily also regulates euphoria which posses a risk of addiction even if this euphoria is elicited at a level not necessarily recognized by the person as the dopamine reward pathway may still be involved on some level with a direct triggering of the pathway by the mu receptor.
Second, opioids are over prescribed for chronic pain such as low back pain when they should first try alternative/proven therapies such as PT/acupuncture/a psychological evaluation with treatment if necessary as issues in the area can increase the severity of perceived pain. The Pharmaceutical industry also lobbies against the utilization of cannabis which has a potential to be used for chronic pain with a side effect profile so low that it’s acceptable for recreational use in multiple states.
I also don’t see the big conspiracy theory that doctors are making money off of these drugs.
No, you don’t get a dime for medication but you are required to follow to a set of rules/algorithms in regards to pain without question and without having other approaches properly explored due to the lobbying of the pharmaceutical industry. These algorithms are in place for safety for the most part but when there is an opioid issue perpetuated by our own medical industry, we have a duty to discover and utilize alternative routes of treatment without the same side effects.
Also, people seem to claim that “We didn’t know opioids were addictive.” This is blatantly false. They have always been controlled substances and categorized as having addictive properties via the FDA. I’ve worked with 100’s of doctors and I have not met one that didn’t know opioids are addictive and have abuse potential.
Yes, we all know that opioids are addictive; however, people don’t truly know until they experience it for themselves. The real issue is that there are alternatives when it comes to understanding and treating pain yet we as medical professionals just throw the traditional medications of our time due to tradition or a requirement to comply/appease patients because of the lack of research of other pain relieving compounds which leads back into the “Big pharma” conspiracy. I used to cringe every time I heard the phrase “Big pharma” but as I started to understand and even speak with patients, heroin addicts/recovered addicts and those who have chosen to self medicate themselves using cannabis I realized how broken the system is to be lobbying against the research and utilization of a substance that has helped people to function without the same side effects of opioids.
As a physician I don’t know exactly how I feel about this.
It’s time we allow that fund of knowledge to progress instead of being entrenched in the same old traditions and letting the pharmaceutical industrial complex limit the available treatments that physicians can prescribe.