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Providing straightforward information pertaining to drugs, drug use & drug policy. The Grey Pages promotes drug-related literacy and advocates a system of viable and tolerant drug policies. This is my personal collection of commentaries, essays, tid-bits, and other such writings on everything ranging from drug use, drug policy and drug-myths, to drug-science, addiction, human behavior, and the workings of the human brain. I started this blog with a particular focus on opioids, and over the past year have found my interest gravitate toward the intriguing, ever-changing world of designer intoxicants (i.e. "research chemicals" or "designer drugs").

Friday, February 10, 2012

The Reasoning Behind The So-Called "War On Pain Management"

Analyzing the Primary Concerns of Those Speaking Out Against Casual-Access to Opioid Therapy: 


(Key Search Terms: chronic pain, opioid therapy, war on doctors, pain patients, chronic opioid use, dependence, long term effects, toxicity)

Summary:

There is an increasing level of social and medical skepticism surrounding the liberal utilization of opioids by doctors, particularly in non-terminal patients. Among their primary concerns:

A scarcity of applicable evidence - i.e. A lack of long term studies to support this practice (Though critics conveniently fail to mention that this is because the FDA does not require 'chronic' clinical studies to prove that a drug actually works; therefore, why would a drug firm waste the money?)

Existing research can not be generalized to everyday clinical practice in the general population; this especially applies to settings such as general practice & primary care.

An increased incidence of opioid "abuse" and addiction which has accompanied an increased utility of opioid therapy for non-cancer pain over the last decade. An increased incidence of opioid related overdose deaths (note: "opioid related death" includes any drug related death attributed to opioid toxicity alone or in which opioids are among multiple drugs detected)

Let's Analyze These Concerns:

Accounting for virtually all of the actual 'evidence' which critics feel justifies more regulation and less access to these drugs is, strictly epidemiological or statistical studies of addiction and mortality rates, or the scarcity of evidence itself to support opioid therapy in the general population - the former of which reflects on sociological and behavioral trends as opposed to the inherent properties of opioids themselves and the effects of their use on health. 

In terms of the pharmacological and medical research regarding the physiological or psychiatric impact of opioids themselves, there is actually no meaningful evidence of damage or toxicity with chronic opioid use. In fact, aside from the unthinking social disapproval toward the idea of narcotic dependence itself, there is no evidence to suggest any significant long term deterioration of health caused by chronic opioid dependence. Likewise, the major harms associated with actual chronic opioid addiction are predominantly by-products of the casual lifestyle, poor hygeine, and improper drug-administration techniques common among of the addicted population; rather than due to any inherent properties of the drugs themselves.

On the other hand: the primary toxicity risk of the opioids themselves is the acute risk of overdose, manifesting as potentially fatal respiratory depression. Aside from acute toxicity risk, which no drug is without, the adverse effects of chronic use of opioids typically consist of addiction and dependence, constipation, low testosterone, decreased libido, emotional changes, and a greater vulnerability to contagious illness. Objection to opioid therapy based on these adverse effects is reasonable - assuming it is based on a lack of comparable potential benefit compared with these risks. There could also be a reasonable objection made to the use of chronic high dose opioid therapy in the treatment of relatively minor symptoms. Although the choice should ultimately rest with the affected individual, it could be argued that such unnecessary use of potentially dangerous drugs by the order of a respected physician should not be discouraged.

Due to a lack of evidence of any significant physiological damage directly attributable to chronic opioid use or even "abuse"; critics tend to make use of hyperbole (i.e. pseudoscientific arguments which appeal to emotion and shock value), citing the relation of the morphine-derived opiates to heroin. The "synthetic heroin" hyperbole, though it is misleadingly used out of context and omits key clarifying points, it is largely effective when the public mindlessly accepts at face value the underlying popular perception of heroin as some sort of uniquely toxic & mystically powerful entity. Though there is a wide spectrum of functional properties which sufficiently distinguish each and every drug of the epoxymethylmorphinan family (i.e. morphine family) from its counterparts, more relevant to consider is that there remains a large disconnect between the actual pharmacological and toxicological nature of heroin and the popular mythological perception of the drug; which in fact when used chronically, arguably poses less risk to physiological health and function than does alcohol or tobacco, perhaps even fried fast food. Serving merely as a lipophilic prodrug for morphine, the effects of heroin are essentially the effects of morphine itself. For more detailed info on the actual dangers of heroin use and heroin addiction, read the literature on the 19th/20th century so-called opiate "epidemic" - The 'Consumers Union Report on Licit & Illicit Drugs' remains the textbook standard for University curriculums.

Historical Clinical Excerpts Regarding the Opioids:

"The addict under his normal tolerance of morphine is medically a well man." (Dr. Walter G. Karr - University of Pennsylvania - Light-Torrance Study 1932.)

"it has not been possible to maintain that addiction to morphine causes marked physical deterioration per se." (Dr. Harris Isbell - Public Health Service's Addiction Research Center in Lexington - 1958)

"It was shown that continued taking of opium or any of its derivatives resulted in no measurable organic damage. The addict when not deprived of his opium showed no abnormal behavior which distinguished him from a nonaddict." (Dr. George B. Wallace - Bellevue Hospital NYC Study)

"The study shows that morphine addiction is not characterized by physical deterioration or impairment of physical fitness aside from the addiction per se. There is no evidence of change in the circulatory, hepatic, renal or endocrine functions. When it is considered that these subjects had been addicted for at least five years, some of them for as long as twenty years, these negative observations are highly significant." (Philadelphia General Hospital Landmark Study Re: Chronic Narcotic Abuse - Committee on Drug Addictions of the Bureau of Social Hygiene & Philadelphia Committee for the Clinical Study of Opium Addiction)

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