In modern day pain medicine, many of the same historic controversies exist.
Addiction is a prevalent problem in society; sometimes it emerges when a patient is ordered pain medication for a legitimate purpose, only to fall victim to a bigger problem Other times, people who are somehow predisposed to substance abuse find themselves drawn to it for recreation purposes. In either case, once addicted, the problem is the same for all of these individuals.
Modern addiction medicine does not employ withdrawal or detoxification as part of treatment; it seems more common to send these persons to day programs or inpatient treatment and prescribe suboxone or some similar agent for maintenance purposes. My biggest problem with this approach is that the problem is not really fixed--it's only patched. You see, suboxone and its nearest relatives merely trick the body's opiate receptors into thinking that all is well.
In my work career, I witnessed this problem many times over. The saddest situations were those where young pregnant women, once addicts, went through rehab only to emerge on one of these maintenance drugs. When their children came into the world, they were born addicted. There were other patients on high dose chronic pain medications or maintenance medication such as suboxone or methadone. At times, pain management was very difficult for these persons.
The FDA's latest efforts with regard to pain medications involves something they call REMS strategy.
This strategy aims to evaluate the risk of abuse potential before drugs with abuse potential are prescribed, and attempt to control the number of abusers in the population. The success of this program remains to be seen.
Meanwhile, a new long acting opioid, Zohydro, has come onto the marketplace. Zohydro is the controlled release version of hydrocodone. It was FDA approved in late 2013. While it seems that this product has great potential to help those with chronic pain, it sure has its share of critics. This stems from the fact that short acting products containing hydrocodone have high abuse potential. Why would Zohydro be any different?
In addition to regulations by the FDA, DEA, State Boards of Medicine, Dentistry, Pharmacy, etc. local governments are attempting chime in with their own regulations regarding opioids. For instance, back in 2013, while Mayor Bloomberg was still in office--he set out to regulate the use of these medications in Emergency Rooms across NYC. Similar rulings have been adopted in Washington State and Utah.
Now, with the latest drug--Zohydro--there is news of regulation in Massachusetts and hearings are underway in Pennsylvania.
Meanwhile, there are many stories about heroin usage on the rise. It seems like the more things change, the more they stay the same. One has to wonder what the future holds for those who suffer from addiction and those who suffer from chronic pain.
Sources: FDA, Washington Times, Masslive, Fox43, Time,Pixabay