This is certainly a tough and broad issue.
As a licensed, and board certified pain physician, I rarely find an indicated use for chronic use of high dose opioids.
The evidence of narcotics use (not just opioids) is very limited to demonstrate long term “good” results and outcomes. In fact, when we look at risk verses benefit with these medications as a whole, the risk is clearly the winner. The use of opioids is very case based, and the positive outcomes are anecdotal.
I think a good place to start with a lot of this, is addressing the culture of “pain management" our patients perceive, and their expectations. One of the biggest challenges in the day to day, is patients getting aggravated with physicians because they will not prescribe medications due to regulations and scope on them. My rebuttal to that is, these medications should not have been so easily available in the past to expect that. Which in turn, now has swung the pendulum back to minimal use and patients need to understand that the past ways, and expectations of narcotics for “not feeling anything” are a thing of the past.
There are certainly a number of patients who are on opioid medications chronically, for conditions which require them. Some patients will require these medications to function, and maintain a good quality of life. Those patients need to be cautious in how they approach their medication management. One must seek out someone who is equipped to handle this type of treatment plan. There are specific types of doctors, who will treat and manage “chronic medication pain management,” and will often has a rigorous treatment plans which likely will include pain contracts, random screenings, pill counts, etc. Given the current environment, these types of things are not to vilify those who need these medications, but to protect them and the prescriber from those with motives other than medical treatment.
Steve M. Aydin