Opioid medicines have become leaders in treating chronic back pain despite the facile treatment that is prescribed due to their availability and broad spectrum of pain relief.
How Did We Get into an Epidemic
of Prescription Opioid Abuse?
Long-Term Opioid Side Effects
Vicodin. The name might ring a bell, it’s the most prescribed medication in the US and Knoll Pharmaceuticals best selling product. Vicodin was a no name until the 80’s when it first became available. Opioids were not always like this and initially did not pose the threat of an epidemic like we see today. In 2019 the US is experiencing an Opioid Epidemic as said by the White House. Opioids first came to light in the US in the late 70’s when medical ethics and patient advocates voiced a need to manage pain in the modern world. Pain was undertreated for patients with terminal illness and cancer, the latest most promising drugs for pain, opioids. Cancer and terminal illness accounts for a fraction of the reasons doctors prescribe opioids. The global leader, back pain, takes up the majority of the prescriptions filled in the US. A paradox like this is not new to the US and agencies like the CDC who has been recording and reporting on the opioid crisis. The epidemic starts because 50 million people are reported to suffer from back pain and the leading medications are Opioids. With such a large part of the country on opioids it is not in the best interest to make the drug illegal or disappear either. As reported by the CDC people who are addicted to prescription opioid painkillers are 40 times more likely to become addicted to heroin. As a result the removal of the drug is not an option and the actions taken today are not ideal either. Despite the announcement of the government’s fight against the opioid epidemic states like Colorado experienced record numbers of opioid deaths and overdose in 2017, and the number doesn’t look to be going down. This is just the prescription side of things where the other side of the epidemic includes the illegal substances such as fentanyl and heroin.
The effectiveness of opioids for chronic pain are not the reason they are so popular. Contrarily the studies that examine long term opioid treatment find that due to dependence and tolerance to the substance the treatment is less effective. Additionally, opioid painkillers have only shown modest advantages over other pain medicines available. Surveys show that patients who take opioids for chronic long term pain report worse pain — while taking opioids — than pain patients who don’t. Opioids do not hold a special advantage and are highly addictive and a gateway drug into illegal opioids. Yet, the popularity still dominates the medical drug market and statistical scare tactics don’t change the increased use in the population. Opioid treatment in turn becomes a dependency and a treatment that for many patients is not improving their pain but is compromising their lives and futures. Opioid medicines have become leaders in treating chronic back pain despite the facile treatment that is prescribed due to their availability and broad spectrum of pain relief.
Opioids bring in way more money than the poppy seeds on a bagel at breakfast. The opioid market has a strong economic grip in the medical community and is promoted by the pharmacies that create them. Despite the facile treatment the revenue is clear with the opioid market being priced at $8.4 billion dollars which was calculated by tracking the use of the medications. This dominance in the market came from the product promotion that the pharmaceutical companies incorporated. One instance comes from the start of OxyContin and Purdue Pharma. Pharmaceutical companies claimed that the drug safety and efficacy were, of course, safe. And Purdue Pharma, producer of the opioid OxyContin, was subject to hundreds of millions of dollars in fines for its false claims. Opioid painkillers carry a significant risk of addiction and overdose, especially for long-term users who build up a tolerance of the high and use more and more of the drug without building as much resistance for the respiratory effects that lead to overdose. Videos released by Purdue had promotional advertising for OxyContin and highlighted the later false claim that the drug is non addictive and safe. This was resolved in 2008, despite the settlement and calling out the company for false claims the opioid problem has not improved. Ohio Attorney General Mike DeWine stated that opioid companies spend millions of dollars on promotional activities and materials that falsely deny or trivialize the risks of opioids while overstating the benefits of using them for chronic pain.” arguing its “borrowing a page from Big Tobacco’s playbook.” De wine makes uses the big tobacco analogy to push a similar method of getting the nation hooked. Similarly to big tobacco opioid manufacturers released false claims that the medicines are not as harmful as they are in reality. Like the advertising in big tobacco it was effective enough to cause an epidemic in the US. With the lawsuits behind them opioid manufacturers still have billion dollar revenues that don’t seem to decline as more medication is being prescribed annually.
In 2009 a patient education guid was released that attempted to counter the “myth” that opioids are addictive, claiming that “any studies show that opioids are rarely addictive when used properly for the management of chronic pain.” Purdue sponsored a publication from the American Pain Foundation, which was heavily funded by opioid companies, claiming that the risk of addiction is less than 1 percent among children prescribed opioids — suggesting pain is undertreated and opioids are necessary.
[“Between 1996 and 2002, Purdue Pharma funded more than 20,000 pain-related educational programs through direct sponsorship or financial grants and launched a multifaceted campaign to encourage long-term use of [opioid painkillers] for chronic non-cancer pain. As part of this campaign, Purdue provided financial support to the American Pain Society, the American Academy of Pain Medicine, the Federation of State Medical Boards, the Joint Commission, pain patient groups, and other organizations”
How do drug companies influence doctors’ conferences and educational programs? One of the medical societies that provides such programs, the American Academy of Pain Medicine (AAPM), lists members of its “Corporate Relations Council” on its website. The society notes,
“They receive premiere status at AAPM’s Annual Meeting and other networking events.” “Premiere status” includes the opportunity to produce sponsored seminars attached to the meetings. The member list includes such companies as Purdue Pharma, Abbott Laboratories, and Endo Pharmaceuticals, the makers of OxyContin, Vicodin, and Percodan, respectively. The same companies appear as Corporate Council Members of the American Pain Society.
Opioid Distributor Example:
Federal and some state laws require distributors to keep an eye on the supply chain to ensure their products aren’t falling into the wrong hands. Letting these drugs proliferate, the lawsuits say, violates those laws.
Opioid manufacturers and distributors, deny these allegations. While some suits have been settled, and some executives have even been criminally convicted for their involvement in the epidemic in the past, opioid companies vigorously reject the argument that they have carelessly fueled the current drug crisis. And so far, what the companies have paid by and large amounts to peanuts compared with the profits they’ve taken in from the drugs.
(High amount of consumer possession, distribution possession, and criminal combat against all these pills. ]
2.
Opioid modest advantages and why it’s so prescribed in doctors angle (not including previous arguments)
The common way doctors treat pain is through the universal pain remedy of opioid medicines. The practical use of these medicines is effective as it does significantly reduce pain and lower the pain itself. This gives opioids the advantage of working effectively to reduce the pain than to make it more bearable like homeopathic remedies such as medical cannabis. However, current treatment largely consists of long term prescriptions that last years rather than months. In prolonged treatments that extend into years requires increased dosages and the far greater likelihood of lifelong dependency.
“evidence from high-quality studies showed that opioid use was associated with statistically significant but small improvements in pain and physical functioning, and increased risk of vomiting compared with placebo. Comparisons of opioids with non opioid alternatives suggested that the benefit for pain and functioning may be similar, although the evidence was from studies of only low to moderate quality.”(Opioids for Chronic Noncancer Pain, Buce)
The side effects and cycle of prolonging treatment. The scale and current science behind pain treatment is very crude. Hospital procedures that assess the patient’s condition nand pain may sound like a helpful tool. Doctors use pain documentation to continue prescribing opioids. The origins of the ten point scale that doctors or nurses ask patients in hospitals is well intentioned. A quick and effective scale of how sever the patient is feeling the pain but, the simplicity means quickly moving onto the next patient. This means that doctors liberally come to the habit of prescribing opioids to give the patient relief and continue out of the hospital. As patients pile up in the growing population means doctors have less and less time to effectively prescribe the right medicines and when to stop. Big pharma was able to market a solution to this slow system of prescribing pain medicine. Opioids have come to treat all kinds of body pain broadening the treatments from terminal illness and cancer to common chronic pains experienced by patients.
3.
Why not other medicines or remedies? What are the remedies that compete with opioids?
“D. D. Palmer, was a magnetic healer practicing in the Midwest in the late 1800s. He claimed that he once cured a janitor’s deafness by manipulating his neck. Thus began the concept of spinal manipulation”
Spinal manipulation is the core treatment that all chiropractors use, though they prefer the term spinal “adjustment.” There are many techniques, varying in the force delivered and the amplitude of movement. It’s unclear how spinal manipulation works to relieve pain. Various theories focus on the small facet joints in the spine, on repositioning disc material, on reducing muscle tension or stiff ness, and on other possibilities. Chiropractors also often recommend therapeutic exercise and sometimes make use of massage and acupressure in addition to
spinal manipulation. Chiropractors don’t have a monopoly on spinal manipulation, of
Course”
As Americans grow weary of opioid treatment for chronic pain the opportunity to give a chiropractic a go opens up. Despite the pseudoscience belief in the medical world, a chiropractic and the spinal “adjustment does provide relief. However, the relief comes from having the patient work alongside the treatment and for some this is not possible. Above all chiropractic require human skill and a workforce unlike pharmaceutical companies who spread production over a supply chain system. Unlike drugs spinal manipulation is non addictive.