The Reasoning Behind The War On Opioids

Primary Concerns of Those Speaking Out Against Liberal-Access to Opioid Therapy: Are They Valid?


(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 health-impact of chronic opioid dependence. Likewise, the major harms associated with chronic full blown opioid addiction are predominantly by-products of the wreckless lifestyle, poor hygeine, and improper drug-administration techniques common among of the addict population; rather than due to any inherent properties of the drugs themselves. The only significant toxicity risk of the opioids themselves is the acute risk of overdose manifesting as potentially fatal respiratory depression (which would surely lead to far fewer deaths with patient-access to antagonists such as narcan, not to mention a greater emphasis on educating patients and narcotic "abusers" alike). Aside from acute toxicity risk, which no drug is without, the adverse effects of chronic use, addiction, or dependence consist of constipation, low testosterone, and a greater vulnerability to contagious illness.

Because they lack evidence of any measurable physiological harm directly attributable to chronic opioid use or even "abuse" (and yes, there have been studies); Critics and anti-opioid 'activists' make use of hyperbole, citing the relation of the morphine-derived opiates to heroin (appealing to emotional sensibilities & shock value). The "synthetic heroin" hyperbole, although vapid & misleading, is largely effective when the public mindlessly accepts at face value the popular perception of heroin as some sort of uniquely toxic & soul-stealing entity. Though there is a wide spectrum of functional properties which sufficiently distinguish each and every drug of the epoxymorphinan family (i.e. morphine family) from its counterparts, the more relevant fact is that there remains a large disconnect between the actual pharmacological and toxicological nature of heroin and the popular mythological perception of this drug; which in fact when used chronically, poses far less risk to long term health than alcohol or fast food. Serving merely as a lipophilic prodrug for morphine, the effects of heroin are in fact 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.

Excerpts from the literature:

"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)