Painkiller is a new show on Netflix that explores the evils of marketing highly addictive substances. Matthew Broderick plays a Sackler, the scion of Purdue Pharmaceuticals, whose deployment of sales reps to sell Oxycontin as a nonaddictive painkiller that provided patients with the relief tolerance, dependence, and addiction they rightfully wrongfully deserved.
An accumulation of opioid-related public policy initiatives have dramatically reduced the number of prescribed opioids in this country.
Despite these policies and a resultant reduction in prescription opioids, opioid-related deaths have continued to escalate as a result of illicit fentanyl. This is scary stuff that we see on our streets. Unfortunately, once people are exposed to opioids over and over (whether through bona fide prescription or via illicit use), they develop a tolerance to the medication. Ultimately, continued repeat opioid exposure can be considered an environmental exposure that has epigenetic consequences on the individual, similar to the consequences of repeat tobacco smoke exposure, or repeat sun exposure. When patients have been treated with these medications for years for valid pain problems, the medications typically stop working but the patient is dependent on the medication. This is a major problem we pain physicians inherited as a downstream consequence of the Purdue years.
Today’s pain physicians have a myriad of technical skills and offerings that are way more effective and more advanced than medications, as depicted below. But we still have patients dependent and tolerant on opioids. How can we treat them with the state-of-the-art??
We need to decouple #PAINMEDICATION from #PAINCARE and treat them both with respect and dignity, even in the same patient. My recommendations for treating this type of patient is captured in this slide below:
Questions? Comments? Email me!
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