Canada and the U.S. have seen alarming increases in opioid prescribing and in opioid-related overdose deaths. Prince's tragic opioid-related death further highlights this international public health problem.
Indeed, the spectre -- and reality -- of opioid limits have sent shockwaves through segments of the chronic pain community. The vast majority of individuals prescribed opioids take them responsibly, yet are now subject to laws created to prevent illicit opioid use.
Patient advocacy groups have loudly decried unjust medical care for chronic pain. Limiting opioids may preclude some opioid overdose deaths, they say, but what about the untold suffering -- and the suicides -- that may occur when patients cannot tolerate severe ongoing pain? The lives of people with chronic pain matter, too, and they should be treated as patients, not as addicts.
It's a Catch-22, of course. The opioid debate engenders strong emotions for both sides: opioid access versus limits. Is it really a zero-sum game where one group must suffer so the other group may survive?
Even when opioids are taken exactly as prescribed by exemplar patients, they come with a range of health risks including overdose fatality. How do we address the need to reduce health risks while treating chronic pain?
Do opioids help some people with chronic pain? Absolutely. For this reason, prescribers must retain discretion to prescribe them, while recalling that it will be for a minority of patients. Opioids may help, but they can't be the whole story.