Dear Patients,

I’ve been practicing pain management since 1994, and as is the case with all of us who have spent many years in the same occupation, I’ve learned a few absolutes. Here are three of them:

  1. Opioids are still the primary analgesic/painkiller available to us, and most of the time, they either help some or help a lot. Some of the time, they don’t help much; rarely, they help not at all.
    1. The majority of patients with severe chronic pain can, if they choose to do so, utilize opioid analgesics very safely and effectively, and for them, opioids are life -saving. Remember, statistically, more Americans commit suicide because of severe pain than die from prescription drug overdose.
  2. A small percentage of patients with chronic pain cannot, on their own, utilize opioid analgesics safely and effectively, and for them, opioids can be life threatening and /or life ending.

I’ve also been alive long enough to conclude that out of everything that makes the United States the greatest place to live, it is our right to the pursuit of happiness that is most unique. In no other country is pursuit of happiness considered a right, and I can think of no other freedom that is as valuable. It was put into lynch pin position by our founders, who sought personal freedom in a world devoid of it. The assumption was that people would then and now rise to the challenges such freedom poses.

With great freedom comes the challenge of great responsibility, and herein lies the problem. The notion of individual responsibility is slowly but steadily receding. This is happening before our very eyes. We all know this, of course, but it is painful to acknowledge it.

Are you among the small percentage of folks who cannot, on their own, utilize opioids safely and effectively? If you are, please know that our ability as United States citizens to access these medications outside of strictly controlled environments hangs in the balance. The steps that you take over the coming months and years will in no small part determine whether or not opioid analgesics remain accessible to the rest of us. As physicians, we’ve learned the hard way that despite the intensity of our patients’ pain, we cannot safely prescribe opioids to all of them.

Short of simply not prescribing any opioids to anyone anymore, I can only ask that if you have found yourself having difficulty complying with our opioid agreement, you take the following measures for your own sake as well as for that of your fellow patients.

  • Shed all shame and embarrassment. Opioid abuse and misuse are diseases that can and must be treated. Fortunately, we live in the day and age of effective treatment and management. Tell me what’s going on. Have I ever before yelled at you/humiliated you/shamed you? Not my style.
  • When you take that courageous step of telling me that you are falling into abuse and misuse, do not worry that your access to needed pain medication will automatically be permanently cut off. As a patient /doctor team, we can find effective ways to safely manage ongoing use of prescription opioids despite a patient being at risk for addiction and abuse in the vast majority of cases. As pain specialists, we have many arrows in our quivers.
  • Tell a trusted family member that you are struggling. He/she can often be just the help you need to safely continue medications.
  • If you are one of the very few patients who, despite both our best efforts and despite help from our behavioral team, simply cannot avoid falling into opioid abuse and misuse, we will creatively search out other approaches that you will find effective.

So now you know.

Thomas M Basch , MD