Should Doctors Try to Alleviate Pain?

The rising level of deaths from opioid overdoses is getting a lot of attention, including from a Nobel laureate economist and the White House. In the rush to find a solution to the problem of opioids, I hope we don't forget the problem that opioids were intended to cure: chronic severe pain. Living with that kind of pain is awful, and it's wonderful that science has found ways to help people in pain.

But that's not the way President Trump's surgeon general sees it. In an NPR interview this week, Dr. Jerome Adams had this to say:

NPR's Elise Hu: Much of this crisis started in doctors’ offices. We’ve heard statistics like doctors in the United States prescribe four times the number of pills per person that doctors in the United Kingdom do, for example. What do you think is encouraging doctors to prescribe at those levels?

Dr. Adams: Well, I can tell you, as one of those doctors, that many of my colleagues tell me they feel pressured to prescribe. You have patients who expect an opioid is the only or main way to treat their pain. But I would take issue with one thing you said—I don’t think it started in the doctors’ offices. I think it starts before that. I think that it starts with this expectation that everyone’s going to have no pain, with the idea that a pill can solve everything. And we need to help folks understand there’s a real danger to feeling like we can medicate our way out of any and all problems. 

(Note: that statement appears at about 4:25 in the audio, but not in the related transcript.)

Of course no one should feel that we can "medicate our way out of any and all problems." But we can relieve some pain. And I am disappointed to hear the surgeon general say that we should get over our attitude that doctors can help to alleviate our pain.

In a 2005 Cato study, Ronald T. Libby argued that opioid therapies for pain had proved successful, but because of criticism and law enforcement efforts "many physicians and pain specialists have shied away from opioid treatment, causing millions of Americans to suffer from chronic pain even as therapies were available to treat it."

In a recent article, surgeon and Cato senior fellow Jeffrey Singer argues that crackdowns on opioid prescription and the resulting decline in prescriptions are driving more patients to the black market, while "opioid abuse and overdose rates have declined by 25 percent in states where marijuana has been made legally available."

There are going to be plenty of arguments about the best policy to deal with opioid abuse. But let's start with the premise that the alleviation of pain is a great thing.