Over the past several years there has been an ongoing methodical attack on people in pain. Although the rhetoric has been leveled at opioids it has had a direct and deleterious effect on people suffering with pain. What is even more concerning is, those feeding this rhetoric against the use of opioids in this area of medicine, are pushing their agenda by using the tragic consequences happening to people who use ILLICIT substances. The climate out there is hostile, ignorant, and misinformed, illegal drug numbers, emergency room visits and overdose deaths are linked with legitimate prescriptions and the media do not vet these numbers or even question the relevancy of such numbers. It seems the media learned nothing from the debacle they created with "Jimmy's World", a completely fabricated story about drugs. The prohibitionists have utilized spurious figures garnered from studies that have used "data dredging" to obtain their information; in addition to information that everyone classifies to be of low scientific value. Their use of Scientism is also egregious. When someone questions their speculations they attack their character and integrity--a sure sign they know full well their own arguments have little merit. Moreover, media coverage rarely includes the perspective of pain patients--or does so only to knock those who advocate for proper access to opioids as pawns of the pharmaceutical industry. We do have a growing illegal drug problem where addicts have issues that need to be addressed. The drama of their situation is being used as a weapon against pain patients. Few average pain patients have enough "drama" to even warrant media attention with a two line story, so the strategy has become, to lump the truly ill with the dramatics of the drug addiction problem. These attacks have only stalled progress in the area of pain, and have sent the treatment of chronic pain reeling backwards into ignorance and fear. The extreme negative media attention is not only making it difficult for legitimate patients to get the medicine they need, it is making them afraid of taking it when it is prescribed to them.

 

The international war on drugs has been a costly failure that has created a "public health and human rights crisis," says a report commissioned by the United Nations, who recently met to discuss drug policy. A 54-page report by the Johns Hopkins--Lancet Commission on Drug Policy and Health indicates many drug policies are based on ideas about drug use and dependence that "are not scientifically grounded" and are particularly harmful to people in pain. The commission estimates about  5.5 billion people worldwide do not have adequate access to controlled , medicines for the management of pain.

 

"Inequality of access to controlled medications for pain management and other clinical uses is now a oublic health and human rights crisis," the report says. "yet, the obligation to prevent abuse of controlled substances has received far more attention than the obligation to ensure their adequate availability for medical and scientific purposes, and this has resulted in countries adopting laws and regulations that consistently and severely impede accessibility of controlled medicines." Abolitionists here in Canada and the United States continue to use the concept that we are in the top 10 prescribers of these medications, which is indeed true, however, what they fail to mention is this in not hard to do as, according to the INCB, about 90% of countries have such strict regulations their citizens don't have access to them, even for the disease of cancer. This approach is drive by the current rash of deaths from the use of ILLICIT substances smuggled in from China and Mexico, but all reports mesh that into the use of legitimate medication.

 

The commission said there were many "myths and exaggerations" about opioid use that have stigmatized people who use these medicines. And rather than lowering the risk of abuse and addiction, prohibition was making the problem worse by forcing many people to turn to the street for opioids. "Prohibition creates unregulated illegal markets in which it is impossible to control the presence of adulterants in street drugs, which add to overdose risk," the commission pointed out. "The idea that all drug use is dangerous and evil has led to enforcement-heavy policies and has made it difficult to see potentially dangerous drugs in the same light as potentially dangerous foods, tobacco and alcohol."

 

This has led to a number of counterfeit pain medications laced with fentanyl and heroin, coming from China that are responsible for many overdose deaths. These fake pain pills have appeared, as a number of Canadians, in collaboration with prohibitionists in the United States, put forward new guidelines by the Centers for Disease Control and Prevention (CDC) that strongly discourage primary care physicians from prescribing opioids for chronic pain. Many patients, who have been on stable doses for years, now fear losing access to opioids because these guidelines and the myopic view of these prohibitionsts has promulgated to policy-makers and regulators. "Policies meant to prohibit or greatly suppress drugs are a paradox. These policies are portrayed and defended vigorously by many policy makers as necessary to preserve public health and safety, yet the evidence suggests they have contributed directly and indirectly to lethal violence, communicable disease transmission, discrimination, forced displacement, unnecessary physical pain, and the undermining of people's right to health," the report concluded. In fact, Debra Houry, MD, Director of the CDC's National Center for Injury Prevention, stated: "It (the guidelines) is not intended to deny access to opioid medication as an option for pain management. It is not intended to take away physician discretion and decision-making".

 

We have for years stated we would have a national policy on euthanasia before one on pain relief. The efforts to bring pain relief to people in pain continue to be overshadowed by the very visible and vocal movement that exploit's people's fear of pain, but offers only death as an answer have borne fruit. Now add the selective misapplication of reports on ILLICIT substance abuse to the equation we have moved even further away from making the lives of millions of Canadians somewhat bearable.

Barry D. Ulmer

Executive Director

The Chronic Pain Association of Canada