Are opioids “bad?” Certainly they can be addictive and that fact can’t be understated. That’s precisely why they are controlled substances. And still nascent abuse deterrent technologies are helping to further decrease the opportunities for improper use. But the value of opioids is, when used as directed, they are highly effective in combatting the scourge of pain.
The truth, of course, is that opioids aren’t bad. The problem is that they’re not perfect nor are they perfectly safe – just like 100% of prescription drugs on the market. “Safe” is a relative term. Opioids are safe when they are used as directed. Are chemotherapy drugs “bad” because of their horrible side effects? Of course not. Why – because the alternative is far worse. So too the case with opioids. For both physicians and the tens of millions of Americans with chronic pain, the absence of opioids would be disaster.
That’s why the FDA and other pertinent constituencies view the future of pain medication through the lens of “safe use.” How can we enhance appropriate prescribing, dispensing, and patient behavior? Abuse deterrent technologies are part of the answer, but better physician, pharmacist, and patient education must be another pillar. The FDA has made this a policy priority. FDA Commissioner Hamburg has called for “Improving appropriate prescribing by physicians and use by patients through educational materials required as a part of a risk mitigation strategy for extended-release and long-acting opioids.” Now it's also time for the DEA to work with the FDA to develop smart policies for specific education as a must-have for prescribing rights.
Alas, there are too many pundits, politicians, and self-anointed citizen advocates who are keen to focus on placing blame. It’s a savvy strategy for media attention but does little to advance the public health. There’s no value in fixing the blame for medicines that aren’t 100% safe. No medicine is 100% safe. That cynical approach just leverages ignorance to produce anger. There’s tremendous value in fixing the problem – through advancing the safe use of opioids – a crucial weapon in the armamentarium against pain.
