I just read Dr. Retherford’s Letter of June 27.

He makes a good point that too many pain pills are a problem, but forgets that all patients are not the same. They have individual experiences and differences and that treating them all the same is not good for them. One size does not fit all.

Suboxone (Buprenorphine/Nalloxone) was approved by the FDA for opiate addiction (opiate use disorder). It was never approved for the treatment of pain.

Suboxone has a ceiling effect on its ability to control severe pain. That is what makes it suited to prescribe for patients with opiate use disorder. While Suboxone helps to get rid of the craving for opiates it does not treat pain as well as other pure opiate pain medications do. Suboxone is a mixed opiate agonist and antagonist, while morphine is a pure morphine agonist and blunts the human response to pain much better.

Personal responsibility for the use of pain medications has to play a role. Patients should not share their pain medications and must store them securely.

Our rules are made for the lowest functioning people who are the 9% of our population that have abused their pain medications. I believe that 9% of the population are the people who have a genetic tendency towards addiction.

Those people should not be prescribed opiate pain meds and Suboxone is the safest medication for them.

Other patients have had multiple spine surgeries, nerve damage and other conditions causing chronic constant pain. Many of these patients do well on opiate pain medications for a long time. Their doses stabilize and they don’t increase and increase. I have had many patients who follow the rules, are responsible with their pain medication, have taken opiate pain medication for 20 or more years, and remain functional and happy.

If they are responsible with their medications they can remain functional, and have a job and care for themselves and their family.

Otherwise these patients without pain medications can’t take care of themselves, become depressed and many would “throw in the towel” and commit suicide to end their constant pain. The rest are in constant pain and many are miserable. Neither is acceptable. The majority should not suffer at the expense of the small minority that abuse. Living in pain is something that most people don’t ever have to experience. Drug abuse is a huge problem for our society that may always exist. The solution is not to deprive the truly needy by making help from their doctors too difficult to provide.

While we are in the midst of an opiate epidemic it is important not to deny the patients that need their pain medications from getting them.

A safer pain medication should be found that will help chronic pain patients.

We have not found it, yet.

Chronic pain is unrelenting constant pain, and suicide should not be a “side effect” of trying to reduce the number of pain pills prescribed. 


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