Recently released statistics show that life expectancy is declining in the US, continuing a trend that began in 2015. Is access to care declining or old people not living as long? It is worse than that.
Recently released statistics show that life expectancy is declining in the US, continuing a trend that began in 2015. Is access to care declining or old people not living as long? It is worse than that. The decrease in life expectancy is directly attributable to medical treatment with prescription pain medicine, and the increase in mortality is only in people younger than 65 years old. These pain medications, like morphine, are related to products derived from the opium poppy; they are therefore known as "opioids."
Overdose deaths from opioids have increased by more than five times since 1999, killing more than 42,000 people in 2016 (the last year for which complete statistics are available), and 40% of these deaths were from prescription opioids. Many of the rest of these overdoses -- though no one knows how many -- were in people that had become addicted to prescription opioids, and then had turned to street drugs because they were more available or cheaper. Fatal drug overdoses are tallied as "Unintentional Injury" fatalities, and that category is now the leading cause of death in the US, behind heart disease and cancer.
Is this a case where the cure is worse than the disease? A few people that have told me they would kill themselves if they didn't get some relief from the pain. However, I think that people are biologically not different from previous generations, and suicide attributable to pain has never been a major cause of death, so the treatment of pain does seem to result in higher mortality than the untreated disease processes. This opioid epidemic is a very complex problem, because the use of these medications changes the bodies reaction to pain, making even minor pain -- such as getting a tetanus shot -- into excruciating pain that completely overwhelms a person for hours. This is a condition known as "hyperalgesia" and this, I believe, is the sort of thing that causes people to literally be dying for relief from pain.
On the other hand, it seems cruel to withhold opioid medication from someone who has a broken bone in their foot, for instance. Likewise, it seems heartless to not treat the pain of cancer, using every tool available. And what is to become of all of the people that are already dependent on these medications, if they are not able to continue getting the prescriptions they have been receiving for their chronic non-cancer pain? As I said, it is a complex problem, but don't worry … the government is here to help. Pharmacists and physicians are coming under increased scrutiny to limit the prescribing of these medications. (See www.cdc.gov/drugoverdose/prescribing/guideline.html) The intentions of the governmental guidelines are good, and they have sound principles such as these. First and foremost, "The Guideline is not intended for patients who are in active cancer treatment, palliative care, or end-of-life care." These are, of course, the very people in whom the cure CANNOT be worse than the disease, because their disease is already fatal! There are other good recommendations, such as that non-drug therapy and medications that are not opioids should be used when and where possible. Also, treatment goals should be established at the outset, along with a plan for discontinuing therapy if the benefits do not clearly outweigh the risks. In my experience, the role of opioid medication in the treatment of chronic pain that is due to a non-fatal condition is this: If pain is preventing someone from doing the simple things in life that give them pleasure and make life worth living, such as going for a walk or attending the concert of a grandson, these medications should be used in the smallest doses, as infrequently as possible in order that the person is able to do those things.
This article is intended to provide general information only, and is not to be taken as medical advice. For advice about a particular case or situation, consult your own physician or other trusted health professional.
Dr. Bundrant is the chief of staff at Ballinger Memorial Hospital. The Health and Wellness Coalition of Runnels County now meets every second Thursday at 7 pm. The next meeting will be April 12 at 7 p.m. in the conference room next to Keel Drug, 2001 Hutchins Ave. and will focus on the implementation of the Guideline for Prescribing Opioids. All interested healthcare professionals are invited.