In 1980, a letter was published in the New England Journal of Medicine stating, quite correctly, that patients prescribed opiates such as morphine in hospital for acute, serious pain did not become addicts once they left hospital. This was important, because American doctors at the time were reluctant to prescribe such drugs even to patients for whom they were indicated for fear of turning them into addicts. Thus opiates were denied to those dying in severe pain, a cruel absurdity.
The letter had unintended and unforeseen consequences. It was used, more than a decade and a half later, to justify the prescription of strong synthetic or semi-synthetic opioids to patients suffering from chronic backache or arthralgia. Even minimally experienced doctors should have been able to distinguish between patients with acute pain and chronic pain. They should have been able to recognize that the two are very distinct; but, for a number of reasons, many American doctors failed to do so. This failure helped to turn the United States into by far the largest consumer of opioids per capita in the world.
Read Full Article »