I have written about pain medicine, previously on this blog, and it generated some spirited responses. Let me be clear that I am completely against all forms of pain, whether foreign or domestic, physical, spiritual, psychic or even phantom. The medical profession has superb tools to combat and relieve pain, and physicians should utilize them, within the boundaries of appropriate use. We now have an actual specialty — pain management and physicians with special training in the science and treatment of all varieties of pain. I utilize these specialists when necessary, and I am grateful for the help they provide to my patients.

There are two forms of drug abuse in our society — legal and illegal. The latter has become a health scourge that is shattering families across the country. A few days before I wrote this, I read the stats of overdose deaths in my state of Ohio. I was shocked to learn that in our state alone, we lose thousands of individuals every year to drug overdoses, most of which are not intentional. The street drugs are often impure or laced with potent additives or substitutes that become a fatal concoction. Extrapolating Ohio’s stats across the country would create a stunning number of drug deaths. The causes and the potential solutions to this plague are vexing but must be pursued.

There is also a legal avenue for drug abuse, medicines prescribed by doctors. This sphere of abuse will be easier to control than the illegal counterpart, as the process is initiated by a doctor’s prescription and subsequently involves a pharmacist. No doctor or pharmacist wants to be a pawn in this game. I believe that these professionals have adapted to a looser culture of prescribing pain medicines and changing expectations on pain relief of the public.

Consider this staggering statistic: According to the National Institute on Drug Abuse, Americans consume more than 80 percent of the planet’s opioid medicines, yet are less than 5 percent of the world’s population. Does this make any sense? Would advocates of the status quo argue that America has nearly 20 times more pain than other nations have?

I can state plainly that I have never seen so many patients in the hospital who are on intravenous and powerful narcotics for stomach pain. These same patients a few decades ago were treated differently, and I recall that we kept most of them reasonably comfortable. The risks of “narcoticomania” are self-evident. Many patients and their families are suffering heartache and misery whose origin can be traced back to a narcotic prescription. This is a great tragedy.

Narcotics have an important role in our patients’ care, and I support their appropriate use. There are patients who need opioid use to manage chronic conditions. But, opioids and narcotics are overused and we need to admit this so we can begin to remedy this reality. Physicians and the public need to reach an understanding of what each expects from the other. Both doctors and our patients need more training on this issue. Doctors should do all we can to make our patients comfortable. Indeed, relieving pain and suffering is fundamental to the healing mission. Patients should recognize that physicians may not be able to guarantee 100 percent pain relief for every situation that you may face. We have an obligation to minimize your pain and discomfort, but also a responsibility to protect you from wandering down a dark and destructive path that may lead you ensnared in a den of demons.

Michael Kirsch is a gastroenterologist who blogs at MD Whistleblower.

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