Opioids are not necessarily evil

Since 1999, the use of opioids for pain management has quadrupled in the USA, resulting in what is now well known as the 'opioid epidemic'—too many Americans are now unnecessarily reliant on the drugs and opioid-related overdoses have rocketed.

Neurology Central is shining a light on this health crisis in an exclusive interview with Michael Schatman (Director of Research, U.S. Pain Foundation, CT, USA) discussing his recent thought-provoking editorial on the misuse of opioid dose calculation techniques in medical guidelines and the drivers of the opioid epidemic.

In the interview, Schatman discusses his recent paper 'The MEDD myth'. Despite the method of MEDD (morphine-equivalent daily dose) being confirmed as invalid late last year (Rennick et al), it has continued to be utilized as a dependent variable in pain research as well as in influential opioid prescribing guidelines, such as the 2015 Washington State Opioid Guidelines. "It's fraudulent, and that means that the guidelines based on this concept are fraudulent," Schatman comments. "We can't have a 'one size fits all' answer."

Schatman debates that these guidelines are a key cause of 'opiophobia', with doctors withdrawing opioid prescriptions where they are still needed and setting dosage limits that do not take into account differences in drug metabolism between patients. "There are many more patients in the US with chronic pain who don't respond to other treatments than there are prescription opioid addicts, yet the media are not particularly concerned with genuine data," explained Schatman.

Despite this, Schatman also considers the epidemic of opioid overdose and related deaths a substantial issue. Since 2007 the indiscriminate prescription of opioids in the USA has been flagged by Schatman personally. In the exclusive interview with Neurology Central, Schatman presents his thoughts on key drivers of the epidemic, including fraudulent marketing, financial motivations, and engrained cultural and political factors.

The discussion finishes on what needs to be done in order to control the overuse of opioids, focusing in on physician education and healthcare messaging: "What is being done, is scaring doctors by writing disingenuous opioid guidelines. What should be done, is what's being done in certain states, that is, mandatory continuing medical education in pain," Schatman comments. "The point is that opioids are not necessarily bad as long as there are careful risk mitigation strategies in place."