Should Doctors Treat Pain? The Surgeon-General Isn't Sure

This article first appeared on the Cato Institute site.

The rising level of deaths from opioid overdoses is getting a lot of attention, including from a Nobel laureate economist and the White House.

In the rush to find a solution to the problem of opioids, I hope we don't forget the problem that opioids were intended to cure: chronic severe pain.

Living with that kind of pain is awful, and it's wonderful that science has found ways to help people in pain.

But that's not the way President Trump's surgeon general sees it. In an NPR interview last week, Dr. Jerome Adams had this to say:

NPR's Elise Hu: Much of this crisis started in doctors' offices. We've heard statistics like doctors in the United States prescribe four times the number of pills per person that doctors in the United Kingdom do, for example.

What do you think is encouraging doctors to prescribe at those levels?

Dr. Adams: Well, I can tell you, as one of those doctors, that many of my colleagues tell me they feel pressured to prescribe. You have patients who expect an opioid is the only or main way to treat their pain.

But I would take issue with one thing you said—I don't think it started in the doctors' offices. I think it starts before that. I think that it starts with this expectation that everyone's going to have no pain, with the idea that a pill can solve everything.

And we need to help folks understand there's a real danger to feeling like we can medicate our way out of any and all problems.

(Note: that statement appears at about 4:25 in the audio, but not in the related transcript.)

Of course, no one should feel that we can "medicate our way out of any and all problems." But we can relieve some pain. And I am disappointed to hear the surgeon general say that we should get over our attitude that doctors can help to alleviate our pain.

In a 2005 Cato study, Ronald T. Libby argued that opioid therapies for pain had proved successful, but because of criticism and law enforcement efforts "many physicians and pain specialists have shied away from opioid treatment, causing millions of Americans to suffer from chronic pain even as therapies were available to treat it."

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Oxycodone pain pills prescribed for a patient with chronic pain lie on display on March 23, 2016 in Norwich, CT. On March 15, the U.S. Centers for Disease Control (CDC), announced guidelines for doctors to reduce the amount of opioid painkillers prescribed, in an effort to curb the epidemic. The CDC estimates that most new heroin addicts first became hooked on prescription pain medication before graduating to heroin, which is stronger and cheaper. John Moore/Getty

In a recent article, surgeon and Cato senior fellow Jeffrey Singer argues that crackdowns on opioid prescription and the resulting decline in prescriptions are driving more patients to the black market, while "opioid abuse and overdose rates have declined by 25 percent in states where marijuana has been made legally available."

There are going to be plenty of arguments about the best policy to deal with opioid abuse.

But let's start with the premise that the alleviation of pain is a great thing.

David Boaz is the executive vice president of the Cato Institute. He is the author of The Libertarian Mind: A Manifesto for Freedom and the editor of The Libertarian Reader.

Should Doctors Treat Pain? The Surgeon-General Isn't Sure | Opinion