Opioids, Chronic Pain and Addiction

Carol Leth Stone
Placerville, Calif.
The writer is a science writer and editor.

To the Editor:

The otherwise thoughtful essay makes an implicit assumption that developed as part of the opioid crisis in the United States and Canada, but that has not happened in almost all other countries with sophisticated health care systems. That is the specific belief that for selected patients with chronic pain, opioids are an effective treatment and addiction risk just needs to be controlled.

Actually there is compelling evidence biologically, epidemiologically, experimentally and clinically that when taken daily, opioids enhance sensitivity to pain (including with patients who show no addictive behaviors). The evidence is now overwhelming that chronic opioids, especially in significant doses, are not effective for pain and they are not safe.

I have been treating opioid-dependent chronic pain patients for more than three decades. The culture of opioid overtreatment has been difficult to overcome because of a confluence of factors, but since the C.D.C. guidelines of 2016, prescription opioids and deaths from the legal use of opioids have fallen.

Because many physicians are not familiar with the best ways to treat opioid dependence, they have been at a loss as how to treat opioid-dependent chronic pain patients. Good treatments are available, and it is quite fulfilling to work with these patients.

Jon Streltzer
Honolulu
The writer is professor emeritus at the John A. Burns School of Medicine, University of Hawaii.

To the Editor:

Humans have not physically evolved to meet the demands of a modern life that can keep us alive, in pain and infirmity long past our ability to care for ourselves and others, but without a social structure to make such disability either acceptable, or a socially and personally enriching and enabled experience.

Rigor is required for social and economic survival in America; yet, without opioids, many chronic pain patients will spend decades of unwanted survival as isolated, bedridden wretches.

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