Building a Wall Between Pain Patients and Their Doctors

Jeffrey A. Singer

The Associated Press reported recently about doctors being threatened by patients who are in desperate pain and have been abruptly cut off from their opioid pain medications. This is not common, but not surprising, given the tendency of policymakers and many health care practitioners to misinterpret and misapply the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain. The misinterpretation of the guidelines and the lack of policymakers’ appreciation for nuance causes many doctors to be intimidated by law enforcement overseeing Prescription Drug Monitory Programs, leading them to undertreat or even abruptly stop medicating patients with chronic, severe pain. Compassionate physicians who want to help their patients read horror stories in the press about doctors like them being arrested or having their licenses suspended. As a result, many doctors are giving up treating pain altogether, refusing to see pain patients.

Misguided drug policy has stigmatized chronic pain patients, who are often suspected of being “drug abusers.” And it doesn’t help matters when many doctors are as misguided as the politicians in their understanding of the pharmacology of opioids, as well as the difference between chemical dependency and addiction.

For instance, the AP story quotes Dr. Carrie DeLone, regional medical director at Penn State Health Community Medical Group, as saying about opioids: “It hijacks their brain. They don’t see themselves as having a problem.”

As we discussed at a Cato policy forum in December 2019, substance use and substance use disorder are much more complicated than that. Many scholars and clinicians consider addiction to be a form of learning disorder, in which compulsive behavior is an automatized means of coping with stress triggers.

It didn’t have to turn out this way. But unfortunately, policymakers continue to believe the overdose crisis was caused by doctors treating their patients in pain when the real cause is drug prohibition and the dangerous black market it creates.

Meanwhile, politicians, law enforcement, and their prohibitionist physician‐​enablers are building a wall between doctors and pain patients, fostering an adversarial relationship instead of a partnership. Some patients, in desperation, resort to the black market to seek relief. Some resort to suicide. It is not difficult to see why some might threaten or even resort to violence.