After the U. S. Drug Enforcement Agency (DEA) changed the classification for hydrocodone combination drugs from Schedule III to Schedule II this week, many medical providers and patients alike are left wondering if the decision will actually make the world safer or if this latest effort to curb prescription drug abuse is simply just a real pain. Hydrocodone is not just one of the most frequently prescribed pain medications, it is also one of the most abused.
According to a DEA press release, nearly seven million Americans abuse prescription medications, including opiate-based painkillers like hydrocodone. While the DEA action to reschedule hydrocodone recognizes that the drug is dangerously addictive, it fails to address the root causes of prescription drug abuse, which lie far beyond the regulatory purview of the DEA.
Possible solutions that could move in the right direction toward addressing the actual problem of prescription drug abuse might lie in the areas of increased mental health services and increased access to non-pharmaceutical, adjunctive treatments for chronic pain. Because chronic pain has a strong emotional component, additional mental health support could be a great asset in preventing addiction. Sadly, the dwindling availability of mental health services continues to severely limit this option, leaving adjunctive treatments as a ray of hope. While numerous non-pharmaceutical approaches to pain management are available, many, such as yoga, acupuncture, and mindfulness meditation, are only beginning to gather the robust body of scientific evidence needed for physician recommendation or insurance coverage. Fortunately, this is changing.
Hopefully, the ruling will help to curb the rising trend of prescription drug addiction. However, skeptics of the rule’s efficacy point to the nature of addiction itself, claiming that with hydrocodone becoming less available, addicts will move on to stronger drugs, such as heroin. Not only will the problem of addiction not be solved, but now the addicts will be using even more dangerous drugs.
In practical consideration, the ruling will likely add to the frustration experienced by primary care providers, who already find pain management in their clinical setting increasingly difficult. Having pledged professionally to do no harm, primary care providers must balance the will to ease the suffering of their patients with the mandate against enabling addiction. Walking this line between healing and harm constitutes an endless loop of frustration that cannot be relieved by tighter restrictions and regulations. Those who walk this line daily are most qualified to offer a real assessment of whether the new hydrocodone restrictions have created a safer environment or simply more pain.
Pain comes in both acute and chronic forms, and each form has a strong emotional component. Acute pain is the pain one experiences after breaking an arm or having surgery. The associated emotions are likely based on short-term survival. This is what opioids are best for: Relieving intense, acute pain. The drugs relieve the mind’s reflection upon the body’s condition.
Chronic pain, however, is the pain that persists for months or years after the accident or operation. Prescribing opioids to relieve chronic pain often sets the stage for addiction, because pain triggers intense emotions, and intense emotions trigger pain, in a chicken-or-egg relationship that can grow intolerable over time. Without other alternatives available, seeking escape through addictive substances becomes understandable.
With new DEA restrictions in place, and no appreciable increases in mental health resources on the horizon, primary care providers are left with very few options for helping their patients manage pain. One strategy worthy of further exploration is for providers to increase their awareness of non-pharmaceutical pain management tools.
Physical therapy and massage can be used effectively as adjunctive treatments for pain management, as can body-mind therapies such as yoga and mindfulness meditation, biofield therapies such as Healing Touch and reiki, and approaches from Chinese medicine, such as acupuncture. Complementary therapies such as these are often not considered by providers when developing a plan of care for a patient, because these interventions are not taught in most medical or nursing schools. Without first-hand knowledge or experience of these therapies, doctors are more likely to dismiss them out-of-hand, citing insufficient evidence. Yet each of these therapies has a growing body of robust scientific evidence to demonstrate its utility in treating people with chronic pain, and as such, is worth trying.
To maintain professionalism under this line of thinking, providers should make themselves aware of the alternatives. At the very least, then, they will be able to empower patients by providing resources. Patients, too, can make themselves aware of alternatives and take proactive action for their own better health, by asking their doctors for referrals and resources.
Time will tell whether the new hydrocodone restrictions will make the world safer or contribute to real, appreciable, increases in patients’ lived experiences of pain. Relieving pain and suffering is one thing, and relieving the root cause of addiction is another.
Opinion By Lane Therrell