An 'Alarming' Improvement in Pain Treatment


Speaking of pain treatment, A.P. has a confusing jumble of a story on the subject with an ambivalent tone summed up in the lead: "People in the United States are living in a world of pain and they are popping pills at an alarming rate to cope with it." If people are "living in a world of pain," why is their consumption of painkillers "alarming"?

The hook for the story is an A.P. analysis of DEA numbers that found "the amount of five major painkillers sold at retail establishments rose 90 percent between 1997 and 2005." A.P. worries that "more people are abusing prescription painkillers because the medications are more available," and it implies that pharmaceutical companies, through slick marketing campaigns, are raising consumption of their products above a level that is medically appropriate.

But as the story notes, there are perfectly legitimate explanations for the increase in painkiller consumption, including the aging of the population and a more enlightened approach to pain in which doctors seek to control it as much as possible instead of telling patients in agony to tough it out. Furthermore, A.P. (to its credit) reports, many physicians, "spooked by high-profile arrests and prosecutions by state and federal authorities," have stopped prescribing narcotics, and "people who desperately need strong painkillers are forced to drive a long way" to get them.

So are doctors too loose with painkillers, or too stingy? Are Americans consuming too many, or not enough? It's possible, of course, that the pills are going to the wrong people, to malingerers, addicts, and drug dealers instead of legitimate patients. If so, the problem is not the quantity consumed but the way in which it's distributed. But that problem is not as easy to fix as the DEA would have you believe. Since pain cannot be objectively verified, the crucial variables are doctors' inclination to trust patients and willingness to help them by prescribing narcotics. In practice, as pain treatment improves, as more people in severe pain get the relief they need, more fakers will slip through. Conversely, as doctors become more suspicious of patients and/or more fearful of losing their licenses, livelihoods, and liberty, fewer people will obtain drugs for nonmedical purposes, but more patients will be denied the medication they need to make their lives livable. This ineluctable tradeoff between drug control and pain control is the reason A.P. can't seem to make up its mind about whether an increase in the sale of painkillers is good news or bad news.

 [Thanks to SPB SPD for the link.]