MMS Ethics Forum Examines Pain Management

The opioid epidemic continues to grow, here in Massachusetts as well as the nation.  In its latest tally, the state has recorded more than 1,000 opioid-related deaths in 2014, 33 percent higher than just two years earlier.

In announcing the figure on Wednesday, Governor Charlie Baker cited research showing that four out of every five heroin addicts got hooked on opioids through pain medications, many starting with legally prescribed medicine, according to a report by The Boston Globe.

While some point to the overprescribing by physicians as part of the problem, the opioid epidemic – and what can be done to reduce the abuse – has been a priority topic for physicians. The MMS’s 2015 Public Health Forum focused on the topic, and Dr. Richard Pieters’ President’s Report to MMS members delivered earlier today recounted some of the Society’s accomplishments in addressing the issue.

Today’s MMS Ethics Forum continued the Society’s emphasis on the topic. Presented by the Committee on Ethics, Grievances, and Professional Standards, the 2015 forum explored the ethical and legal consideration in pain management. Among the topics included were responsible prescribing, the complexity of pain as a clinical issue , and the ethical problems associated with undertreatment and overtreatment, and the balance between a physician’s obligations to the patient and obligations to public health.

Participants include Seven Adelman, M.D., director of Physician Health Service; Dr. Richard Pels, Director of Graduate Medical Education at Cambridge Health Associates; and Mark Eisenberg, M.D., Unit Chief of Adult Medicine at Massachusetts General Hospital-Charlestown Health care Center.

Visuals from the presentations may be viewed here.

  1. Emi says:

    Opiates, bad. We know this. But sometimes they are circual to pain relief. As Carlos pointed out, overreaching in the area of opiate control did an incredible disservice to patients who were too often left with no means of relieving their agony. But what is more astounding to me is there is a substance available, which enhances the effects of opiates without increasing the severe side effects; and which can lead to the reduction, and even elimination of opiates for pain management. That substance would be cannabis. 100 years ago, and for more than half a century before that, cannabis tincture was widely prescribed to relieve a panoply of pain symptoms; and it was also used as a way of weaning off of opiate addiction. The only problem with cannabis was that, unlike opiates, which are water soluble, cannabis requires a lipid solvent, and thus administration methods were limited. Deferring to ease of administration, rather than patient benefit, physicians gravitated toward the use of opiates. Unfortunate, but understandable. Today, however, there is absolutely no excuse for the continued prohibition of this powerful, beneficial and mostly benign medicine. We need to reschedule cannabis at the Federal level as soon as possible if we want to see effective alternatives to opiate analgesia developed. Please tell me, what is holding this up?

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