By Sy Mukherjee
July 10, 2018

For years now, the extent of the heroin and prescription opioid painkiller addiction scourge ravaging the United States has become increasingly clear. It’s a crisis that afflicts communities both rich and poor, which reverberates through social and economic life alike.

That reality has led, understandably, to a flurry of public health measures aimed at containing this ever-growing opioid epidemic, which kills tens of thousands of people every year (and may actually be getting worse). But, as a Food and Drug Administration (FDA) meeting held Monday highlights, the issue is extremely complicated—especially for the millions of Americans who legitimately suffer from chronic pain and feel that recent public health efforts are in effect cutting off a vital resource that helps them lead more bearable lives.

One patient attending the meeting laid out the reality in dark, stark terms: “Suicide is always an option for us,” said Mariann Farrell, who reportedly suffers from conditions like fibromyalgia and other chronic pain-inducing diseases, according to NBC.

Several other attendees highlighted what, for them, amounted to harmful unintended consequences of the national crackdown on opioids, including the increasing stigma of prescribing powerful painkillers and stricter drug monitoring programs. Several said they could no longer find doctors willing to prescribe the treatments they desperately need.

Federal health authorities, including the Food and Drug Administration (FDA) chief, took a cautious approach in responding to the concerns.

“Unfortunately, the fact remains that there are still too many prescriptions being written for opioids, and too many prescriptions written for long durations of use that aren’t appropriate for the medical need for which the opioid is being prescribed,” said FDA commissioner Scott Gottlieb in a statement. “This presents a difficult challenge both for the FDA and for providers. We don’t want to perpetuate practices that led to the misuse of these drugs, and the addiction crisis. At the same time, we don’t want to act in ways that are poorly targeted, and end up disadvantaging legitimate patients.”

Balancing those delicate needs is a difficult task, indeed—one that major medical groups like the cancer outfit American Society of Clinical Oncology (ASCO) have noted in their own proposed guidelines. “ASCO believes that cancer patients should be largely exempt from regulations restricting access to or limiting doses of prescription opioids in recognition of the unique nature of their disease, its treatment, and potentially life-long adverse health effects from having had cancer,” wrote the group in a 2016 position paper.

Millions of Americans suffer from pain. Millions suffer from addiction. Both can be deadly—the question is how to best produce the best outcomes for all involved parties.

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