Opioids are killing people. In Hawaii, opioid medications were responsible for 35 percent of the 778 overdose deaths from 2010-2014.

Whether taken alone or in combination with other pills, the use of these medications can have lethal consequences. Across the United States, the numbers of addicts are rising, and many state legislatures are crafting laws regarding the appropriate use of these prescribed pills.

In Hawaii, Senate Bill 505 was approved and awaits the consideration of Gov. David Ige. It would establish variable limits on the amount that can be prescribed based on the indication for its use.

If opioids are so deadly, why are they prescribed at all? And will this legislation help?

Capitol Building Honolulu Legislature. 1 may 2017
The bill that came out of the Legislature won’t solve Hawaii’s opioid addiction problem. Cory Lum/Civil Beat

In order to fully understand how pain pills work, a brief review of pharmacology is necessary. Pain from anywhere in the body is a complex process by which signals are sent to the brain and bind to certain receptors that trigger the sensation of pain.

Opioid medications also bind to those receptors, making them unavailable for pain mediators, and creating a sensation of pain relief, anti-anxiety and a sense of relaxation. The higher the dose, the more receptors that are blocked from pain signals and instead available for pleasurable relief.

But the body adapts, and if the painful stimulus is still around, more receptors are produced, creating a greater dose requirement to achieve the same level of pain control. So, unless the cause of pain is relieved, the doses required to control the symptoms usually rise over time.

Temporary use of pain medication, such as after surgery or breaking a bone, is often required to help someone deal with the symptoms while their body heals. This use of pain pills for an acute event is often medically necessary to avoid extreme pain and suffering. As the body heals, the requirement for medication goes away, and hopefully these people will be able to stop using all pain pills quickly.

The greater risk comes with chronic pain. Two common situations occur, either the source of the pain stimulus is gone but the person still experiences pain, or the stimulus is there, and untreatable, such as with severe arthritis.

These people may be on chronic pain medication just to function. Without the medication, their brain creates such a strong craving that they will do anything to get the pills they need. This type of situation is not easy to treat.

In addition to limiting the number of pills prescribed at one time, SB 505 would require a signed pain contract between the prescribing doctor and the patient that specifies the requirements for monitoring if the medication is to be used for longer than the original prescription provides.

At first glance, this seems like a great start to addressing the drug abuse that often starts with prescriptions for pain pills. Creating more work for prescribing physicians would mean that many just won’t give opioid pain pills anymore, thus leading to fewer chances at addiction.

But that doesn’t seem like a good long term solution. I can only envision patients coming to my door telling me that their surgeons won’t give them pain pills because of the paperwork, and then feeling obligated to do what I can to help them, but not really understanding their pain control requirements.

Restricting doctors from doing their job correctly by creating an administrative hassle doesn’t seem like it’s going to work for most physicians I know. Many patients who have surgery need to have pain control for a lot longer than a week. Lengthening the duration of the initial prescription to at least a month may help to provide better options that would apply to more patients than the one week time limit currently proposed.

The other downfall is that some patients really do need to use chronic pain pills, and are not able to treat their primary condition at all. Severe arthritis, chronic neck and back pain from narrowing of the spine, headaches that are unexplained by anatomical scans — these types of conditions can be disabling, and yet treatment is unavailable to do anything more than control the pain. These patients will be restricted from getting their medication unless they comply with the newer system of contracts, urine toxicology screens, or they’ll have to see a chronic pain specialist.

By creating more hoops to jump through, the Legislature is going to inadvertently limit the numbers of doctors willing to prescribe pain medication to anyone. That will create a greater demand for pain management specialists, and there is already a major shortage of these physicians now.

What will chronic pain patients do then? One option may be the medical marijuana dispensaries, for those with qualifying conditions. Studies show fewer prescriptions are made in states where medical marijuana is legal.

However, the other option will be what has unfortunately become the choice of many, the illegal use of street drugs.

A more comprehensive approach is warranted. More needs to be done to address the growing crisis of pain management, and bring more experts to our medical community to help.

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