For many years, health care providers like me were told that we were undertreating pain and that pain was a vital sign that needed to be measured. Concurrently, we were reassured that opioids were a safe and effective way to treat pain, with very little potential for development of abuse. As a result, opioid prescriptions in the United States skyrocketed. A common way to compare opioids is to calculate their strength relative to morphine, called morphine milligram equivalents, or MMEs. In 1992, our country dispensed 25 billion MMEs of prescription opioids; by 2011, that number had reached 242 billion. Meanwhile, opioid-related deaths and treatment admissions increased in parallel.
Living Well with Osteoarthritis: A guide to relieving the pain and caring for your joints
This report focuses primarily on osteoarthritis — the most common type of arthritis — which affects 27 million Americans. Many people believe it’s a crippling and inevitable part of growing old. But things are changing. Treatments are better, and plenty of people age well without much arthritis. If you have osteoarthritis, you can take steps to protect your joints, reduce discomfort, and improve mobility — all of which are detailed in this Special Health Report, Living Well with Osteoarthritis: A guide to keeping your joints healthy. If you don’t have osteoarthritis, the report offers strategies for preventing it.
The guidelines raised several concerns among patients with chronic pain on high-dose opioids, as well as the providers who cared for them. Should patients on more than 90 MME be abruptly cut off? Should a rapid taper occur to get to the safe upper limit? What should be done if a patient has been on a stable, but high, dose of opioids for a long time and they are doing well? A recent open letter written by a group called Health Professionals for Patients in Pain and signed by hundreds of experts across the country made some scathing accusations: doctors and regulators believed that the 90 MME cutoff was an absolute dose limit, which led providers, pharmacists, and patients to come under suspicion; insurer-imposed barriers, pharmacy limitations, and metrics were then applied that adversely affected patients on high-dose opioids; and some patients had even turned to suicide or illicit substance use as a result of this unnecessary suffering.
