LAUSR

1Division of Medical Ethics, NYU School of Medicine, New York, NY, USA; 2Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU School of Medicine, New York, NY, USA; 3School of Social Work, North Carolina State University, Raleigh, NC, USA; 4McLean Hospital, Division of Alcohol, Drugs, and Addiction, Harvard Medical School, Boston, MA, USA The “war on opioids” is well publicized, albeit sometimes misguided. Much has been written on how efforts to reduce the flow of prescription opioids have morphed into a war on chronic pain patients. There have been numerous editorials and articles published expressing concerns regarding the unfortunate consequences of the resulting “opiophobia” and “oligoanalgesia”, and many other key opinion leaders have and continue to express similar concerns. Efforts to counteract these tragic consequences have met with a degree of success, although much more needs to be done if chronic pain patients for whom there are frequently no other viable, accessible alternatives to opioid analgesia are to regain access to judiciously prescribed opioids. Unfortunately, advocacy for patients with pain, particularly on social media, has seemingly devolved into purely advocacy for access to opioids. We see this as problematic on a number of levels. First and foremost, opioids are not the only treatment for many types of chronic pain, and certainly not necessarily the safest and most effective. Pain management should be based on best practices guided by clinical judgement and the supporting science. Opioids and other analgesics, as well as many procedures and surgeries, generally represent purely biomedical approaches to chronic pain. Over 2 decades ago, Rollin “Mac” Gallagher astutely noted that “The history of pain medicine is replete with failures of the biomedical model”. (p. 559). Numerous others with broader understandings of pain management have subsequently echoed his sentiments. The importance of providing chronic pain patients with education in order to help them reconceptualize their pain away from flawed biomedical approaches has also been addressed in the literature. Accordingly, we posit that advocating solely for access to opioid analgesia is in fact advocating for ineffective, purely biomedical care, as opposed to coordinated interdisciplinary treatment that is likely to be far more beneficial for most patients. Second, the image of patients with chronic pain (as well as that of many of us who treat them) is less than stellar at this juncture. Radically anti-opioid forces have done their best to discredit patients with chronic pain through the use of stigmatizing and marginalizing rhetoric and hyperbole. For example, when interviewed for an article published in the Richmond Times-Dispatch in 2015, Andrew Kolodny (an addiction psychiatrist, not a pain physician) reportedly stated, “When we talk about opioid painkillers we are essentially talking about heroin pills”. More recently, Dr Keith Humphreys (an addiction psychologist, not a pain psychologist) testified to a US House of Representatives subcommittee, stating “as long as we continue putting countless Americans in 'heroin Correspondence: Michael E Schatman Division of Medical Ethics, Department of Population Health, NYU School of Medicine, 550 First Avenue, New York, NY, 10016, USA Tel +1 425-647-4880 Email [email protected]