To err is human, but failure to learn from mistakes is foolish. Many mistakes have been made when it comes to treating pain and the future of pain medicine hinges on whether or not we can learn from these mistakes. The dismal lack of education and knowledge among health care professionals and the public has really amounted to a huge number of mistakes, some deadly.
Between 1999 and 2007, drug-induced deaths were second only to motor vehicle accidents.1 Since the early 1990's, the rate of unintentional drug overdoses has dramatically risen in conjunction with the dramatically increasing number of opioid prescriptions.2
Other mistakes may have been more insidious because greed and addiction have hooked many. The results can be just as deadly as we have all seen in the high profile cases splattered across the headlines about Anna Nicole Smith and Michael Jackson. These big names overshadow the millions of lesser known victims out there among the youth of America who have gotten a taste for pills found in unlocked medicine cabinets, trash bins or in the pockets of "friends." Now, the future of pain medicine is precariously perched at the edge of a cliff unless we can all learn from our mistakes.
Dealing with the pain epidemic is extremely difficult when America is also caught in the crosshairs of a prescription drug abuse epidemic. Public health officials like the Surgeon General know that the key to successfully stopping any epidemic is education. Education has helped solve many public health crises. With the recent White House report release "Epidemic: Response to America's Prescription Drug Abuse Crisis," this administration has launched a strategy to deal with the prescription drug abuse epidemic, but whether or not this plan will undermine the current war against pain is yet to be determined.
The first strategic arm of this plan addresses the lack of education in the current population of medical care profession surrounding the treatment of pain and the risks of prescription drug use. This call for action will not only help to address to pain epidemic, but should also help to curtail the substance abuse epidemic. Health providers will be educated about risk assessment, outcome monitoring, and the standard of care for those in pain. According to Scott Fishman, MD, President and Chair of the American Pain Foundation, physicians will be asked to participate in "16 hours of medical education and a test about the treatment of pain." Dr. Fishman's home state of California already has a law (AB487) that requires most doctors to complete 12 hours of pain medicine or palliative care education. The entire nation will be moving in that same direction because, as Dr. Fishman says, "The time to address the lack of education in the current doctor population has come."
Educating health care professionals is just the beginning. The general public, parents, law enforcement officers and children are all targets of a larger education process which aims to curtail the prescription drug abuse in America. In addition to a public health education campaign, the government is encouraging research into new technologies to combat drug abuse. Although the pharmaceutical industry is developing more "abuse deterrent medications" that cannot be tampered with and injected, this technology may give doctors and the public a false sense of security. According to Dr. Carol Warfield, FDA consultant and Harvard Professor, "Shooting-up is not the primary way that kids are using these drugs. Many are going to parties and taking the pills orally. These tamper-proof drugs are not necessarily a real abuse deterrent."
