In the U.S., in fact in most free societies, presumption of innocence is one of the key tenets of the justice system. Defense attorneys get quite upset when the media depicts their clients as guilty before they have even gone to trial. And the courts bend over backwards to ensure that each defendant's right to being presumed innocent until proven guilty is protected.
My question is, why is this same right not afforded to chronic pain patients by the medical community? It seems to me that it would be much better to assume a patient is really in severe pain until they are proven to be drug abusers. Unfortunately, too often the reverse is true – patients are presumed to be drug abusers until they can somehow prove they are really in pain.
Every day I read SharePosts, letters and questions from people whose lives have been turned upside down by pain and it breaks my heart. They have lost jobs; their marriages have broken up; their family and friends have turned away from them; and they are made to feel they have mental problems – all because they cannot get relief from the unrelenting pain. Yet so often they can't find a doctor who is willing to help them for fear of being prosecuted for prescribing too many opioid medications.
I understand the dilemma doctors face. It only takes one or two cases of caring doctors being prosecuted because a few of their patients abused the drugs they were prescribed to scare off hundreds of other doctors. Add to that the fact that often malpractice insurance rates skyrocket if the doctor prescribes opioids and it's easy to see why so many doctors decide they just can't take the risk.
So what is the answer? I wish I knew. I'm afraid the solution is going to have to start with the government, which is a slow and difficult way to go. A big part of the problem is that different parts of the government are not communicating or coordinating with one another, which is apparently not unusual as we learned after 9/11. Almost eight years ago Congress passed a law declaring this the “Decade of Pain Control and Research.” However, around the same time the DEA stepped up its war on drugs, prosecuting doctors who were presribing too many narcotics.
I think that both goals can be accomplished – pain control can be improved and drug abuse can be reduced – but the various departments of government and the medical community have to work together for the good of the patient. For too long the primary emphasis has been on reducing drug abuse. It's time now to focus on helping people in pain. It's time to apply the presumption of innocence rule to pain patients.