The flaws of the major systems bring us to the core issue: People with pain and addiction and the doctors treating them live in a world of false alarms often vilified for social and medical problems.
This also means every physician prescribing controlled substances must watch out.... must remain vigilant to remain off the law enforcement radar. Reality says it makes sense to avoid red flags (high or frequent prescription of narcotics.) The important thing to note here is that the fear factor may dampen the Hippocratic spirit: The duty to place the need of a patient ahead of all other influences. The fear factor is toxic. Rooted in survival instincts it compromises sound judgment and individual needs.
In summary, the way we treat people with chronic pain and addiction is wrong. Science, not law must lead neuroscience In Washington DC, Rome Istanbul now or 1000 years from now. Science has the solutions but only if we let science lead the practice of medicine.
References:
1-Institute of medicine report, June 2011
2-Apkarian AV, Sosa Y, Levy RM, Parrish TB, Gilelman DR. Chronic back pain is associated with decreased prefrontal and thalamic gray matter density. The Journal of neuroscience. November 17, 2004 24(46)10401-10415
3-Salerian AJ. Addictive potential. Medical hypotheses 74(2010) 1081-1083
4-Basile AS, Federova I, Zapata A, Liu X, Shippenburg T et al. 2002. Deletion on the M5 muscarinic acetylcholine receptor attenuates reinforcement and withdrawal but not morphine analgesia. In: proceedings of the national Academy of science USA p. 11457.
5-Webster LR, Dasgupta N . Hope obtaining adequate data to determine causes of opioid deaths. Pain medicine 2011; 12; 586-592
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