Opioid Treatment in the News

The content of the WSJ article titled "Painkiller Advocate Thinks Twice" neither shocks nor surprises me. Its a fact that in the US opioids are being prescribed by medical practitioners with little or no training in their clinical indication, application, dosing and length of treatment. As an international medical graduate from Germany and Israel I can attest to the fact that the use of prescription narcotics is far more restricted and controlled in other countries than in the US. It appears that in the US doctors are practicing on another planet, where the laws and rules of medicine do not apply: no tolerance to drugs, no drug induced hyperalgesia , no addiction. In South Florida ( another planet by itself) I routinely see patients for opiod dependence treatment who are being prescribed ungodly amounts of Oxycontin,Percocet or Lorcet for unspecified chronic pain syndromes related to "old" injuries, migraine or back pain with no, or little, documentation. Most of them I safely took off opioids and they are doing much better. The article clearly points out that the proponents of long-term opioid treatment provided little evidence for their efficacy or safety. Furthermore, the article also highlights how pharmaceutical companies such as Purdue Pharma, influenced and manipulated key decision makers and regulators including the Federation of State Medical Boards. Regarding Dr. Portenoy: after years of opioid treatment "education" and hundreds of thousands of dollars worth of paychecks by the pharmaceutical industry he still seems to struggle with the reality that opioid dependence can be induced by prescription narcotics and can be treated successfully. This article serves as an attempt by Dr. Portenoy to emulate Pilate in Matthew 27:24 in which he washes his hands in public to proclaim his own innocence. I definitely do not believe him and neither should any of the readers of this article. Happy Holidays. Yours