Too many opioids. Not enough opioids. Behold the opioid paradox.
The United States is in the midst of a massive opioid epidemic, as The Washington Post and other news organizations have documented extensively. In 2015, more than 33,000 people died from overdoses of opioids, meaning prescription painkillers, heroin, fentanyl or any combination. That easily keeps pace here with fatal motor vehicle accidents and gun-related deaths.
Certain states have been particularly affected. The Charleston Gazette just reported that opioid wholesalers shipped 780 million oxycodone and hydrocodone pills into West Virginia over a six-year period — enough for 433 pills for every person in the state. Meanwhile, 1,728 West Virginians died from overdoses of those two drugs.
But there's another side to the story. Opioids can be an effective treatment for chronic pain, and too many people around the world have limited access to them.
"We view pain relief as a human rights issue," Kathleen Foley, a neurologist at Memorial Sloan Kettering Cancer Center, said at a Princeton symposium on pain and opioids this month. Historically, she said, pain has been under-treated, and she is concerned that the opioid epidemic "has stigmatized all patients with pain."
Even in this country, some patients may be denied opioids because doctors are not convinced their described pain is real or fear the pills will be diverted to the illegal market. Keith Wailoo, a Princeton historian of medicine and health policy, who also spoke at the symposium, calls it a "pain gap" and says it is why African Americans with sickle cell disease, for example, have reported trouble getting prescription painkillers. "Think of it as a pain gap between the haves and the have-nots, along lines of class and race," Wailoo wrote in the Daily Beast.