Surgeon General’s Important Report on Opiate Addiction Misses on Solutions

Chronic pain impacts over 100 million Americans, but what it has in common with a huge portion of the substance abuse epidemic is opioids

A Duke pain control expert praised today’s Surgeon General’s report on opiate abuse, but said the report missed an opportunity to call for research and development of additional medical alternatives to opiates for pain management.

"This is an outstanding report that outlines ways to deal with an overt problem around addiction and substance abuse, and provides full recognition that this is disease rather than a character flaw," says Duke Health pain expert Dr. William Maixner, director of the Center for Translational Pain Medicine and the Innovative Pain Therapies at Brier Creek within Duke’s Department of Anesthesiology.

The report on addiction and substance abuse is a call to action for dealing with an epidemic that afflicts nearly 21 million people and costs $420 billion a year.

“There is an inter-relationship between this very overt substance abuse epidemic, which affects more than 20 million people in the U.S. and has a profound impact on the human condition, and the subtler and large covert epidemic of chronic pain. Chronic pain impacts over 100 million Americans, but what it has in common with a huge portion of the substance abuse epidemic is opioids.”

William Maixner is a professor of anesthesiology at Duke School of Medicine, specializing in pain medicine. He serves on the Interagency Pain Research Coordinating Committee at the U.S. Department of Health and Human Services, and was a recent board member of the American Pain Society.

“The exposure that is leading to much of this substance abuse epidemic comes from pain management -- well-intended pain management, but pain management where opioids are one of the few outlets many physicians have available,” Maixner said.

“As a pain expert, I had hoped the Surgeon General’s report would present a greater emphasis on the need to develop alternatives to opioids that can be used for pain management, which would eliminate this key pathway to abuse. We have a fundamental problem when we are trying to manage pain for the 100 million people who have some form of chronic pain, and opioids are among the few therapies available that work.

“The cost of treating chronic pain is greater than the combined costs of diabetes, cancer and heart disease. Yet we spend just 4 cents per pain patient annually on research, while pain patients consume about 15 percent of health care costs annually. That’s a big imbalance.”