Pain treatment, drug diversion, and the casualties of war

It is unfortunate that well-meaning individuals can often find themselves at odds over issues where both parties share similar goals, that of improving the health and well-being of the populace, due to differing perspectives of the same issue. As health care providers focused on reducing suffering and improving comfort, physicians are eager to provide pain relief, often in the form of opioid analgesics. Over the recent decade, we have witnessed a greater emphasis on the diagnosis and treatment of pain. Although many of us still see considerable room for improvement in the quality of pain treatment in the United States, in fact, substantial gains have been made. Pain assessment has become an accepted standard in the care of hospitalized patients, and there is a greater expectation on the part of our patients for pain relief. One hallmark of this success has been the development of federally funded guidelines for the management of cancer and acute perioperative pain. Another indicator has been the dramatic escalation in the use of opioid analgesics. Based on data from the U.S. Drug Enforcement Agency (DEA) Automation of Reports and Consolidated Order System (ARCOS), which monitors opioid production and delivery to retail pharmacies, between 1997 and 2004 the amount of oxycodone, hydrocodone, and methadone delivered increased by 640%, 275%, and 903%, respectively. From the perspective …