Why you should care

Regulations that make it harder to buy painkillers might curb addiction, but they harm everyone.

Professional fighter Nikko Jackson accepts pain as a daily fact of life. He can usually manage it with over-the-counter painkillers, but when he tore his ACL in 2007, the pain became unbearable — like someone had taken a drill gun to his knee. Amid all that pain it was hard to stomach the endless regulations around the hydrocodone his doctor prescribed. “You can take only so many pills a day, so it’s like a math problem instead of actually what’s going on with the patient,” he says.

Are we overregulating painkillers? Many of the 100 million Americans who endure chronic pain don’t get the relief they need, according to a 2011 Institute of Medicine report, which blames a regulatory morass meant to prevent painkiller abuse. That’s a noble aim, but it overlooks a crucial fact: Although painkillers do pose health risks, so does pain itself. And blanket restrictions delay or deny relief to people suffering from debilitating pain related to cancer, or even torn ACLs. In the end, undertreating pain hurts everyone, costing the U.S. up to $635 billion in medical bills and lost productivity each year, says the Institute of Medicine report.

Few cite research showing that such severe cases typically benefit from these painkillers without developing an abuse problem.

No doubt, prescription painkiller abuse remains a huge problem in the U.S. According to the CDC, more than 12 million people said they misused or abused prescription painkillers in 2010, while recent studies suggest that prescription painkiller abuse has fueled a rise in heroin abuse. To turn the tide, the Drug Enforcement Administration regulates how long patients can take narcotic painkillers, how often they can get refills and more. Even over-the-counter meds like NyQuil have come under scrutiny. The point is to protect those “at risk due to genetics and social factors,” says Jason Hoppe, an emergency medical specialist at University of Colorado Hospital.

Which is a pain — quite literally — for those not prone to addiction. Untreated pain brings its own health problems, from decreased mobility to bad sleep. Chronic pain has been linked to sexual dysfunction and anxiety, and those who suffer it have threefold the average risk of developing psychiatric disorders like depression. Sure, the “opioid painkiller epidemic” dominates headlines, but few cite research showing that such severe cases typically benefit from these painkillers without developing an abuse problem. Erring on the side of regulation might lower abuse, “but you run the risk of this collateral damage,” says Russell Portenoy, a pain care specialist at Beth Israel Medical Center in New York City. Prescriptions “will also go down for those who should be given the treatment.”

A few creative solutions could go a long way toward widening access to pain relief while still curbing abuse. More electronic prescription databases, for one. Drug take-back programs, too. And pharmaceutical companies could be incentivized to develop what are known as abuse-deterrent formulations of painkillers that still do the job but might, say, form a gel when crushed so abusers can’t snort them. Bottom line: Some oversight is necessary, but the regulations shouldn’t be a pain for all.

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