“I love my opiates! I couldn’t live without my opiates!”
Paula was one of the many people within whom pain was having such a major effect, impacting the way she lived, the way she interacted with others, impacting her desire for life.
In fact she attributes Dr Thomas with saving her life! And Dr Foley indicates pain can lead to death as it has been shown to do so in animal experiments. Dr Thomas found both the right medications and the correct way of delivering these mediations to treat her pain.
A number of things struck me about Paula’s story.
1) Opiates (yes drugs like morphine) are very effective in treating pain. In fact they are essential in the treatment of pain according to the Single Convention of Narcotic Drugs signed by the countries of the world in 1961. Still 80% of the world’s people lack access to these medications. Ivory Coast’s strong opiate consumption in 2008 (measured in mg/person) was 500,000 times less than Australia and over one million times less than the USA. And Ivory Coast is the lowest morphine consuming country of those that reported. Over 50 countries had zero morphine consumed or did not report.
2) Opiates can be used for the treatment of neuropathic pain (pain associated with nerve damage). So often we hear that this sort of pain is “opioid resistant” that is it is a pain for which opiatea do not work. They can work in the treatment of neuropathic pain, but may need higher doses and different delivery methods, but neuropathic pain can respond to opioids together with many co-analgesic drugs (e.g. local anesthetic agents, antidepressants and anti-seizure medications).
3) Opiates should not be reserved just for folks who are at death’s doorstep. While is seems that Paula’s cancer has spread to the nerves at the top of her arm, we heard nothing about the disease spreading further in her body. Opiates can be used at any stage throughout a patients journey with HIV, cancer or other conditions. As with all medications, risks and benefits need to be weighed and explored with the patient, but it should be our clinical obligation to present opioids as a treatment option.
4) Paula loves her opiates. A statement like that may be interpreted by many to say she that she is “addicted” or has “dependency syndrome.” But not to me. Paula is saying this because opiates have given her her life back.
Lets give back their lives to the millions of patients who are suffering needless pain throughout the world. Yes give them opiates as part of smart, balanced plan for the improved global access to pain relief.
Treat the Pain: http://www.treatthepain.com
Pain and Policy Study Group http://www.painpolicy.wisc.edu
Life before Death: http://www.lifebeforedeath.com
Union for International Cancer Control: http://www.uicc.org