Overcoming Pain

Why people experience chronic pain, and the power they have to de-intensify it

A New Generation of “Flatliners”

Naloxone is a great drug, commonly used in the hospital and emergency settings.

Who can forget that hoot of a movie, where Julia Roberts and Kiefer Sutherland take turns bringing each other back from a pharmacologically-induced death? I still recall the debate I had with my fellow residents who saw that movie: Didn’t the defibrillator paddles do more for Ms. Roberts’s sex appeal than that Louis Vuitton accessory that accompanied her during her last visit to Oprah?

Who would think that perhaps a significant segment of the population is about to become this generation’s Flatliners?

Rates of fatal drug overdoses have more than doubled in this country over the past ten years. In fact, drug overdose deaths hit a record high 38,329 in 2010, overtaking motor vehicle accidents as the leading cause of preventable injury death. The majority of these deaths are associated with prescription opioids, trending along with the continuing rise in opioid prescribing. Is there something we can do to bring these overdose victims back from the edge—to keep them from killing themselves or others?

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One answer is increasing the availability of naloxone to the lay public. Naloxone is most easily described as the “antidote” to opioids. And a recent analysis published earlier this month in “Annals of Internal Medicine” found the distribution of naloxone to members of the public for use during an opioid overdose to be clinically effective---and cost effective. Naloxone is a great drug, commonly used in the hospital and emergency settings to reverse the life-threatening effects of opioids. However, its use as a public health intervention is only recently being advocated with greater intensity.

Federal health agencies are encouraging development of user-friendly naloxone delivery systems, in addition to studying overdose interventions in the field. Of course, they are also studying how to incorporate naloxone availability and use into a larger approach to drug addiction: Perhaps such a “near-death experience” will result in entry to a drug treatment program. In addition, it would be both interesting and economically wise to study whether naloxone has the same positive impact on, say, inner city and suburban heroin users, or inner city and suburban OxyContin users. It is always best to target, and thus tailor, opioid abuse interventions.

The National Institute on Drug Abuse, working with the pain specialists at the National Institutes of Health, has funded “pain centers of excellence” to assist health care professionals in the basics of screening for and monitoring pain, and the treatment of that pain.

I certainly hope such interventions result in less need for some frantic emergency room doctors to have to say “CLEAR” over the lifeless body of the next overdose victim.

It’s never a good day to die.

Mark Borigini, M.D., is a board-certified rheumatologist who has devoted his career to treating illnesses that cause chronic pain and disability.

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