Authors: Alice Weatherston
Since 1999 the use of opioids for pain management has quadrupled in the USA, resulting in what is now well known as the ‘opioid epidemic’ – too many people are now unnecessarily reliant on the drugs and opioid-related overdoses have rocketed. The prescription of opioids within the USA is now considered to be one of the biggest health crises facing the nation, however the battle to ‘fix’ the problem is complex.
Michael Schatman has worked in multidisciplinary chronic pain management for over 30 years and has published more than 90 journal articles on pain management and pain bioethics. He recently published an article discussing the ‘MEDD myth’, exploring the impact of reliance on unreliable techniques for calculating opioid doses within the medical literature and in the generation of opioid guidelines. We contacted Michael to find out more about this as well as his extensive work around the ongoing opioid epidemic in the USA.
How significant is the problem of undertreated pain within the patient population?
To some extent in the UK and Europe it’s a problem, but nowhere near as bad as it is in the USA. I have written extensively about the problems going on. One of the key problems is that pain medicine is no longer a profession in the USA, it’s purely a business. Furthermore, we have a severe shortage of qualified or certified pain specialists across the whole country (currently only 4700).
In addition, primary care is responsible for the majority of chronic pain treatment, but they’re not trained in it well. When people think of the USA they think of the big cities; New York, San Francisco, Chicago, but 20% of the population live in rural areas which are underserved, in these places if you can find a family doctor and veterinarian you’re doing well.
So what is the ‘MEDD myth’?
The MEDD myth is a paper that just appeared in the Journal of Pain Research, which I authored with Jeffrey Fudin (University of Connecticut, CT, USA; Western New England University, MA, USA) and Jacqueline Pratt Cleary (Stratton VA Medical Center, Albany, NY, USA). The concept of MEDD (morphine-equivalent daily dose) was established as invalid in an article that came out late last year in Pain Medicine by Rennick et al., which indicated that the variation in equivalent calculations is enormous and that each individual responds differently to different opioids. Yet research uses MEDD as a dependent variable and probably more importantly and more tragically, opioid prescribing guidelines rely upon it.