Published on: September 30, 2011

Short Film 20 of 50 in the LIFE Before Death documentary series about the global crisis in untreated pain and the dramatic life changing affect palliative care services can deliver to patients and their families around the world.

In “Finding a Balance” we discover that there is a problem with the abuse of prescription pain medications – particularly in the United States – however a balance needs to be stuck to ensure that policing of this type of diversion does not limit access to essential pain medications for patients in need of them around the world.

“The use of prescription drugs for illegal purposes is increasing,” reports Police Chief Ed Medrano (USA). “It’s especially increasing in our youth. We’ve seen some decline in the United States in the use of harder drugs but one thing we do see now is an increased use among our kids of prescription drugs. Obviously opiates play an important role in managing pain and I understand that from a medical perspective and if the world was perfect that’s where it would end. But unfortunately the world’s not perfect.”

“This is the biggest problem that the regulators face everywhere,” explains M.P. George (India). “Especially in the case of narcotic drugs. They’re good pain relievers, but at the same time they’re misused.”

“You talk about campaigns and movements,” considers Mary Callaway (USA). “The Just Say No campaign to drugs has had a huge detrimental effect on the availability of opioids for pain management. I mean this has got to be one of the most successful public campaigns that’s ever been done.”

“This is a big problem because in some countries there are really no good opioid drugs available because of the paranoia about the use of illicit drugs,” reflects Professor Michael Cousins (Australia).

“I think when people first started doing this they had no idea they were going to have a global impact with this Just Say No campaign,” suggests Callaway. “So I think it set back pain management years — decades — because everybody had to fight with that.”

“There is a problem in the United States with prescription drug abuse,” admits Dr Stephen Connor (USA). “We have a problem. In our experience it’s not as big a problem as the quote ‘War On Drugs’ people would have you believe. But it is a problem.”

“Diversion is not a reason to prevent people from taking morphine,” asserts Dr Natalya Dinat (South Africa). “We, like any other country in the world, have huge exploding illicit drug use.”

“Obviously just as a human I would want people to be treated to the best standard possible,” states Medrano. “The problem is it’s a fine line and as you look at the best standard for pain treatment. Is it a standard that could create an addictive situation?”

“The reason why we keep hammering on about opioid access is because there are no other pain medications that are equally strong,” reports Diederik Lohman (The Netherlands). “When the pain becomes severe we have to move to stronger medications and opioids are the only ones we have so far. So there’s no alternative.”

“In the balance between preventing diversion and providing good analgesia I’m afraid the scales have tipped,” reflects Dr Judith Paice (USA). “So patients are going to have reduced access to very crucial medications.”

“Balance is the critical issue,” states Dr Jim Cleary (Australia). “We need to balance making sure people have access to pain medicines at the same time we’re minimizing diversion.”

“Every patient who needs opioid medications should have access to them,” continues Lohman. “If making those medications available means there’s going to be some misuse – well we need to fight the misuse. But we shouldn’t say; ‘There’s potential for misuse so let’s just deprive people who are in terrible pain access to pain medications’.”

Featuring Ed Medrano (USA), M.P. George (India), Mary Callaway (USA), Professor Michael Cousins (Australia), Dr Stephen Connor (USA), Dr Natalya Dinat (South Africa), Diederik Lohman (The Netherlands), Dr Judith Paice (USA), Dr Jim Cleary (Australia).

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If you’ve missed previous episodes, catch up on the LIFE Before Death website…