Published on: April 18, 2015

Are you an activist in favour of access to pain management? Do you feel sad that so much of unnecessary suffering goes on around us, just because people who need opioids are denied it?

In all our enthusiasm, let us not allow the pendulum to swing too far the other way. The world is still suffering from the backlash in the USA.

Opioids have their role in treatment of chronic, non-cancer pain. No doubt. The American Pain Society’s recommendations of 2009 include this sentence, which summarises the situation: “Although evidence is limited, the expert panel concluded that chronic opioid therapy can be an effective therapy for carefully selected and monitored patients with chronic, non-cancer pain.”

However, they need to be used with caution. Read the article in Forbes.com, Opioid Misuse In Chronic Pain Patients Is Around 25%, New Study Shows, which states that the rate of addiction to opioids, when used in chronic non-cancer pain, can be as high as 10%. Depending on the social environment, up to 30% have been shown to be misused. Diversion to illicit channels must be guarded against.

We are happy that in India, though we were so keen to overcome the regulatory barriers to opioids, from the beginning we did not argue for unrestricted access to opioids through all pharmacies. When the “Narcotics Amendment Act” comes to be implemented, strong opioids will be available only through “recognised medical institutions”.