'Not allowed to be compassionate': chronic pain, the overdose crisis, and unintended harms in the US

Chronic pain Pharmaceuticals Addiction Opioids Prescription medication Private health insurance United States of America

An estimated 40 million adults in the United States suffer from significant levels of chronic pain, making it one of the most common health problems and the leading cause of disability in the country. People with chronic pain tend to have worse overall health than other Americans, experience depression and anxiety disorders at higher rates, and use the health care system more frequently. 

Despite the extent of this problem and its medical, social, and economic impacts, many patients in the US do not have access to adequate treatment for chronic pain. This is in part because chronic pain can be difficult to treat: it can result from a wide range of causes and it affects different people in different ways. But it is also because most clinicians are poorly trained in pain management, health insurance policies often do not adequately cover non-pharmacological treatments, and the health care system does not facilitate multidisciplinary treatment of chronic pain, which is often the most effective option for complex pain.

The opioid overdose crisis that has struck the US in recent years, which claimed more than 70,000 lives in 2017, has further complicated the situation for chronic pain patients.

This report presents the challenges faced by chronic pain patients in obtaining appropriate care. It examines how the US government’s legitimate efforts to address the opioid epidemic have contributed to unintended but serious harm, and fallen short of its responsibilities to address the needs of individuals taking opioid medicines for chronic pain. It is based on 86 interviews with chronic pain patients, healthcare providers and officials and reviews of relevant state and federal laws, regulations and clinical guidelines related to chronic pain management and opioid prescribing.

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