The opioid epidemic has exploded into the national consciousness in the last two years. While anti-medicine groups seek to lay blame on pharmaceutical companies and doctors who give out prescriptions too easily, other groups wonder why the crack epidemic, which was far worse, got less attention, and suggest it is because addiction is exculpatory when the victims are white.

In the journal Healthcare Transformation, moderator Antonia Chen, MD, MBA, Associate Editor of the publication, led a straight-talking conversation between Jane C. Ballantyne, MD, University of Washington, Seattle, who advocates for the appropriate use of opioids and education for physicians and patients, and Meghna Patel, MHA, Director of the Prescription Drug Monitoring Program (PDMP) Office in the Pennsylvania Department of Health, Harrisburg, who has implemented state regulations aimed at curbing the opioid epidemic and believes even more government is needed.

Key questions were "How do we fix the opioid epidemic?" and "What is the role of regulation for physicians?" Dr. Chen asked, "What is the best way to educate patients and doctors?" and "What is the role of other alternative medications [such as marijuana and other prescription drugs]?"

In Dr. Ballantyne's view, people taking opioids tend to think there is no alternative. "But the more we look at this, the more we realize that people who tend to succeed in getting off opiates altogether often feel a lot better, and patients who never go down the opiate pathway usually have much better outcomes in terms of their function and even pain."

Ms. Patel stated, "I think that the total avoidance of prescription opioids is not an ethical option. If a patient is in chronic pain, then the patient may need a prescription opioid and whatever the physician thinks is best for the patient."

What do you say? In the past, pain was a non-specific symptom. Do you have fibromyalgia? There is no diagnosis for it, it is a blanket diagnosis given to people with a range of self-reported symptoms. And "medical" marijuana prescriptions were given out like candy to anyone claiming pain. Then there is "doctor shopping", where patients would go from doctor to doctor filling prescriptions, but there was no way to log that because patient privacy groups insist electronic medical records will be used to discriminate against insurance patients.

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