I would kindly ask you to review how most opiate addicts in this current wave are created. Unfortunately, opiate medication is really the only 'easy' solution we have for many patients who have chronic, debilitating pain. I speak of patients suffering from malignancies, chronic back pain, post-traumatic injuries like motor vehicle collisions or workplace-related injuries. While there are novel attempts at cognitive behavioral therapy, setting patient expectations regarding pain and physical therapy, opiates are the mainstay of our (speaking as a resident physician) arsenal. Unfortunately, many of my colleagues prescribe ever higher doses of opiates without educating the patient on the reality and expectation of chronic pain. The patient continues to fill his/her prescription, until the point where he/she is taking heroic doses of opiates daily. At this point, many things can happen: the patient's legal provider is suddenly shocked at the amount of opiates given and stops, the patient transfers care/moves and is suddenly unable to obtain their original script, and voila - the once legal plain jane 45 year old female with chronic pain is suddenly forced to rely on the grey and black market, and since she can't obtain further legal prescriptions (because who's going to give Jane 20 oxycodone daily when seeing her for the first time), she's suddenly relying on sketchy mcsketchball who offers her illegal oxycodone... and you can imagine the downward spiral from there. So please, review how many of our opiate dependent abusers start, instead of focusing on the ugly finality of their early deaths.
From your description of tolerance buildup it sounds like you are describing a drug which is functionally ineffective for chronic pain (eventually tolerance will overtake the maximum does you can safely administer) except where the patient wont live long enough for the tolerance.
It sounds like a drug family that would be mostly useful for non-chronic pain, where the patient can be weaned off before the dosages become high.
Yes, you're right. Opioids are a good choice for short term pain. They're a good choice for end of life pain. They're a poor choice for long term pain, although they serve some use if carefully prescribed. Weirdly, the US prescribes a lot of opioid medication, and prescribes it for people with long term pain.
AFAIK, it's because, whilst opiates aren't a great choice for chronic pain, they're just aren't many options that are useful for many forms of chronic, severe pain.
You're 100% correct. However, we really don't have many other non-opiate options for chronic pain, and a lot of the other therapies (alternate modalities, adjusting perceptions/expected amounts of pain/etc) are things that require more money and time. As many providers are overworked and patients lack insurance, opiates become unfortunately a crutch in many plans.
