In the summer of 2012, the Finance Committee of the U.S. Senate announced that it was initiating an investigation of the financial connections between certain major pharmaceutical manufacturers of prescription pain medications and experts in pain medicine, organizations that issue professional guidelines for the prescribing of such medications, and advocacy groups for patients with pain. The primary motivating factor for the investigation appears to be the prescription drug abuse epidemic alluded to in the introduction to this article and. more particularly, the suspicion that financial support of professional organizations in the field of pain medicine and their thought leaders has skewed practice guidelines, model policies, and even articles in peer-reviewed publications toward promotion of increased prescribing of opioid analgesics. The focus of the media accounts of this announcement was almost exclusively on those who acquire and misuse prescription pain medications and the injury and death that often follow from abuse of these medications. The plight of the many patients who receive and benefit significantly from these medications appeared as at best an afterthought and secondary consideration. For all of the reasons reviewed in this article, we now find ourselves in an increasingly hostile environment for chronic pain patients and the physicians who strive to treat them. More than ever, these patients are at risk that our society will revert to past prejudices against those who must rely on opioids for pain relief and functional improvement, and there is also a risk that our society will revert to a re-emergence of the opiophobia that plagued the health professions not so very long ago. The vulnerability of those afflicted with significant and persistent pain demands that medicine and society proceed with great caution in erecting barriers between conscientious physicians and their patients.
Finally, our criticisms of opioid contracts and the universal precautions approach ultimately do not depend on any substantive view of the propriety of opioid analgesics. That is to say, even if one maintains that the public health problem of prescription drug abuse sufficiently justifies curtailment of the use of opioid analgesics, it remains an open question whether the use of opioid contracts is ethically justified as a means to that end. Our position here is that regardless of one’s perspective on the merits of the end, the universal use of opioid contracts is ethically dubious and should be scaled back if not abandoned entirely.
2014. Goldberg, D. & Rich, B. Pharmacovigilence and the plight of chronic pain patients: in pursuit of a realistic and responsible ethic of care. Indiana Health Law Review, 11 Ind. Health L. Rev. 83: 16.