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The big thing Congress can’t do to fix the opioid epidemic

In a rare moment of bipartisanship, Congress is moving forward on a major legislative package to combat the opioid epidemic.

Both chambers have voted overwhelmingly to spend billions combating and preventing opioid addiction. The Senate vote was 99-1; the House vote was 393-8. Congress doesn’t agree on much, but its members clearly agree that it’s time to do more on opioids.

Both Lev Facher at STAT and Abby Goodnough at the New York Times have excellent pieces summarizing the major components of these bills. They will expand access to inpatient treatment for opioid addiction and aim to increase access to anti-addiction medications like buprenorphine.

These seem like the right steps to help the millions of Americans with opioid addiction right now. Both are badly needed to make it easier for people with addiction to get the treatment they need, with less stigma. And given how much gridlock we’re used to with Congress, it’s fantastic to see a big policy intervention moving forward on the deadly opioid crisis.

But the bigger challenge that the new opioids package struggles to tackle is what do we do about chronic pain?

This is a question that has plagued our country for centuries. As Beth Macy recounts in her excellent new book, Dopesick, the search for a non-addictive but powerful pain reliever dates all the way back to the Civil War. It was standard, she writes, for doctors to visit veterans at home and “leave behind morphine and hypodermic needles, with instructions to use as needed.” At the time, doctors were told that morphine was not addictive.

When the medical establishment realized that morphine was, in fact, quite addictive, there was another drug to take its place: heroin. I was surprised to learn in Dopesick that heroin was originally marketed in the late 1800s as a “nonaddictive alternative for morphine” by the pharmaceutical company Bayer. The company told doctors that “addiction can scarce be possible.”

The new opioids package does include a $2 billion bump to the National Institutes of Health’s budget, largely to increase research on chronic pain treatment. Hopefully, that will lead to better cures for the Americans who live with pain day in and day out — the Americans who were harmed when they received opioids as their treatment for that pain.

But that cure, unfortunately, doesn’t exist right now. And what decades of research has taught us is this: Curing pain is maddeningly difficult. As Vox’s German Lopez wrote earlier this week, “50 million adults in the US in 2016 suffered from chronic (long-term) pain, according to the latest CDC estimates. ... Many of these patients, although not all or even most, may genuinely need opioids to mitigate pain.”

I liked German’s piece because it looks at how we can thoughtfully treat chronic pain while still fighting the opioid epidemic, like not abruptly cutting off patients currently on opioids and encouraging doctors to be more thoughtful about whom they do prescribe to.

But there is one quote in German’s piece that stands out to me the most, from drug policy expert Keith Humphreys: “Something needs to be worked through the culture as well about how pain is part of life. If you’re in excruciating pain, it sucks. And I’ve had pain conditions myself. But not all pain is intolerable or needs to be pushed down to zero with an opioid.”

This, I think, is the hardest part of backing away from opioids: admitting that medicine doesn’t have a perfect cure for pain — that for some patients, zero pain isn’t possible.

Legislation is badly needed to address the opioid epidemic. It can help increase treatment options. It can help increase funding to find better cures for pain too. As someone who counts herself among the millions of chronic pain patients in the United States, I really hope that research pays dividends! (I’ve talked more about my personal experiences with chronic pain here.)

Legislation can do lots of things — but it can’t create a cure for the chronic pain patients right now. That’s what opioids were marketed as in the first place; that’s what made them so appealing. But as we pull back on opioids now, the hardest challenge seems to be that there isn’t one silver-bullet treatment to fill their void.

This story appears in VoxCare, a newsletter from Vox on the latest twists and turns in America’s health care debate. Sign up to get VoxCare in your inbox along with more health care stats and news.

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