A local anesthesiologist who has been helping patients treat postoperative pain since the 1980s says he feels “duped” by pharmaceutical companies that promoted opioid pain medication.
“I feel like I was fed a party line from pharmaceutical companies that had one goal in mind – and that was to improve their bottom line,” said Dr. Neil Seeley, chief of the Division of Anesthesia and Cancer Treatment Centers of America and medical director of anesthesiology at CTCA Atlanta in Newnan.
“I remember when I was at Emory and I was seeing post-operative pain patients and I have said a thousand times – don’t worry about it,” Seeley said.
Sometimes patients would ask him if there was any risk of becoming addicted to the medication.
“Ten, even five years ago, I would have said, ‘No, the literature supports that you will not become addicted,’” Seeley said. “Now, we know a little better.”
Opium and its derivatives have been a problem for centuries, but it’s only in the past few decades that medical use has become a major addictive issue, Seeley said.
It was in the 1980s that treatment of pain became a much more important part of medical treatment, according to Seeley.
“We got too much exuberance about chasing pain and trying to control it because we could,” he said.
But some people think there was also some conspiracy among the drug manufacturers. Seeley pointed to a 1980 letter to the editor printed in the New England Journal of Medicine as fuel for the current opioid epidemic.
In the short letter, a doctor from Boston University Medical Center writes that a check of hospital records found that of patients without a history of addiction who were treated with opioids while they were hospitalized, only a minute percentage became addicted.
“It was just a letter to the editor. It wasn’t a double-blind study that showed this was true,” Seeley said. The letter also only referenced the use of opioids in hospitals and did not reference prescriptions for outpatient use.
“It was quoted widely for years and years and exacerbated by the pharmaceutical companies that picked up that reference as if it was gospel,” Seeley said.
A 2017 letter to the editor of the same journal referenced the 1980 letter and its impact. That letter, signed by four Canadian doctors and researchers, found that the original letter had been cited in medical articles 608 times. In 72 percent of the articles, the authors cited it as evidence that addiction was rare in patients treated with opioids, and in 80 percent, the doctors didn’t specify that the letter only dealt with patients who were hospitalized when they received opioids.
“I’m old enough to have been listening to those drug reps who came into our offices,” Seeley said. “I feel duped."
Seeley said he was told once a patient’s pain went away, patients could stop taking the drugs without any problems. In truth, there is a subset of patients that will become chronic users, he said.
Seeley said studies have shown that more than 15 percent of patients who had knee or colon surgery will still be using narcotics six months after surgery.
“The vast majority do not have a problem with narcotic use,” Seeley said. “That is why it is incumbent upon us to screen patients, to talk to our patients, to keep the communication open so that we can help patients identify if they are at risk. And then we can monitor them closely."
But most people shouldn’t fear going through surgery and having to take opioid pain medication, or needing the medication for other short-term, severe pain, he said.
“Addiction is not out of the blue,” he said.
But he said there are certain patient characteristics that can make addiction more likely, and that’s why doctors need to talk to their patients about these issues.