Brennan had met her husband, who is also a lawyer, on a blind date. “I didn’t think I could manage running SIB and being a new mom,” she admits. “But I’ve been extremely fortunate to have great babysitters”—Carol 1, followed by Carol 2. “Without them, I never would have had the peace of mind to come to work.” The children are teenagers now. Still, Brennan says, “when I was feeling a little overwhelmed a few years ago, I was sort of musing out loud, and I said to the kids, ‘What if I just quit working and stayed home?’ And my son said, ‘No, then you’d just bother us all the time. And besides, what would Carol do?’ ”
Brennan laughs, pauses, then says, “If I were to bring all my focus and energy and lay it on my kids, I think it would be overbearing.”
ALTHOUGH SHE RAILS against the physicians who now “prescribe this stuff like candy,” Brennan, like most people today, would agree that nobody should suffer needlessly from debilitating discomfort. As boomers age—and life spans increase—the demand for effective pain relief will only grow stronger. There was a time when doctors were too reluctant to prescribe these drugs, says Andrew Kolodny, MD, chair of the department of psychiatry at Maimonides Medical Center in Brooklyn and president of the group Physicians for Responsible Opioid Prescribing. “It was silly to worry about addiction in someone who’s got a terminal illness,” explains Kolodny, who has served with Brennan on task forces and given presentations to her staff.
Perspectives began to change in 1986, when the World Health Organization recommended the use of opioids where necessary for end-of-life care. The undertreatment of people with chronic pain who were not about to die also gained traction as an issue, and by 1996 Purdue Pharma was marketing opioids—especially its new drug, OxyContin—as a safe, long-term solution. Addiction and OD rates soared, and in 2007 three top Purdue executives pleaded guilty to misrepresenting OxyContin’s addictive qualities, an admission that led to charges against the individuals and the company and some $634 million in fines.
A new hydrocodone pill, about 10 times as powerful as Vicodin, is now being tested by several manufacturers. Clearly, “opiophobia” has been overcome. But what many patients and doctors don’t realize, says Kolodny, is that opioids are in the same pharmaceutical class as heroin. “And if taking heroin for your back pain sounds like a bad idea,” he says, “you’re right.”
For an estimated 116 million Americans living with chronic pain, however, opioids may feel like a lifesaver. “Untreated or poorly managed pain can compromise every aspect of [a person’s] life, ” says Micke A. Brown, BSN, RN, director of communications for the American Pain Foundation.* The organization gets much of its funding from the pharmaceutical industry; Brown explains that the foundation seeks money from diverse sources, adding, “If government grants were available to address pain, we would be seeking those as well. Sadly, they are seriously lacking.”
Because she was traveling, Brown responded to More’s query via e-mail. She never uses the word opioid in her reply, despite several questions about this specific class of drug. She does say that we have a “basic human right to timely, appropriate and effective [pain] treatment” and that treatment plans “must include access to medications, including controlled substances.” Yet “barriers to accessing appropriate pain care are increasing,” Brown warns. “Those whose focus is law enforcement will use that lens and not necessarily think about the medical needs of others.”