Painkillers increase risk of car crashes proclaims the headline in today’s Globe and Mail. Apparently, researchers at the “Toronto based Institute for Clinical Evaluative Sciences have found a correlation between even low-dose regular opioid use (two Tylenol 3’s three times a day) and an increased risk of car accidents.
Not a huge risk, the head researcher David Juurlink, hastens to add; certainly nowhere near as high as alcohol, but a risk nonetheless.
Wonderful. Two of my favorite things – correlational studies and experts rambling on about opioids in the same piece with blinkered experts continuing on their merry way, all pleased and sending out press releases (don’t kid yourself, that’s the only way a paper from something called the Institute for Clinical Evaluative Sciences that nobody has ever heard of would get a piece in the Health section of the Globe and Mail).
Um, did it ever occur to these geniuses that the reason people take those drugs, namely pain, might have something to do with those slightly increased numbers of car crashes? I use the term slightly advisedly: the risk increases between 21 and 42% according to the “scientists”. (Scientists in quotes because surely any scientist worth his salt knows that unless you know what you’re comparing something to a percentage – relative risk – is absolutely meaningless.)
Surely pain – which means someone gets more easily fatigued and could become less alert – could have a thing or three to do with it?
Oh no, it’s the opioids.
Of course by the same token, ice creams causes an increased number of drownings. Think about it. In the summer people eat more ice cream – and more people drown. QED.
Last March I wrote a post on Oxycontin and made some disparaging noises (OK, loud, angry noises) about the ado being made about addiction and pain killers. Notably, a Fifth Estate that had me virtually apoplectic with rage. Using largely American stories the CBC newsmagazine insisted that addiction to oxycontin was a massive problem that we should all get worked up about, especially when it came to First Nations communities in the north.
By contrast, a few weeks ago I happened to come across a BBC mini-documentary about the same topic and the contrast could not have been more marked. I missed the start of the piece but what I did watch was superb. It was a program called “Our World” and the journalist’s name was Linda Sills. (I hope that’s how one spells it.) She had travelled to several communities in northern Ontario, spoken to various tribal elders, artists and addicted individuals and – wonder of wonders – had actually done some research and thought about the subject.
Sills, like the people she spoke to, all agreed that the problem was not opioids (in the ‘80’s it was alcohol and in the ‘90’s glue sniffing) but the situation. The environment. The socio economic conditions. When people are unhappy and hopeless they take solace in drugs, whatever is around, whatever they can get. Solutions are complex, multi-factorial and must emerge from the grassroots of the community itself. An artist who looked to be in his forties, addicted to oxycontin himself, talked of how his art was helping him reduce his drug intake (even though he genuinely looked as though he was still in pain, physical and psychic).
Opioids have been around for thousands of years. Officially they were discovered around the time of the Trojan War (war has always been excellent for medicine) but no doubt people knew of the pain relieving properties of the poppy long before that. They are the single most effective agent in treating pain and although we’ve tried to come up with synthetic variants (Demerol, Fentanyl) and alternatives (non-steroidal anti inflammatories) there simply has never been a drug that works as well, as consistently.
Treating pain with opioids allows people who suffer from chronic pain to function. To have lives. To work, interact with families and friends and feel like the are part of the world. But in recent years, perhaps with the rise of right wing moralizing in the U.S. and what some people call the rise of the nanny state we have taken a sharp turn away from treating pain to calling individuals who need medication “addicts”.
Our reverence for numeric reasoning and bad statistics naturally hasn’t helped any; after all, what could be more qualitative and unmeasureable than pain, which, by definition, is whatever the person says it is?