Hyrum Neizer was a successful Salt Lake City truck driver and a happily married man until the headaches began. Then, suddenly, for no apparent reason, he was disabled by pain—pain so punishing that he often ended up in the emergency room. He sought help from physician after physician, but the experts were either stumped or skeptical. They either didn’t believe his pain was as bad as he said or, worse, they thought he was faking the headaches in order to get drugs. Even his wife grew doubtful over time. Finally, having lost his job, his home, and his dignity, he stuck the barrel of a gun into his mouth and poised to pull the trigger.
Neizer would be dead if his wife had not happened to walk in at that moment. At her urging, he renewed his efforts to find an answer, and, finally, another expert ran some tests that no one had run before. The tests revealed that he had two aneurysms: ballooning arteries in his brain. A surgeon operated that night and again soon after. And then the pain was gone.
Hyrum Neizer is one of millions of Americans who suffer from chronic pain. He is also a casualty in what Judy Foreman calls the Opioid Wars, in which the battlefronts are medical, economic, psychological, cultural, and political. And if Foreman is right, these clashes are leaving many Americans to suffer needlessly in an unrecognized public health epidemic.
The problem begins in medical school, where the nation’s future doctors learn—or, more accurately, do not learn—about pain. Foreman reports on the way pain biology is taught in medical schools, and what she finds is distressing. Pain is the leading reason why people go to doctors, and it accounts for more than 40 percent of ER visits; yet aspiring physicians get almost no instruction in pain biology or palliative care. According to a survey by the American Association of Medical Colleges, accredited medical schools offer only 8 to 16 hours of pain instruction—over a period of four years. Other studies suggest that the figure is far less. Indeed, only four American medical schools require a full course on pain. Veterinarians receive about twice the pain education physicians do.
This educational failure reverberates through the entire practice of medicine. Most people in pain are cared for by their primary care physician, but primary care physicians have not been taught the best practices in pain management. Doctors themselves know this: In one survey, only about a third said that they were comfortable treating people in chronic pain. What’s more, because their pain instruction is so hit-and-miss, young doctors have little interest in becoming pain specialists. As a result, there are only about 3-4,000 pain specialists in America—far too few for the millions seeking relief.
In short, medical education in this country is out of sync with the reality of chronic pain. So it’s not surprising that Hyrum Neizer had to shop unsuccessfully for so long before he found a physician who took his suffering seriously and had the skill to diagnose the problem.
But it wasn’t just ignorance of biology that Neizer encountered. He also collided with a potent, and completely unfounded, bias against pain medication—opiates in particular. Patients in legitimate pain, who seek relief from agony, are suspected of seeking mind-altering, recreational drugs. Not to put too fine a point on it, they are dismissed as deceptive, malingering drug addicts.
Foreman argues that there are in fact two public health emergencies—epidemics—in America right now, and that they are on a collision course. The more visible and obvious emergency is widespread abuse of narcotics—pain pills such as Vicodin and Oxycontin, as well as street drugs such as heroin. Abusers, often young people, have created an insatiable demand for these drugs, which can be addictive and life-threatening. The federal government, as a result of this abuse, is cracking down on illicit narcotics. But, ironically, this militancy spills over into the regulation of medical narcotics. This leads to an “opioid conundrum”: Street abusers have a plentiful supply of illegal narcotics, while people in chronic pain—often older people with no history of drug abuse—cannot get the drugs they need and would most likely use responsibly.