Treating Chronic Pain

June 2007

A Primary Disease
Chronic Pain Afflicts a Huge Number of Americans, But There are Few Abstinence-Based Programs

Treating Cronic PainNot too long ago, a wealthy Southern California construction entrepreneur fell victim to intense and highly debilitating pain. An internal morphine pump was then installed, upon which the entrepreneur later became very highly dependent. Worried family members, who had witnessed the man’s descent from a vigorous individual engaged with life, to a listless, unmotivated and demoralized opiate addict, approached clinicians at Bayside Marin, a Northern California high-end center, seeking help.

“This man had a real sense that he could never again live without that internal morphine pump,” says Roland Williams, a 20-yr treatment industry veteran who has been the clinical director at Bayside Marin since its opening several years ago. “But we asked him if he was really ready to throw in the towel on his life, which is what keeping the internal morphine pump would have meant.” The upshot is that the entrepreneur agreed to enter treatment at Bayside Marin, one of the relatively few addiction treatment centers nationwide that offers a special track for treating those who have become addicted due to chronic and debilitating pain. Responsible for the medical treatment of chronic pain clients at Bayside Marin, addiction medicine specialist Dr. Raymond Deutsch says that, eventually, the man’s morphine pump was discontinued. “His recovery was really astonishing,” says Dr. Deutsch. “He had the morphine pump discontinued while he was with us, successfully completed the program and has now returned home to start his life anew.”

Many Successes
With over 100 clients treated at its chronic pain program, Bayside Marin has helped many clients move away from dependence on addictive medications to deal with their pain, instead teaching clients methods that are more in tune with abstinence-based recovery from addiction.And, certainly, there are enormous numbers of Americans who are suffering from chronic pain, which is defined by the medical profession as a primary disease. The cost of chronic pain to society is huge, estimated at $50 billion annually, although far less the cost of addiction, which is in the hundreds of billions. And while a relatively small number of these chronic pain sufferers – which number about 50 million in the U.S., according to the American Pain Institute – are thought to actually become drug dependent, much less full blown addicts, because of the pain medications they take, it is certain that many thousands of individuals every year do become dependent on meds linked to their pain treatment.

Skyrocketing Abuse
And, of course, there are many who use opiates for completely non-medical purposes. In fact, the number of Americans who abuse prescription pain narcotics has been skyrocketing, with SAMHSA estimating that the number of prescription opiate abusers to have more than quadrupled since 1990 to 2.5 million people. But the rate of addiction that occurs because people have suffered chronic pain and then, because of that, later become dependent or addicted, or what doctors call the “iatrogenic” rate of addiction, is not at this point able to be determined with any accuracy.

The FDA has admitted that no reliable studies have really ever been undertaken into the iatrogenic causes of addiction. This despite the fact that there was a very strong movement, begun in the mid-1980s and backed aggressively by certain drug makers and by pain treatment advocates, claiming that the risk of addiction from treating chronic pain with powerful narcotics medications was negligible.

But the studies upon which these claims were made, even their staunchest boosters now admit, were flawed and misused. That did not, however, stop the narcotics prescription liberalization bandwagon from developing a powerful head of steam, backed as it was in part by the deep pockets of some greedy and highly unscrupulous drug manufacturers.

Representing the apex of the narcotics prescription liberalization movement, and driven by marketing to doctors that contained outright lies and falsifications about addiction risks, Purdue Pharma in the mid-1990s took annual sales of its OxyContin narcotic pain killer from less than $50 million to over $1.5 billion over a five year period.

Treating Cronic PainIn the process, Purdue rained down on American society one of the most egregious epidemics of prescription drug abuse in history. In May, calling the destructive consequences of Purdue’s lies about the addictive properties of OxyContin “staggering,” federal prosecutors accepted the criminal guilty pleas of Purdue and its top executives, levying massive fines on both totaling more than $600 million. Critics said that amount was still far too low, considering the vast profits made by OxyContin and the destruction it wrought. About $130 million of the fines will go to settle civil charges brought by pain patients who say they became addicted to OxyContin as a result of being prescribed the pain killer. And there are many more civil suits from pain patients against Purdue that have yet to settle.

A Market Opportunity
Whatever the true rate of iatrogenic addiction, minimal as some claim or perhaps not so minimal, Bayside Marin founder and CEO Perry Litchfield spied opportunity in chronic pain early on. “In my investigations while I was in the planning stages for Bayside Marin, quite a number people pointed out to me that there were few chronic pain clinics that took an abstinence based approach to treatment,” he says. “There are, of course, thousands of pain clinics, but narcotics prescriptions are a key part of therapies at most of these clinics, whereas our clients must agree to forego the use of narcotics.” Over the last couple of years, new abstinence based programs have been sprouting up, and more are in the planning stages. In Southern California, the Johnson family, medical industry entrepreneurs, invested millions turning a property near tony Rancho Santa Fe north of San Diego into a high-end treatment center. In addition to eating disorder and trauma tracks, Casa Palmera recently opened a pain management program that seeks to get people off narcotics while addressing the source of the pain, rather than suppressing it. Alan Johnson, who manages Casa Palmera, says about 75 people have gone through the center’s chronic pain program so far. And at Salus Health Group, a new treatment operation with ambitious national roll out plans headed by veteran EAP industry entrepreneur John Stenzel, abstinence based chronic pain treatment is a key element of the new company’s vision of the future. “We plan on developing five regional treatment hubs with various tracks and levels of care at each,” says Stenzel. “We think chronic pain can be a key track at each of these hubs, and we expect our first chronic pain program will be opening latest in the spring of 2008.” And while chronic pain, because of its complexity, is an ideal offering for high-end centers, they aren’t the only ones offering abstinence based chronic pain care. Hemet Valley Recovery Center has been a pioneer offering modestly priced care. TJ