The History of Opiophobia

"In fields of medicine involving controlled substances, especially addiction medicine and pain medicine, the doctor-patient relationship has become grossly distorted."

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"... opiophobia is interesting. Reasons which would explain practice by doctors that is out of step with evidence include lack of awareness of the evidence, philosophical disagreement despite the evidence ..."

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"And how did they manage to take that giant step against the American Opiophobia? Put some Narcan in it."

Interesting forum discussion.

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"Opiophobia is the prejudice against the use and prescription. of opioid analgesics. ... ED physicians have significant opiophobia."

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"Much of the developing world shares the "opiophobia" and the burden of needless suffering."

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"Just over 20 years ago, John Morgan, and American pharmacologist, coined the term opiophobia to describe the analgesic-prescribing habits of physicians he had studied."

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"Many of those who once contributed to the pervasive problem of undertreated pain ... now recognize that the failure to assess and manage pain harms patients and constitutes substandard care."

Excellent article.

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This presentation mentions opiophobia.

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"Opiophobia -
Fear medical doctors experience of prescribing needed pain medications for patients.

'Hahahahaha!!... Wait a SECOND: what the hell, how come... how is it.... is it curabl... what?'
I know, that's what I said too. Dude, I have this thing about doctors..."


Opiophobia creates lots of different reactions.

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"At graduation, some North American medical students repeat the Prayer of Maimonides

“never to forget that the patient is a fellow creature in pain, not a mere vessel of disease.”[2] How could a physician ever forget that a patient is in pain?"

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"Abstract:
A brief history of opiophobia and its effect on prescribing of opioid analgesics is presented. Barriers to opioid prescribing and additional readings on the topic are described."

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"It should be noted that opiate use for pain management does not constitute addiction, and opiophobia is itself another evil of the drug war just as is medical marijuana prohibition. For some patients marijuana is a better medicine, for others opioids are better."

Just a footnote to another article.

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"Most arguments against the use of opioids for a significant short-term or longterm pain problem are usually based on irrational fears, or so-called “opiophobia.” However, this ignores a more practical perspective."

An article on Opiophobia.

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"One of the world's most effective programs for Opiophobia, the Vanquish Fear & Anxiety Home Study CD Program immerses you in the most effective techniques we teach our 'VIP' clients and at our advanced Seminars. ...

If you have been living with Opiophobia, now is the time to learn how easily you can now be free."

This looks questionable. It looks like a overcoming fear for _____ (Plug in the Fear).

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"SUMMARY: Nature of Relief Sought
This lawsuit is the result of grossly misinformed prejudices about opioid1 pain medications held by high-level Washington public health officials. Those prejudices are identified in medical literature as “opiophobia.”2 As a direct result of public health policies based on opiophobia, chronic pain patients in Washington are now unable reliably to secure necessary and appropriate treatment for theirsevere pain anywhere within the State of Washington. The dilemma of the chronic pain patients arises out of overreaching actions on behalf of senior public health officials based on their underlying opiophobia, and that opiophobia now permeates
the entire Washington State health culture and unlawfully influences medical licensing decisions."

An excellent analysis of current opiophobia.

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"The expert phobia team at The CTRN Phobia Clinic is board-certified to help with Opiophobia and a variety of related problems. The success rate of our 24 hour program is close to 100%."

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"The pursuit of what I believe is an impossible balance - the apples of pain relief against the lemons of the drug war - has pretty much consumed the efforts of the public health, academic medical, medical ethics communities for decades, culminating in the Amazing, Vanishing DEA FAQ3."

For supposedly rational creatures, we certainly react irrationally to many things.

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"Pain is woefully under-treated in this country. This tragic state of affairs, which has devastating consequences for individuals, families and communities, is rooted not so much in technology as in ignorance and persistent prejudice about pain, opioids, and addiction."

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"To describe the irrational fear of opiates in the U.S. and elsewhere, he coined the term 'opiaphobia' -- and wrote the definitive scholarly article on the phenomenon."

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"John P. Morgan ... In a 1985 book chapter he coined the word 'opiophobia' to describe clinicians who habitually under-prescribe pain relievers for seriously ill patients 'based on an irrational and undocumented fear that appropriate use will lead patients to become addicts.'"

The history of the word Opiophobia.

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"By 1925, the Treasury Department had shut down 44 heroin-maintenance clinics around the country. One third of all persons in federal penitentiaries in mid-1928 were Harrison Act violators, more than the combined total for the next two categories of prisoners: violators of alcohol prohibition. By 1938, 25,000 doctors had been arraigned for supplying narcotics to users, and 3000 of them were serving prison sentences... "

The Harrison Act put 3000 doctors in prison and started opiophobia.

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"Patients and American doctors (who should know better) are unreasonably afraid of opioids. This 'opiophobia' is not based on fact, but is a product of outmoded knowledge and the War on Drugs. Medical research demonstrates the utility and safety of opioid use for otherwise untreatable pain."

So the why of opiophobia is outmoded knowledge and the War on Drugs. It just raises more questions on why.

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"However a clause applying to doctors allowed distribution 'in the course of his professional practice only.' This clause was interpreted after 1917 to mean that a doctor could not prescribe opiates to an addict, since addiction was not considered a disease. A number of doctors were arrested and some were imprisoned. The medical profession quickly learned not to supply opiates to addicts. In 1919, the Supreme Court ruled in Doremus that the Harrison Act was constitutional and in Webb that physicians could not prescribe narcotics solely for maintenance."

Many think the Harrison Narcotics Tax Act is the start of the development of opiophobia in the medical profession in the United States.

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opiophobia

unreasonable and harmful fear of opiates leading to countless cases of untreated pain in the 20th century

opiophilia

unwarranted and harmful attraction to opiates leading to tremendous, unsupervised over-use of opiates in the 19th century

opiognosis

broad and inclusive knowledge of opiates leading to its wise use

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Summary of articles and books on the History of Opiophobia.

Jacob Sullum
"No Relief in Sight"

Annica Rhodin
"The Rise of Opiophobia: Is History a Barrier to Prescribing?"

Dr. Romayne Gallagher
"The history of opiophobia in North America"

J.S. Hochman MD
National Foundation for the Treatment of Pain
"For Whom the Bell Tolls"

Peggy Peck
Nothing to Fear but Fear Itself
The U.S. has a history of opio-phobia that stretches back to legendary newspaper publisher William Randolph Hearst, says Bennett, who used his newspapers to campaign against the dangers of opium almost 100 years ago.

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"Senior Editor Jacob Sullum’s January 1997 story “No Relief in
Sight,” (also a finalist for the National Magazine Award—the “Oscar”
of magazine publishing) chronicled the suffering of patients
sentenced to a life of constant pain by “opiophobia”—the reluctance
of doctors to prescribe drugs derived from opium because of their
addictive properties and their fear of scrutiny from the Drug Enforcement
Administration. In a pathbreaking article, Sullum
chronicles the history of opiophobia and the suffering of its victims."

Another history that is not readily available. I will gather the three authors together in one post in order to watch for available research.

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"The Rise of Opiophobia
Author: Rhodin, Annica1
Source: Journal of Pain & Palliative Care Pharmacotherapy, Volume 20, Number 3, 27 July 2006 , pp. 31-32(2)
Publisher: Haworth Press"

Another article from Annical Rhodin. They articles are expensive, but Rhodin seems to be the one researching the Rise of Opiophobia.

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"While there can be little argument that the inertia of ignorance continues to propel most of the opiophobia in the American medical community, recent thinking has begun to contemplate far more serious causes. ... Money very probably plays a very large factor in opiophobia."

This is a very strong view of the history of opiophobia fueled by drug companies, misguided government policies, and ignorance. A powerful emotional argument.

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"American physicians markedly undertreat severe pain based on an irrational and undocumented fear that appropriate use will lead patients to become addicts. Such irrational fear-opiophobia-resists educational intervention as phobic fears resist rational explanation and exploration. Because this phobia has become fixed in the customary behavior of physicians, it is particularly resistant to change. Re-education might better be directed to the changing of mistaken attitudes about drug use and abuse that are part of the American culture and which are not amenable to alteration by medical education."

Again, the problem is identified as opiophobia. It is sadly noted as particularly resistant to change.

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"The scientific literature and extensive clinical experience abundantly demonstrate that the failure to adequately treat severe acute or chronic pain may produce a plethora of serious complications, including death from pain-related cardiovascular collapse [Brookhoff 2000; Tennant 2004]."

The failure to treat acute or chronic pain is based on opiophobia. This article addresses some of issues in treating opiophobia. It is most interesting that the cause of the problem is related to opiophobia, and not pain addiction.

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"BACKGROUND: Barriers to pain management include physicians' lack of knowledge and attitudes. Our aim was to investigate future physicians' knowledge and attitudes toward pain and the use of opioid analgesics. METHODS: We tested a medical school class during their freshman and senior years. Stepwise regression analysis was used to identify the personal traits that predicted opiophobia."

Excellent. This research tried to predict which Doctors would develop opiophobia, and suggest ways to deal with it like any other phobia.

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"Clinicians and researchers have long remarked on the link between opiophobia and undertreatment of pain. In a 1966 pharmacology textbook, the psychiatrist Jerome H. Jaffe, who later became Richard Nixon's drug czar, noted that patients who take narcotics long enough develop tolerance (a need for larger doses to achieve the same effect) and physical dependence (resulting in withdrawal symptoms). But he cautioned that 'such considerations should not in any way prevent the physician from fulfilling his primary obligation to ease the patient's discomfort. The physician should not wait until the pain becomes agonizing; no patient should ever wish for death because of his physician's reluctance to use adequate amounts of potent narcotics.'"

Again, opiophobia is the problem, but where does it come from?

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"The Rise of Opiophobia: Is History a Barrier to Prescribing?
Author Rhodin, A."

This article seems to be right on according to the title. The history of opiophobia is influencing the prescribing today. Have to send away for this article.

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"Dr. Romayne Gallagher ... presented a socio-political examination of the history of opiod prescription in Canda. ... We saw how the culture and concepts around opioids has swung back and forth over the last 100 years.

Dr. Romayne Gallagher presented a talk on “The history of opiophobia in North America” at our March 2006 general meeting."

This seems like it would be a great start to understanding the history of opiophobia, but so far, I have not found a readily available copy.

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"People in recovery from addiction are often scared to take pain medication ... Some go so far as to refuse opiate pain killers after major surgery...

This attitude can be severely destructive. Pain slows the healing process, and untreated pain is more likely to lead to relapse urges than properly treated pain. Even if your drug of choice was heroin or prescription opiates, you should not refuse appropriate, doctor-prescribed medication."

Being scared of taking pain medication is called opiophobia. What is opiophobia and where does it come from?

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"Many doctors underprescribe painkillers because they overestimate the potential for patients to become addicted to medications such as morphine and codeine. Although these drugs carry a heightened risk of addiction, research has shown that providers' concerns that patients will become addicted to pain medication are largely unfounded. This fear of prescribing opioid pain medications is known as 'opiophobia."

So patients suffer because of opiophobia, but where does opiophobia come from? When did it develop in this country.

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"'But every day patients and families come to me filled with fear about taking opioids,' she says -- narcotic drugs like methadone, morphine, and OxyContin. That fear, called 'opio-phobia,' can stand in the way of relief for many patients."

Opio-phobia stands in the way of people being treated effectively.

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