“Never Only Opioids” and the Joint Commission: toward a Conservative, Whole-system treatment standard for pain

Column John Weeks has been active as writer, organizer, executive, consultant, and speaker in the movement for integra-tive health and medicine for more than 30 years. His leadership-focused Integrator Blog News and Reports (www.theintegratorblog.com) and now his Global Integrator Blog are go-to sources on breaking developments in policy, business, academics and interprofessional activity. I view mainly as dumb luck the way I dodged the magic bullet of opioid dependence during my treatment for throat cancer 6 years ago. My doctors forewarned that radiation and chemotherapy together wreak havoc on throat tissues. I was sent home with a quart of pink liquid and a recommendation to use it preventively, just before I felt that pain might be coming on. They guaranteed I would need it. No one mentioned any other options for pain management. I never needed the painkillers. One factor may be a cautionary view toward medication passed down in my natal family. Another may have been my use of multiple self-care and integrative methods and practitioners before, during, and after treatment. A friend who underwent a similar throat cancer treatment protocol who also took advantage of multiple integra-tive therapies had such pain that she needed ultimately to find her way to her new normal through a foggy tunnel of opioid dependency. My family joked that the grace that kept me from opioids could be chalked up to gross insensitivity. Bullet-dodging in my episode of pain treatment did not end there. A year later, a neighbor shared that he was in horrible chronic joint pain linked to an athletic over-use injury. I mentioned the painkiller in the house. He thanked me and left with the bottle. He returned within hours, thrusting the quart back at me. He explained that he had a past addiction to pain medications. The proximity of excess leftover prescription opioids nearly pushed him off the wagon. Another magic bullet dodged. Versions of this experience are reflected in the lives of tens of millions of individuals since 2000 when what was then called the Joint Commission on Accreditation of Healthcare Organizations passed pain standards for healthcare organizations in the United States. The standard focused on ensuring that pain was treated. Accreditation's quasi–police power pushed healthcare workers to err on the side of prescribing. Opioids and other painkillers became readily available. Dosing also tended toward the high end. Unused medications frequently ended up with unintended users. Pain treatment …