Dr. Christina Rama


GREENSBORO — The opioid epidemic that blew up locally, statewide and nationally during the last decade has roots in a few sentences written in a medical journal almost 40 years ago.

The January 1980 letter in the prestigious New England Journal of Medicine took only one paragraph to say that based on observing thousands of patients on narcotic painkillers at Boston University Medical Center, “addiction is rare in medical patients with no history of addiction.”

“It was just one person’s opinion,” said Dr. Christina Rama of Cone Health, an internist knowledgeable about opioid dependency. “The drug companies seized on that and used it as a marketing tool to say these drugs were safe.”

Over the years, that basic misunderstanding led to the theory that “pain is the fifth vital sign” and that physicians should do everything in their power to eliminate it with prescription opioids safe to use in increasing doses, Rama said.

Major pharmaceutical companies supported research that lawsuits filed against them by Greensboro, Guilford County and thousands of other communities now dismiss as junk science.

The lawsuits claim that researchers supported by the industry developed false theories such as “pseudo addiction” that boosted sales. The concept held that when patients taking opioids showed symptoms of addiction, they actually were displaying signs of untreated pain and just needed higher doses of the painkiller.

In fact, both natural opioids such as heroin and more powerful synthetics are central nervous system depressants that are extremely addictive and “very easy to abuse,” Rama said.

They dull the body’s pain pathways but also affect “the pleasure center of the brain, inducing a sense of well-being,” she said.

One of their disadvantages is that over time the body adapts and requires ever higher doses to achieve the same level of euphoria and pain reduction, she said.

Like doctors, pharmacists also had their thinking rewired as opioids became more prominent, said Pete Crouch, owner of Eden Drug Co.

When he graduated from pharmacy school in 1976, “we were very conservative on the amount of pain medication that patients could receive,” Crouch said.

He said the transition to a less strict approach came as the hospice movement gained popularity, changing America’s approach to death from one where people often died in hospitals. That shifted to the creation of a special place where terminally ill patients’ last days were made as comfortable as possible — often relying on heavy doses of opioids.

It was a good change, but the “genie got out of the bottle when we started using them for chronic pain,” he said.

Some medical professionals learned the hard way that they had to be more careful prescribing pain medication for people with such long-term maladies as debilitating back pain.

“When that patient is going live another 30 years, that’s where people got into trouble,” Crouch said.

Crouch and Rama said these painkillers have a legitimate place as tools to combat pain, but under careful supervision.

“I work to take the edge off pain, but my goal isn’t to totally remove all pain,” Rama said. “I think physicians have a duty to disclose that these drugs can be highly addictive.”

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