美国国家公共电台 NPR Is There A Way To Keep Using Opioid Painkillers And Reduce Risk?（在线收听）

STEVE INSKEEP, HOST:

In Your Health on this Monday, we report on the dilemma at the heart of the opioid crisis. Many of the addictive drugs that ruin or end lives are also helpful to people with severe pain, so doctors have to strike a balance. We have reporting from two members of NPR's Health team, starting with Allison Aubrey.

ALLISON AUBREY, BYLINE: Imagine the kind of pain where even small movements are excruciating. Jon McHann knows how that feels. He's 56 and lives in Smithville, Tenn. We spoke to him by Skype.

JON MCHANN: I've laid in bed at times where my pain's at a nine or a 10, and I can't open my eyes because I know if I blink it's going to hurt.

AUBREY: McHann is a truck driver who operated heavy equipment, or at least that's what he used to do. But about 10 years ago, he took a bad fall.

MCHANN: I fell a few feet and I hit my tailbone just right. And I created a severe bulging disc that needed to be surgically corrected immediately.

AUBREY: McHann expected to make a full recovery and go back to work, but that didn't happen.

MCHANN: After the surgery, the pain was still like a nine or a 10, just excruciating to the point where you're just unable to really function.

AUBREY: His spinal problems turned out to be much more complicated and hard to treat. He went on to have several more surgeries but got no relief. So his doctors gave him a prescription for methadone, a powerful opioid drug, and he stayed on it for seven years.

MCHANN: It helped immensely. It brought my pain down to a five or a six where I could function fairly well throughout the day. I mean, I could go to church every weekend, I could help my wife shop, I could help around the house a little bit.

AUBREY: From McCann's perspective, the opioids were working. But then, as concerns about the epidemic grew, he started getting pushback from his doctors.

MCHANN: Every time I saw a clinician, my opioids were reduced.

AUBREY: His pain started to increase, and he worried that he'd be cut off the drug entirely.

MCHANN: Basically, life wasn't going to be worth living if I couldn't get this pain under control.

AUBREY: McHann is not alone. Physician Stefan Kertesz says there are lots of patients with similar stories.

STEFAN KERTESZ: I have certainly met a good number of patients who have not found better options and they are now taking opioids for chronic pain.

AUBREY: Kertesz is a professor at the University of Alabama at Birmingham School of Medicine. He says some doctors feel caught between a rock and a hard place. With the rise in opioid overdose deaths, there's a lot of pressure to limit prescriptions. CDC guidelines point to the serious risks of high dosages and long-term use. But Kertesz says some people who take opioids long term seem to benefit. So he says it's not always in the best interest of the patient to cut them off.

KERTESZ: Do I think we prescribed opioids too much over 20 years? Absolutely. We caused new addiction in some people by prescribing opioids too aggressively. But the idea that you can simply take them away, sometimes for people who need them, is mistaken.

AUBREY: Kertesz knows that his position is controversial. He pushes against the current thinking so much, I had to ask him if he ever worked for the pharmaceutical companies that market these drugs.

KERTESZ: I have never worked a day in my life for the pharmaceutical industry, and I have no interest in doing it in the future.

AUBREY: Kertesz says what he is an advocate for is helping people in pain.

KERTESZ: I do hope for better medications that have less potential for addiction. But I think human suffering's really complicated and doctors need to have room to make a professional decision together with their patient about what works best for them.

AUBREY: As for Jon McHann, just last month he had a procedure to ease the nerve compression in his back, and for now, he's optimistic.

MCHANN: So far I'm happier and I'm hoping to be opioid free. I don't know if I'll get there, but I want to try.

AUBREY: He's down to a daily Percocet, which is nowhere near the strength of the opioids he had been taking for so many years. Allison Aubrey, NPR News.