For those old enough, cast your mind back to the mid-1990s. There were no oral opiate medications aside from those containing codeine, and these were used sparingly. 


Then two significant events occurred. Pain was declared the fifth vital sign and oral versions of morphine came on the market. Nobody wants to be in pain and no doctor wants a patient to suffer. However, the notion of everyone being totally pain free all the time was, and is still, not realistic.

Dr Joe Kosterich, Clinical Editor

History records that since the late ’90s we have had major problems with use of opioid medications leading to the term “opioid crisis” being coined. The CDC reports that in 2020 there were 91,799 drug overdose deaths in the US, with prescription opiates being a major contributor. The AIHW reports 1849 drug overdose deaths in Australia in 2020
with 60% involving an opiate. 

Does this mean we should not use these medications? 

Of course not. It does mean that we need to be more judicious than in the past and look for other options. 

To that end, this month we feature a number of articles which examine ways of treating pain that do not involve analgesics. This includes managing the psychological aspects and taking a patient-centred approach. Yes, I know that some if you will say this is a cliché, but it is still important. The roles of radiofrequency techniques and spinal injections are covered, and we bust some myths about what to advise the person with back pain.

The AIHW reports 1849 drug overdose deaths in Australia in 2020 with 60% involving an opiate. Does this mean we should not use these medications? Of course not. It does mean that we need to be more judicious than in the past and look for other options.


IBS is a painful condition where pharmaceuticals have offered little. Medicinal cannabis (full disclosure I am Medical Advisor to Little Green Pharma) shows promise and a trial based in Perth will explore this further. A view from a doctor on managing pain from “the other side”
of the surgical knife makes interesting reading.

In January, Reuters reported that US cities and counties have “embraced a proposed settlement worth up to US$26 billion resolving lawsuits against three large drug distributors and drug maker Johnson and Johnson”. Other multibillion dollar claims have been made against Purdue and the Sackler family.

Going forward, the solution is not to totally reject the use of oral opiates – they have a role. We do need to better educate patients about pills not being the only answer, be open to other approaches and genuinely do our best to take a patient-centred approach. First do no harm!