Post by Admin on May 8, 2023 23:17:40 GMT
How Opioids Made the Jump from Palliative Care to Mainstream Use
Decades before it gripped communities across the United States, the roots of the opioid epidemic began with shifting ideas about palliative care among medical professionals.
www.truthdig.com/articles/how-opioids-made-the-jump-from-palliative-care-to-mainstream-use/
The journey toward declaring not just palliative care, but pain relief itself, a basic human right occurred under the leadership of one of the pioneers in the pain field, Michael Cousins. Cousins was a master persuader. He represented the pain field in Australia over the entire span of his very long career, and probably had more influence on how pain was managed there than any other single individual. As a young anesthetist in Sydney in the late 1960s, he undertook a postgraduate fellowship in acute pain management and worked for a while in McGill University, Montreal, which was pioneering the use of epidural pain relief. Between 1970 and 1974, he worked at Stanford University, California. During his time living and working in Canada and the United States, he interacted with other top pain specialists, Ronald Melzack, Patrick Wall and John Bonica, which vastly broadened his horizons.
Cousins went back to Australia determined to build pain services and research in Australia much as Bonica was doing in the United States. He thus became part of the grand global scheme to improve pain management. His first task was to develop a multidisciplinary pain center at Flinders Medical Center in Adelaide, after which he moved back home to Sydney and developed another large multidisciplinary pain center at the Royal North Shore Hospital. Both centers became internationally recognized in their time. In 1979, he became the founding president of the Australian Pain Society, and in 1987 he became president of the International Association for the Study of Pain (IASP). He played a key role in the formation of an official relationship between IASP and the World Health Organization (WHO). He raised funds for pain research and education through the nonprofit community-based organization Pain Management Research Institute Ltd., which he founded in the 1990s. In 1995, he was made a Member of the Order of Australia for “service to medicine particularly in the fields of pain management and anesthesia.” By 1999, he had become the founding dean of the Faculty of Pain Medicine, and in 2005, he played a key role in the recognition by the Australian government of pain medicine as an independent medical specialty.
Influenced by his role in IASP, his palliative care colleagues and his perception that acute pain management could be better, Cousins long held the view that pain relief, not just palliative care, should be considered a fundamental human right. He had been thinking and writing about the humanitarian aspects of pain relief since the 1980s. In his 1999 Rovenstine Memorial Lecture, he wrote:
In 1948, the United Nations Declaration of Human Rights said that “all persons are equal in dignity and rights and have the right to life, liberty and security.” One can obtain that document incidentally on the Internet, and you will find that it is implied that, with appropriate medical care, one is able to achieve the aim of some quality of life. Interestingly, the United Nations Declaration does not mention pain relief as being a human right. However, I ask you just to ponder what would be your priority list for basic human rights. Would you consider freedom from hunger, which has been discussed so extensively? Freedom from thirst? Peace without political or other persecution? Freedom of speech, press, religion, assembly, mobility? Certainly, these are all important. However, they are difficult to enjoy if one has unrelenting, severe pain. I put it to you that the relief of severe, unrelenting pain would come at the top of a list of basic human rights.
In the year 2000, he wrote in the Medical Journal of Australia, “Relief of acute, severe pain is a basic human right, limited only by our ability to provide it safely in the circumstances of individual patients.”
Frank Brennan and Daniel Carr were natural allies in Cousins’ quest to establish pain relief as a basic human right. Brennan was a palliative care physician/lawyer in Sydney who had published widely about the human rights dimensions of palliative care. Carr was an endocrinologist, anesthesiologist and advocate leading the movement to embrace evidence-based acute pain management in the United States. The year 2004 was a banner year for their efforts. A “Global Day Against Pain” was launched by the WHO, in partnership with the IASP and the European Federation of IASP Chapters (EFIC). The theme of the global day was “Pain Relief: A Universal Human Right.” In an editorial with the same title published in the IASP’s journal Pain, Cousins, Brennan and Carr wrote:
Decades before it gripped communities across the United States, the roots of the opioid epidemic began with shifting ideas about palliative care among medical professionals.
www.truthdig.com/articles/how-opioids-made-the-jump-from-palliative-care-to-mainstream-use/
The journey toward declaring not just palliative care, but pain relief itself, a basic human right occurred under the leadership of one of the pioneers in the pain field, Michael Cousins. Cousins was a master persuader. He represented the pain field in Australia over the entire span of his very long career, and probably had more influence on how pain was managed there than any other single individual. As a young anesthetist in Sydney in the late 1960s, he undertook a postgraduate fellowship in acute pain management and worked for a while in McGill University, Montreal, which was pioneering the use of epidural pain relief. Between 1970 and 1974, he worked at Stanford University, California. During his time living and working in Canada and the United States, he interacted with other top pain specialists, Ronald Melzack, Patrick Wall and John Bonica, which vastly broadened his horizons.
Cousins went back to Australia determined to build pain services and research in Australia much as Bonica was doing in the United States. He thus became part of the grand global scheme to improve pain management. His first task was to develop a multidisciplinary pain center at Flinders Medical Center in Adelaide, after which he moved back home to Sydney and developed another large multidisciplinary pain center at the Royal North Shore Hospital. Both centers became internationally recognized in their time. In 1979, he became the founding president of the Australian Pain Society, and in 1987 he became president of the International Association for the Study of Pain (IASP). He played a key role in the formation of an official relationship between IASP and the World Health Organization (WHO). He raised funds for pain research and education through the nonprofit community-based organization Pain Management Research Institute Ltd., which he founded in the 1990s. In 1995, he was made a Member of the Order of Australia for “service to medicine particularly in the fields of pain management and anesthesia.” By 1999, he had become the founding dean of the Faculty of Pain Medicine, and in 2005, he played a key role in the recognition by the Australian government of pain medicine as an independent medical specialty.
Influenced by his role in IASP, his palliative care colleagues and his perception that acute pain management could be better, Cousins long held the view that pain relief, not just palliative care, should be considered a fundamental human right. He had been thinking and writing about the humanitarian aspects of pain relief since the 1980s. In his 1999 Rovenstine Memorial Lecture, he wrote:
In 1948, the United Nations Declaration of Human Rights said that “all persons are equal in dignity and rights and have the right to life, liberty and security.” One can obtain that document incidentally on the Internet, and you will find that it is implied that, with appropriate medical care, one is able to achieve the aim of some quality of life. Interestingly, the United Nations Declaration does not mention pain relief as being a human right. However, I ask you just to ponder what would be your priority list for basic human rights. Would you consider freedom from hunger, which has been discussed so extensively? Freedom from thirst? Peace without political or other persecution? Freedom of speech, press, religion, assembly, mobility? Certainly, these are all important. However, they are difficult to enjoy if one has unrelenting, severe pain. I put it to you that the relief of severe, unrelenting pain would come at the top of a list of basic human rights.
In the year 2000, he wrote in the Medical Journal of Australia, “Relief of acute, severe pain is a basic human right, limited only by our ability to provide it safely in the circumstances of individual patients.”
Frank Brennan and Daniel Carr were natural allies in Cousins’ quest to establish pain relief as a basic human right. Brennan was a palliative care physician/lawyer in Sydney who had published widely about the human rights dimensions of palliative care. Carr was an endocrinologist, anesthesiologist and advocate leading the movement to embrace evidence-based acute pain management in the United States. The year 2004 was a banner year for their efforts. A “Global Day Against Pain” was launched by the WHO, in partnership with the IASP and the European Federation of IASP Chapters (EFIC). The theme of the global day was “Pain Relief: A Universal Human Right.” In an editorial with the same title published in the IASP’s journal Pain, Cousins, Brennan and Carr wrote: