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More Than Just Plugging a Hole Opioid Legislation in Congress Part 5


By Alexander Germanis

Dating back to the mid-1800s is a tale about a little Dutch boy who saves his country by plugging a hole in the dike with his finger, thus preventing the North Sea from flooding all of Holland.

While his initial action is lauded as heroic, it is, nevertheless, not enough to solve the greater problem. Other actions need to be taken by many people in order to truly fix the dire situation.

Unfortunately, fixing any major problem is always more complicated than simply “plugging a hole.” Opioid abuse in the United States is one such problem.

Synthetic narcotics with opium-like effects, opioids are often prescribed as painkillers. Opioid overdoses claimed the lives of 42,249 in 2016, a number that more than quadrupled since the close of the 20th century.

The American Society of Interventional Pain Physicians (ASIPP), interested in curbing these continued deaths, asked Bloomington’s own Dr. Ramsin Benyamin, founder and medical director of Millennium Pain Center, to represent them this past February before the United States House of Representatives Ways and Means Committee.

Presented in a three-tiered approach, Dr. Benyamin outlined for the committee “more effective legislative efforts to curb opioid abuse and reduce opioid deaths, while maintaining appropriate access, and the promotion of nonopioid modalities available.”

As described more in detail in previous articles, the first tier encapsulated education. Providing education to both the general public and patients on the dangers of opioid use, the ASIPP also feels educating prescribing physicians is just as important.

The second tier is related to finding and utilizing other techniques to combat pain in order to reduce the number of opioids even prescribed in the first place. These other techniques include interventional pain methods such as nerve and joint blocks and epidural injections.

More than just putting a finger in the dike, tier three involves several different steps like new national regulations, changing some aspects of patient treatment, and even the discontinuation of a currently prescribed drug.

“Buprenorphine must be available for chronic pain management in addition to medication-assisted treatment,” Dr. Benyamin outlined, “with a change of controlled substance scheduling to a Schedule II drug.”

An opioid used to treat opioid addiction, buprenorphine also acts as reliever of moderate pain. Re-classifying this opioid to a Schedule II drug would officially mark it as one with a high potential for abuse. Currently, buprenorphine is a Schedule III drug, meaning its official status is as one with little potential for abuse and, therefore, it is under much lighter restrictions.

A prescription drug the ASIPP would like to seen done away with entirely is methadone. Another opioid used to treat addiction, methadone is meant to treat heroin addicts while also serving as a pain reliever. However, as Dr. Benyamin pointed out, the “cure” has proven to be nearly as bad as the “disease” itself. “Methadone is responsible for over 3,000 deaths per year [while making up] only one percent of total prescriptions,” he said.

The final step of the three-tiered approach “is to develop treatment paradigms for patients with true somatic causes of pain,” Dr. Benyamin concluded. “Nonopioid techniques have been recommended by the Institute of Medicine (IOM) and attorney generals of many states. Yet, these have not been adequately considered. In fact, reductions and cuts continue to make difficulties in being able to utilize physical therapy, interventional techniques, and ironically, even nonopioid medical therapy options.”

Similar to a leaking dike, one person making a single move is not enough to foster the change necessary to reduce the senseless deaths resulting from opioid misuse. But, like the boy in the tale, Dr. Benyamin has showed it often only takes a single person to spur others into action and, hopefully, to save countless lives.

This is the final installment of this series on opioid legislation in congress. If you missed the previous articles, you may read them online at or contact Cheryl at 309-664-2524.

For more information on any type of pain, you may contact Millennium Pain Center at 309-662-4321 or Their new office is located at 2406 E. Empire in Bloomington. The practice provides the most advanced and comprehensive pain management for a wide variety of conditions.

Drs. Benyamin and Vallejo have been selected among 70 of the Best Pain Physicians in America.