By MATT McCORD
Using opioids to treat acute pain is a lot like burning coal to power our homes. Both are legacy solutions from an earlier era. Both were once celebrated as breakthroughs. And both have since proven to be dirty, dangerous, and incredibly costly to clean up. Despite this, we continue to rely on them, even as safer, smarter alternatives sit right in front of us.
Coal fueled the Industrial Revolution—but it did so at a steep price: polluted air, poisoned water, caused respiratory illness, and climate instability. It was never a clean solution, just a convenient one. Similarly, opioids became the go-to solution for pain not because they were ideal, but because they were easy. They blunt pain quickly, require no special skill to administer, and were aggressively marketed to physicians as safe and effective. We now know the truth: opioids for acute pain can ignite a chain reaction that leads to dependence, chronic pain, disability, and even death.
Short-Term Relief, Long-Term Consequences
The similarities run deep. Coal gives you power today but saddles society with pollution and disease tomorrow. Opioids offer pain relief in the moment but often leave patients worse off in the long run. In both cases, what’s convenient in the short term creates massive long-term externalities—not for the industries that profit, but for the workers, families, and communities left to clean up the mess.
Systemic Pollution
Coal pollution clogs lungs and chokes rivers. Opioids pollute something more intimate—the brain’s natural ability to regulate pain.
Acute use of opioids disrupts normal pain modulation, leading to a phenomenon called opioid-induced hyperalgesia—a worsening sensitivity to pain. It’s like installing a furnace that makes your house colder over time, requiring more fuel just to maintain baseline comfort. That’s the trap many patients fall into after routine surgery or injury.
Hidden Costs and Broken Systems
Coal seems cheap—until you calculate the health consequences, environmental damage, and regulatory burden. The same is true for opioids. The prescription may be covered by insurance, but the downstream effects—addiction treatment, emergency room visits, lost productivity, broken families, foster care placements, criminal justice costs, and overdose deaths—are paid for by the rest of us. And the price is staggering. Like coal, opioids externalize their costs, masking the true price we all pay.
Entrenched Interests and Resistance to Change
Just as coal was propped up by powerful lobbies and outdated infrastructure, opioids have persisted because of habit, inertia, and industry influence. For decades, pharmaceutical companies promoted opioids with junk science and aggressive marketing. Today, the pharmaceutical industry continues to shape public perception—not just through lobbying, but through the media itself. Pharmaceutical companies are among the largest advertisers on television, particularly during news programming. This significant advertising presence may influence media narratives, potentially downplaying the role of prescription opioids in the opioid crisis.
As a result, the public is often fed a new narrative: that fentanyl is the problem, not prescription opioids.
But this is dangerously misleading. According to the National Institute on Drug Abuse, approximately 75% of people with opioid use disorder began with a legally prescribed opioid. It’s only when we fail to taper appropriately or offer effective alternatives that patients turn to illicit drugs—now increasingly laced with fentanyl. This shift in blame masks the root cause and perpetuates a dangerous cycle.
We Have Better Alternatives
The good news is that better pain solutions exist. Just as solar, wind, and even modern nuclear energy are reshaping the power economy, modern pain care is increasingly multimodal, non-opioid, and personalized. Safer, smarter options are already available—from nerve blocks and anti-inflammatory care to non-addictive medications like ketamine and gabapentin, along with physical therapy and proven mind-body approaches like cognitive behavioral therapy. These techniques don’t just relieve pain—they do it more effectively, with less risk, greater long-term success, and without disrupting the body’s natural pain-regulating systems. They don’t just cover up pain—they treat its causes.
Quitting Coal Healed Our Environment
The air cleared, the water got cleaner, and entire communities began to thrive. The same will be true for opioids. When we stop overprescribing them for acute pain, we’ll see fewer addictions, fewer deaths, and a stronger, more resilient society. But that future won’t come on its own. Like coal, opioids won’t disappear quietly—they must be replaced. The coal era is over. It’s time the opioid era was too.
Matt McCord, MD is Cofounder and Executive Director of Opioid Free Solutions
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