Misunderstanding The Opioid Epidemic
I’m going to start this particular post off with some background information about myself. I have been in the medical field for 9 years and I am a current pain management patient.
Now, I want to address the elephant in the room: Opioid Addiction and how we are just making things worse. Let me first say that I understand narcotic pain medications are dangerous and that we do have a problem with them. No one can deny that. However, we are putting all of the blame on the wrong source. Like most issues, this one is not black and white — but there is a starting point and it needs to be addressed.
Opioid Epidemic: The Beginning
In the 1990s, doctors started prescribing opioid medications more and more because they were under the impression that these were safe medications for people to take. This is in part due to the relentless campaign of manufacturers such as Purdue Pharmaceuticals, but nonetheless, this was when we started seeing an uptick in prescription opioids.
It wasn’t until the early to mid-2000s that we really started seeing an increase in the use, abuse and overdoses related to these medications. That’s because starting in the late ‘90s to early ‘00s, certain people discovered that they could open up storefronts in strip malls, hire physicians and make a boatload of money by handing out prescriptions to hundreds of thousands of people. Because of this, the overdose rate increased by nearly four times from 1999 to 2008.
So, over a period of about 5 to 10 years, these storefronts opened up all across America and handed out millions of pills to thousands of people who didn’t need them. These patients did not generally have actual health issues requiring the use of narcotic medications. Instead, they found out through the grapevine that if they brought cash in hand, they could walk out with large amounts of medications. This created the epidemic of addiction. Some patients wouldn’t use, but would instead sell their pills to make money. Others would take some and sell some.
I worked in an urgent care center in 2010 that was located in the same area as a pill mill. I knew it was a pill mill because not only did we have multiple people a day show up with their out-of-state IDs thinking we were the other office, but we had to call the police on more than one occasion to break up fights that were started in the queue that reached out into the parking lot.
The Crackdown — Our First Mistake
Now we have a real problem, and it’s not due to legitimate pain management offices or legitimate chronic pain patients. It’s due to the greed of criminals and physicians throughout the country who immorally handed out prescription medications to people who didn’t need them. Once the overdoses started increasing, America started to take notice. When mothers were screaming because their children died after being given hundreds of uppers and downers, America started to ask questions. Our government, both at the state and federal level, had to do something so they instituted a crackdown in a knee-jerk fashion.
Slowly but surely they started shutting these operations down, which was great and totally necessary. What was not great was how in shutting these places down they were sending thousands of people to the black market. Just because there were no longer pill mills did not mean there were no longer addicts. So now we went from having an epidemic of prescription medication abuse to an epidemic of heroin overdoses. Because when an addict loses their supply, they are desperate to find more of the same or an alternative. They quickly learned that there was an alternative and that it was much, much cheaper.
Addiction Treatment in America
Addiction treatment in America is woefully inept. As an addict, your options in America are as follows:
- Inpatient treatment center for detoxing
- Outpatient treatment center
- Medication-assisted treatment
- 12 Step/Narcotics Anonymous/AA
Let’s go over these one by one. First, we have the inpatient treatment centers. These really are the best option because you get away from whatever substance you’re addicted to and whatever triggers you have for a long period of time. If you have insurance, you might have coverage, but you probably don’t. If you don’t have insurance, you’re looking at upwards of $20,000 for a stay in a 30-day center. There are some places that are cheaper, but they usually have long wait times and/or no availability.
Then there are outpatient centers. These rely solely on you not relapsing, which is very difficult to do if you have no way to get away from people/places that trigger your use. If you don’t have a good support system at home to keep you accountable, outpatient therapy won’t do you a lot of good. As for cost, it is cheaper than inpatient, but still not affordable for a lot of people. When you factor in counseling sessions multiple times a week, that’s a lot of time and money that some people just don’t have.
There are also medication-assisted varieties of treatment, but just like with everything else, not everyone benefits from them. For example, some people swear by it, but others say that it is as bad, if not worse, than the substance they are trying to quit. Side effects include excessive tiredness, dizziness, problems with coordination, dependency and addiction. There are other medications available, like methadone, but the same applies to them. Not everyone will react to these medications positively, and if you are getting a monthly supply of something (which is often the case with Suboxone) and you have no one to keep you accountable, it’s easy to fall right back into the addictive behavior.
Some states are trying to pass laws for addicts to use medicinal marijuana to help them come off of opioids. Although there is not a lot of research, anecdotal evidence shows that there is some promise to this theory. However, since we currently have an administration that is pro-drug war and anti-marijuana, it’s unlikely that more research will be done any time soon.
As I noted a second ago, counseling and/or therapy is great, but it’s not feasible for a lot of people. Even if you have insurance that covers it, you generally need to go at least once a week, if not more, during treatment. This means that not only do you have to take time off of work if you work in an office or for a company with similar hours as your therapist, but you also have to shell out a copay/coinsurance/deductible at every visit.
Generally, along with outpatient therapy they want you to attend meetings with NA or, if you cannot find an NA group, AA. This is fine and there are a lot of people who have used these programs to get clean and stay clean. However, if you are at all introverted or if your schedule does not work with your local groups, you’re not going to go. For an introvert, there is nothing worse or more miserable than going to a meeting with a bunch of strangers, introducing yourself and trying to find someone who will sponsor you. For most, it’s just not going to happen.
If you are an addict and your options are to lose your job, go broke from treatment or to buy heroin which will stave off the withdrawals, you’ll go for the latter more often than not. There are so many hoops to jump through regarding treatment that at the end of the day it’s just more feasible to keep using. I’m not saying that is a good thing or that people shouldn’t be held accountable for their actions, but none of that matters when it comes down to it.
So, now in 2017 we are in a place where politicians want the public to think they’re doing something about the problem and they also want votes, and the media does not differentiate between who is overdosing and on what. This has led to some very serious issues regarding the epidemic and to a lot of completely unnecessary suffering on the part of legitimate pain patients.
We have done a great job of demonizing pain medications, the doctors who prescribe them and the patients who need them, but we have done a terrible job of educating the masses on the underlying problems. It’s easier and quicker to put everything under a one-size-fits-all umbrella than to dig in and find the actual causes.
There is already a stigma and a lack of empathy surrounding chronic pain patients. What a lot of people don’t seem to get is that the majority of people who are in pain management have tried other modes of treatment. They’ve undergone surgery, physical therapy, massage therapy, facet injections, etc. and were left with pain medications as a last resort.
Chronic pain patients do not enjoy having to be on these medications. We would much rather not have to deal with the pain, stigma, and anxiety that being on them involves. We don’t enjoy having to wonder every single month if they will be cut off or if the pharmacy will have what they need. Being a chronic pain patient is not fun; it’s a living hell. We are dependent upon a pill to function and that means that we are at the mercy of multiple factors, including the whims of people who have no idea what we’re going through.
This lack of education and intensifying of fear mongering is leading to another crisis, one that will no doubt lead to even more overdoses and deaths.
The Next Wave
I can tell you first hand that it is not as easy as you may think it is to get pain killers. Sure, if you have a surgical procedure your doctor may give you a few Lortab for post-op pain, but once you’re out of that you probably won’t be getting any more. Physicians are scared to death to prescribe pain medications these days, so they aren’t “handing them out like candy” like the pill mills did. I’ve been on the same medication regimen for over three years now and every month I have anxiety attacks over the idea that I will be cut off.
Because that’s what is happening now and it is what is further contributing to the epidemic. Patients who have been getting legitimate prescriptions are being cut off because doctors are afraid of losing their license or even going to jail. So these patients now are dealing with constant excruciating pain and they have no recourse. Their options are to writhe in pain all day, lose what semblance of normalcy they have or find relief through avenues they never imagined they would. After a few weeks or months they will be desperate and will look for relief wherever they can find it. Street dealers know this and plan on it.
The overdoses we hear about today are not from pain management patients on a regimen. They are from people who became addicted through the pill mills and people who have been cut off from their medications. They buy on the street not knowing that what they’re taking contains a highly potent form of fentanyl and they overdose.
I won’t pretend to have all of the answers here, because I know that I don’t. I am not a physician or a politician, but I am a patient and a medical professional and I have seen both sides of this issue for a long time.
Focus less on demonizing current legitimate pain clinics and patients and focus more on improving treatment and making it more available to those with low incomes and no insurance.
Put more money into researching the benefits of marijuana usage to help ease withdrawal symptoms and implement it as a part of addiction treatment.
Some pain management clinics require that their patients bring in their medications to every visit to be counted, ensuring compliance. All pain management offices can and should implement this, allowing providers to deal with whatever issue their patient is having. If they are selling their medications because they need the money, they could offer them resources for assistance and stop providing the prescriptions. If they are taking too much of their medications, they can get them help. Instead of cutting off patients they could wean them down or send them to therapy, and we would have fewer people looking for drugs from street dealers.
Create positions within government and medical offices for people who can personally help each patient with recovery. A patient advocate, if you will. Instead of sending a patient home with a list of centers and never following up, call the centers for them and make the appointments, etc.
If a pain clinic or physician has no history of questionable practices, stop punishing them for the problems of other patients/offices.
If a patient has no history of abusing their medications, don’t cut them off because of fear.
Review prescribing practices and their efficiency. Focus on other modes of treatment alongside medication.
Start specifying who is overdosing on what. Stop lumping all pain medication users in with addicts.
The fact is that there will always be people who become addicted to these medications. There is no way around that. Cutting people off and stopping the sale of these medications is not going to help anyone; it’s only going to put more money into the pockets of street dealers.
These are strong medications and they deserve scrutiny, but so far we have only succeeded in making the problem worse by attacking the wrong people and issues.
Focus on the causes of addiction and work through them and maybe then we can come to an actual solution.