“The Pain Problem” is — Literally — 1000 Times Worse Than “The Opioid Epidemic”
About 100 million Americans live with chronic pain — myself among them.
If tens of thousands of people dying annually from overdoses is an Epidemic?
The tens of millions of us suffering insufficiently treated pain should be recognized as a Cataclysm — made all the worse by the deafening media silence.
A recent NPR, Morning Edition, piece on the abortion law likely to be signed momentarily by the governor of Alabama (15 May 2019) featured an interview with a physician who said that, because of the legal jeopardy with which it threatens providers, the law would create “the only situation in which a physician has to consider his/her welfare above that of the patient.”
As someone who has been in chronic pain for three decades now, I can certify that this is manifestly untrue.
Can’t Help You in the Office, But There’s an Alley Downtown . . .
We are beginning to get public health studies that ratify what I’ve been saying for years: a majority of opioid overdose deaths (which result overwhelmingly from the use of street drugs, not from prescribed medication, which is very rarely abused) is being caused by patients — people like me — being pushed out of medical settings and into the street.
They die there, my brothers and sisters who dwell in the Cathedral of Pain: of overdoses or from fentanyl contamination or from Hepatitis C.
They commit suicide, unable to bear untreated pain.
Or they suffer liver failure or fatal gastric bleeds, from the “innocuous” over the counter medications towards which they are pushed: Acetaminophen, Ibuprofen, Naprosyn.
Do the OTC drugs cause more deaths than the opiates?
We don’t know.
We keep no records of that toll.
These deaths are happening because, under pressure from medical practices, medical societies, state and federal laws, insurers, and pharmacies — to name a few of the groups that get to weigh in on whether or not I get pain control sufficient to allow me something approaching a normal life — providers are considering their own liability above the welfare of their patients.
Who is Being “Cared For”?
I understand: “A medical license is a terrible thing to waste.”
If I went hundreds of thousands of dollars into debt to professionally credential myself, I would surely think twice before risking my livelihood over the choice of type and quantity of medication I prescribed.
Nevertheless, this is a shameful betrayal of the ethic of care that is supposed to undergird the doctor/patient relationship.
It is no less shameful that the media endlessly blare news — and decontextualized, often inaccurate, statistics — about “the opioid epidemic” and “the toll it is taking,” while saying little or nothing about what is happening to a far larger group of people.
Draconian policies are killing people.
Which leads to . . . even more Draconian policies.
Which leads to . . . even more deaths.
“First: Do No Harm”?
For every 10,000 people who OD, there are 10 million people in chronic pain.
If only 10% of those people have their meds either reduced to an ineffective level or fully cut off (and the percentage is FAR higher than that), those million people are given a stark menu of choices: disability, suicide, or . . . street drugs — which feeds the OD cycle, and around we go again.
The opioid epidemic is a serious problem: We should have unlimited addiction treatment, on demand and without regard for ability to pay; the heads of a few dozen Big Pharma executives should be on pikes on beaches all across the country; finding alternatives to addictive narcotics should be one of our highest medical research priorities.
But — First: Do no harm? — you don’t treat pain by causing more pain.
And you don’t reduce ODs by pushing desperate patients in unremitting pain toward street drugs.