(176): Yet Another Rant About Rampant Misunderstanding of The Opioid Epidemic (TM)
My mother-in-law is trying to make Sunday dinners at her place a weekly thing, putting pressure on my husband and me to attend every weekend. She started this the weekend before Easter. She then invited us the next weekend, “because it’s Easter.” And this weekend, she invited us again. My husband, who grew up under her boot, knows how this goes. She is creating a precedent, a pressure by repetition that puts the onus on us to either refuse, come down “to get some food and take it home,” or to come down and partake with the family (and listen to the distressing gossip and opinions as fee for the food that we can’t just refuse).
Today, we chose the second option, picking up the food and taking it home. My husband asked me to do it on my own, as his mother is adept at creating push points when he is present that creates tension and anxiety, and this happens to be the absolute most busy and anxiety-producing time for him during the Spring semester. I came up with the suitable excuse that he is not attending due to “end of semester mop-up” and complaining about students being able to contact him through his cell phone at all hours and days. This is a thing. Office hours hardly make sense now that students and employers can find you anytime, anywhere. You’re always on.
But I digress. Today’s encounter stressed ME out, because they were talking about how the drug companies are pouring pain pills into rural communities, and that the local pharmacy gave my father-in-law a hard time refilling his (medically necessary) blood pressure pills, while “they’d pour them out in a bucket for you if you went to get opiates.” Yes, he said that, and I had to stay silent. I know better, because I have to adhere to the authorization limits and go through many hoops to obtain controlled substances, one an opioid, to control my chronic pain. These hoops increase my baseline cost (extra office visits with their associated co-pays and drug tests).
This is why I don’t tell them I take these pills. They would jump to the conclusion that I am addicted to them and that I could overdose at any moment. The part they don’t understand is that there is a difference between addiction and physical dependence (even though this Wiki article seems to conflate them in part of its text, while discriminate between them at the same time). Addiction is a psychological effect, while dependence is a physical effect, which only becomes apparent when a drug is suddenly discontinued. I have the latter, but not the former. I do not crave the opioid, only the pain relief it can provide.
I take it to avoid the extreme discomfort of daily rising level of pain that I can predict by the clock. If I delay taking the opioid beyond 3 p.m., the pain is too great to be knocked down even by the maximum dose. I try to take it every day between noon and 1 p.m., because I’ve learned that it will relieve pain at a tolerable level for much of the afternoon after that, and I can tolerate the pain level without the medication until that time without negative knock-on effects beyond the ones I’ve decided I can tolerate.
I’m not sure why I’m explaining all this. Perhaps it is because I am unable to simply confront my in-laws and explain how things really are to them. They won’t listen, and once my secret is out, there’s no going back. I would not put it past them to attempt to involuntarily commit me or pressure my husband to do the same. I’ve heard horror stories from my husband about his earlier life. So I kept silent. It makes me fume though. It is this pervasive lack of understanding by the rank and file who watch the news and hear the hue and cry against The Opioid Epidemic(TM) .
They think that, if they just make them harder to get, that’ll solve the overdose problem. No, they don’t understand that, once the legal prescription opioids are too hard to get, then desperate people in excruciating pain will then turn to street drugs like heroin, which really ARE dangerous, and present a very real danger of overdose, due to the unregulated dosing inherent in buying off the street. I am not saying that the only people who turn to heroin are chronic pain sufferers who can no longer get prescription pills, but I’m willing to bet that, as this CNN article notes, that pain sufferers are caught in the crossfire between regulators and the addicts they’re seeking to disincentivize.
Sorry, folks, I get het up about stuff like this. People who don’t understand the problem and have too much power just end up making things a whole lot worse. And then they ask, “how did it come to this?” Look inward, policy makers! And start looking into alternate explanations and solutions for addictive behavior like the ones outlined in this TED Talk:
Some of my other writings on the chronic pain experience:
