Don’t get me wrong. Chronic pain is a real thing and we need solutions for people who suffer from it. But we also need to get real about an epidemic that is slaughtering our people at a very alarming rate. Just in Staten Island alone, more than 70 people died from opioid overdoses in 2012. The deaths were split, roughly 50%-50%, between heroin and prescription pill overdoses, but most likely all of the victims started out with the pills.
It used to be that the medical profession undertreated pain. Doctors didn’t want to create opioid addicts, and the consensus was that patients should suffer rather than risk addiction. That started to change in the seventies, with the rise of the pain-management movement, when pain came to be seen not only as a symptom but as an illness in itself. Now the worry was of “opiophobia.” A widely used pharmaceuticals textbook advised, “Although many physicians are concerned about ‘creating addicts,’ very few individuals begin their drug addiction problems by misuse of prescription drugs. . . . Fear of producing such medical addicts results in needless suffering among patients with pain.”
Strong opioids like morphine or oxycodone already existed for patients with intense, short-term pain from healing trauma or end-of-life illnesses. Long-term, chronic pain was another matter—no existing drug was ideal for that. Seeing the need, Purdue Frederick, a pharmaceutical company in Norwalk, Connecticut, developed a long-term pain reliever called MS Contin, which was a morphine pill with a time-release formula. When the patent ran out on MS Contin, Purdue introduced a time-release oxycodone pill, OxyContin.
The pill entered the market in 1996 and quickly became an iatrogenic disaster. OxyContin’s purpose was merciful—to provide pain relief at a steady rate over a ten- or twelve-hour period, so a pain sufferer could sleep—and millions benefitted from taking it. But for its effect to last that long the pill had to contain a lot of oxycodone. People discovered that the capsules could be crushed, then swallowed, snorted, or injected for a powerful high. Purdue marketed the drug aggressively to general practitioners who accepted the company’s claim (untested and untrue) that OxyContin was difficult to abuse. Overdoses involving OxyContin soon became horribly routine in places like Maine and West Virginia. As the epidemic of “Oxy” addiction and overdose spread, Purdue did not take the drug off the market. Several states and many individuals sued the company, which fought with tobacco-company-like determination but eventually gave in. In 2007, Purdue pleaded guilty in federal court to misbranding the drug by not stating its potential for causing addiction—a felony—and paid a fine that totalled $634.5 million. It also introduced a version of OxyContin that was more tamper-proof. By that time, the drug had made the company many billions of dollars.
I don’t know if it was ever true that “very few individuals begin their drug addiction problems by misuse of prescription drugs” but it is the furthest thing from true today. Almost no one is introduced to opioids by taking heroin. Lower level prescription opioids like Vicodin, Oxy-Contins, and Percocets are now routinely abused as party drugs. Kids get hooked on these pills which are often pilfered from medicine cabinets, and then discover that heroin is more powerful and much cheaper. It’s not even true that everyone who becomes an addict started out with the intention to get high. Plenty of people get addicted to painkillers that were actually prescribed for them for legitimate purposes, usually to manage pain following minor surgery.
Whenever I write about this problem, I get some push back from people who suffer from chronic pain. They’re concerned that they’ll either be denied the medication they need or they’ll find getting their medication to be a bigger hassle than it should be. As the cited article indicates, it’s true that chronic pain used to be under-treated. But it is clearly over-treated today. In the mid-1980’s, when I had four impacted wisdom teeth removed, I was prescribed codeine pills that were pretty inadequate for treating my pain. But I survived, and I didn’t become an addict. Today, I would not suffer. Today, I would be given Percocets or something stronger. And, depending on my genetic predispositions, I might become an addict.
This is a difficult issue where changes in policy will cause pain to shift from one group to another. There are no easy solutions. The cost of lowering the number of overdoses and addicts is that more people have to experience pain. But, if you look at the numbers, you can see pretty clearly that we have moved too far in the direction of eliminating pain. More kids are dying today from opioid overdoses than are dying in automobile accidents.
We need policies that recognize this fact.
