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.
The underlying problem is the same one as with guns: companies make billions from manufacturing products which kill tens of thousands annually. From a societal standpoint, it’s insane for these products to be so widely available, but in our society, money has power and people don’t. The cruxpoints are campaign contributions and media control. We all know how campaign contributions from corporations corrupt the system, but IMO media control is more important. Prescription drug abuse is one of the leading causes of premature death these days, but how often do you hear about drug busts compared to prescription drug abuse?
Read a book about the Japanese occupation of China. By the thirties it pretty much controlled the opium and morphine business there. Besides making lots of money it kept a large segment of the population passive.
When you’re chasing the dragon you’re not chasing civil rights, equal rights et al.
is contributed to by a doctor who wrote a 3 separate posts on painkiller addiction in the NFL and the promise of more effective and less dangerous treatments using derivatives of marijuana plants. It was really interesting reading and not what one would expect from a sports’ blog.
http://www.itsalloverfatman.com/broncos/entry/opioid-use-and-chronic-pain
http://www.itsalloverfatman.com/broncos/entry/pro-sports-and-cannabis-part-1
http://www.itsalloverfatman.com/broncos/entry/pro-sports-beyond-cannabis-part-2
Tangent: Eventually I will update my comment signature here from a 2008 googlebomb Chris Bowers campaign against John McCain to something more contemporary. 🙂
You know what I’m going to ssy. I hate to be AG-like in my predictability, but, yeah. When people keep casually calling for my life to be destroyed, I’m gonna keep “pushing back.”
This is already the case, both with doctors and pharmacies. But this is not the outcome a lot of people concerned about the abuse epidemic are calling for. As the above comments indicate, the rhetoric around this issue causes a lot of people to call for the outright ban of opioid pain medications, which are equated with some or another great historical evil.
I’m willing to bet large numbers of these people have never experienced ongoing, serious chronic pain. It destroys lives, too. Your rhetoric is more measured here than in some past folks, but telling people for whom pain relief is the difference between life and death to simply “suck it up” isn’t just glib, it’s offensive.
My sister is an MD in Canada specializing in treatment of chronic pain.
I think she would say that overprescription of opioid painkillers is a big problem that must be addressed, in part, by education of BOTH doctors and the public. It is often easier for doctors to simply write a scrip than it is to come up with a balanced plan to address long term pain. But definitely the new drugs must be part of the doctors arsenal.
Clearskies you are so right. Last year I attended a seminar given by Dr Tauben, Director of Pain Medicine Education at UW and it was frightening the low percentage of physicians who deal with pain that were adequately trained in pain management. Care to guess? Under 30%.
As usual in healthcare the answers are not that simple.
Well, obviously, I am not calling for your life to be destroyed.
I’m surprised you would suggest something so absurd.
I don’t know about this. My sympathy for addicts and overdosers is pretty limited these days. I have direct experience with both… as a former drug user myself and as an acquaintance of other users.
There is a point at which you really cannot help them and I have little patience for making others suffer because a few can’t handle their drugs.
Maybe we don’t have the right balance, I can’t say… but if I were going to make an error… I would make it in favor of sick and injured people over preventing addiction and overdose.
This is another example of conservative thinking.
It’s basically the kind of thinking that justifies banning abortion because some women don’t take the precautions they should to avoid pregnancy.
If there’s one abortion that you find hard to justify, then the procedure should be banned for everyone always.
So, if someone decided to get high on pain pills and then became addicted, we should do nothing about a system that creates tons of addicts who never took pain pills to get high.
I’ll tell you one thing. If you had a child who got addicted to the pain pills his dentist prescribed for him, you would have more than limited sympathy for them.
I suppose it is an example of thinking about self-reliance and self-control. That has, sadly, gotten a bad reputation. I’m not arguing against drug treatment programs or having a ready supply of overdose treatments. But how much do we insulate those members of our society from things that might hurt them at the expense of others who are helped?
We’re going through this debate over the relative evils of pot and alcohol for recreational use right now. Pain medication at least has some positive benefit compared to the others. I’ve danced with the devils of drug abuse and have seen some awful things happen to people I loved too… We have to deal with these problems closer to home. I just don’t think prohibition really works. Heroin was around for a ling time before OxyContin.
I’m not calling for abolition, either.
But let’s talk about heroin before Oxy-Contin.
When I was growing up in the 1980’s, heroin had a bad name, even on Dead Tour. I knew some people who snorted it once or twice. The only two people I knew who did more than that are both dead, one by suicide and the other from a lethal combo of alcohol, heroin, cocaine and sleep apnea. But, the thing is, opioid use was rare even among the druggies who were experimenting with practically everything.
Our parents didn’t have medicine cabinets filled with opioids. It wasn’t a drug people even talked about doing.
We all knew what it had done to our heroes like Eric Clapton and Keith Richards, and what it was in the process of doing to Jerry Garcia. Most of us wanted no part of it.
That changed with the introduction of Oxy-Contin. Today, pain-killers are almost as common as weed at high school parties. And kids do not consider these pills to be a pathway to IV-heroin use, but that’s what they are for thousands of kids.
And one thing about self-reliance and self-control is that opioids have the tendency to make a total mockery of those things. The withdrawal symptoms are so brutal that most people need inpatient treatment just to make the attempt.
That’s fine if you have the money and your employer is understanding, but it can be a real problem for everyone else.
The problem we have right now is not that people are lacking in self-control. The problem we have is that so many people are getting addicted when they had no intention of getting addicted. And we don’t have the resources allocated to deal with the problem so a lot of people are dying unnecessarily.
Currently the majority of opioid addicts start with a legitimate attempt to treat pain. They aren’t aware of the addiction risk. Once they’re addicted, they act like, well, addicts, but it’s not that they were bad people, it’s that opiates are very powerful drugs and (excuse my French) directly f**k up your motivational and goal-setting systems.
I think an (almost) death sentence, which is the result of opiate addiction, is an excessive punishment for the bad judgement of trying recreational drugs. But it’s certainly an excessive punishment for using a doctor’s prescription for oral surgery or endometriosis or what-have-you.
Especially from dentists and doctors who have no background in pain management. I have had two gum grafts and each time I got a prescription to a week’s worth of hydrocodone when I needed maybe a day if that. Then last spring I had bronchitis and I received a prescription for coughing syrup with hydrocodone. If I had an addictive physiology those would have been my gateway
On the other hand there are instances where doctors under-prescribe out of fear of creating addicts and that is wrong too. If someone needs to be treated for chronic pain, they need to be treated for chronic pain and a doctor shouldn’t deny them that treatment because of the doctors concerns about addiction.
This is where medical education is failing us. There needs to be more of concentration on pain management
I know one person and have heard second hand about another who were made dependent on opioids for chronic pain and who, in retrospect, feel that their doctors unnecessarily turned them into addicts. But that’s what they are now, and they would have to go through rehab and the 12-step program to have any hope of quitting.
They still have chronic pain, but they’d rather suffer from that than be in the position they’ve found themselves in now.
Obviously, it depends on how much pain you are in. But if you can live through it and work, you’re better off toughing it out. If you can’t, you can’t.
Obviously, it’s hard for a doctor to tell a patient to suck it up when they have chronic pain, which is why this is such a vexing problem.
The appropriate policy IMHO has little to do with regulation of drug prescription or use.
It has to do with a health care system that has enough long term interaction with individuals to better manage pain and to see when there is a potential cascade into overdosing–of anything, not just opioids.
It has to do with federal funding of research into what exactly is going on with the perception of pain physiologically and what opioids do to manage the symptoms of pain while obscuring functional sources. And this will not be inexpensive, but it will be less expensive than locking up generations of people for drug use of all kinds.
It has to do with available local programs to allow treatment of addictive behaviors of all kinds without stigma.
And it requires some high-profile consequences under the current regime to highlight the problem. I think that actually sending Rush Limbaugh to jail for drug use might trigger a helpful debate about this issue just by getting it out of the “black and drugs” frame of discussion.
The fact of the matter is that the US is last of all developed countries in being able to handle issues like this because of its deference to large pharmaceutical companies that have a vested interest in pushing more and more pills even if it (unfortunately, as they would say) kills some of their customers.
In the 1960s when I had an impacted wisdom tooth removed, the first remedy was a wet tea bag. And if that didn’t work, Tylenol. But then often what was considered fussy children likely was post-teething paregoric withdrawal symptoms.
Youth drug overdoses and deaths are a consequence of loss of parental and societal credibility on drugs because of overhyping the dangers of marijuana and other drugs and not being straight up about the large effects context can have on experiences of drugs. And underestimating the effects that parental use of painkillers has as a model of behavior.
We will not have good policy on this issue until we come clean as a society about the totally bogus premises of the drug war and privatized medicine.