It has been all over the news and the US election – the opioid abuse epidemic. Like most issues, there are several components that complicate the matter beyond what many people want us to believe. These complications are actually negatively affecting the people who are using prescription opioids as prescribed, namely chronic pain patients, and doing so will generally not improve this crisis.
Before getting into things, here’s some background information:
- Opioids “are substances that work on the nervous system in the body or specific receptors in the brain to reduce the intensity of pain” (x).
- There are 4 different categories of opioids: natural opioid analgesics and semi-synthetic opioid analgesics (morphine, codeine, hydrocodone, etc.), methadone, synthetic opioid analgesics (like tramadol and fentanyl), and heroine. (x)
- This includes medications that are regularly prescribed after surgery, medications that are prescribed for chronic pain patients, medications that are never prescribed, medications that are taken illegally, and more.
What is going on in the opioid abuse crisis?
There are several problems that contribute to what has been dubbed the opioid epidemic. One – the number of opioid overdose deaths. The American Society of Addiction Medicine says, “Drug overdose is the leading cause of accidental death in the US, with 47,055 lethal drug overdoses in 2014” (x). Today, “at least half of all U.S. opioid overdose deaths involve a prescription opioid” (x).
Two – rate of abuse or dependence on opioids. As you may know, addiction is “a primary, chronic and relapsing brain disease characterized by an individual pathologically pursuing reward and/or relief by substance use and other behaviors” (x). On opiate addiction specifically, the ASAM also says, “Of the 21.5 million Americans 12 or older that had a substance use disorder in 2014, 1.9 million had a substance use disorder involving prescription pain relievers and 586,000 had a substance use disorder involving heroin” (x). To understand where this fits, in 2010, an estimated 23 million Americans over the age of 12 were addicted to alcohol or drugs (x– note that I did a LOT of digging and it was difficult to find this information, so if you know of more accurate information, please let me know!).
Three – the increase of these things. According to the CDC, “More people died from drug overdoses in 2014 than in any other year on record. Deaths from drug overdose are up among both men and women, all races, and adults of nearly all ages” (x). On the rate of overdose deaths, the CDC says, “Overdose deaths from opioids, including prescription opioids and heroin, have nearly quadrupled since 1999” (x). So while (according to the data previously discussed) opioid addiction might not be the largest substance people are addicted to, it is causing an incredibly large number of deaths.
Let me be extremely clear here: I agree that this is an issue. I do not deny that this is happening. I do not deny that it is possible for chronic pain patients to become addicts. I do not deny that we need to reduce the extent of it.
Where do chronic pain patients fit in?
There is so much misunderstanding around those who are prescribed opioids because they need them and use them as prescribed and do not become addicted. I’ve talked about this a fair amount before, but most people who become addicted are never prescribed opioids in the first place. To quote my piece People Prescribed Opioids Are Not Automatically “Junkies,”
“A study in the American Journal of Psychiatry found that 78% of people addicted to opiates were not prescribed the drug for any medical reason. A study by the Partnership for Drug-Free Kids found that 9 in 10 chronic pain patients tried a non-opiate based treatment before relying on opiates. Oh, and my favorite statistic? 96 percent of chronic pain patients on opioids do not become addicted. That’s right. Ninety-six percent.”
A recent Twitter interaction I had resulted in learning that the statistic of 96% might be from a study that was flawed – I do not know enough about studies like this to argue for or against this – but in that case, the other studies that was offered said that a more accurate number is 88%. But even in that case, that’s 88%! Additionally, what a lot of people need to understand is that this is a very specific statistic; it’s not saying that chronic pain patients do not become addicted to them or that they do not become addicted to anything.
What is it like being a chronic pain patient in the current atmosphere?
I am constantly demonized. Sometimes it’s nurses or doctors in the ER and sometimes is the average person in line behind me at the pharmacy. Sometimes it’s the pharmacy interns and sometimes it’s a random person on Twitter. Anyone who actually knows me and my health history agrees that I am a great example of the type of person who does need a narcotic prescription, but the average person who looks at me and sees someone who looks healthy thinks that I’m a drug addict or someone trying to game the system. Unfortunately for me, I have a severe and highly active autoimmune disease that’s trying to destroy my body, so yeah, I actually need the medication.
I feel guilty for taking the pain medication that my doctors all agree I need. Before I take one of my pain pills, I ask myself, “Do I really need this right now? What if I waited another thirty minutes? Could I try and wait another couple of hours?” But if I don’t take it, then I suffer significantly and am unable to do pretty much anything. My rheumatologist once told me that I shouldn’t be able to physically get out of bed every day – and I still ask myself multiple times a day if I’m exaggerating my own pain to myself.
Many people believe that I am only taking opiates and that opiates are my only way for combatting pain. Surprise! Every chronic pain patient I know is on a cocktail of medications and uses many different ways to reduce their pain. I personally take 33 pills a day (an additional 2 with my pain medications), have physical and occupational therapy exercises that I do most days, use heat and ice, wear KT tape, have a TENS unit, and more. Narcotic pain medication is often one more tool in the toolbox for dealing with chronic pain; it isn’t the main treatment, which is something that the average layperson doesn’t know.Chronic pain patients and the opioid abuse crisis Click To Tweet
Where can we go from here?
Where is the source of the increase in addiction? We can’t reduce the number of addicts until we know what is causing the addiction. As I’ve stated, prescriptions of opiates aren’t necessarily what is causing the frequency of addiction. If a smoker is at risk for lung cancer, you don’t focus on eating healthy to prevent it; you help them stop smoking. If chronic pain patients aren’t necessarily the ones becoming addicted, why would you focus on them?
Who is prescribing it to people who might not need it and who is prescribing it to people who do? If some doctors are prescribing it to people who don’t need it, that definitely needs to be cut down because even if they don’t become addicted, maybe someone in their household will because there is a bottle of pills in the bathroom cupboard. Additionally, we need to look at what kind of doctors are prescribing opiates. Are the lead prescribers in a certain specialty, and is that specialty one that you might expect patients to need opiates like oncology?
Regardless of the answers to these questions, the biggest point I can make is that we as a society have to stop demonizing addicts, regardless of what they are addicted to, so that they have the support they need to seek help. They deserve better, and addiction in the world will not decrease until they get better treatment from the average person.