In the conversation around opioid use and the abuse crisis, the voice of chronic pain patients is often forgotten because many people consider us a large factor of the problem. On one hand, I understand this; it is a huge crisis, and most people truly don’t understand how many chronic pain patients there are out there and what our lives are like. But on the other hand, we’re the ones being denied medical treatment and treated like we don’t actually have pain because of the crisis and a lack of understanding. So, for all of you don’t get why people use opioids for chronic pain, I hope that this will help you see how they are used and why.
Dosage – Like with all medications, every patient is on a different dose, and like all categories of medications, all patients are not on the same type of opioid. There are many different varieties and doses, so one patient could be on a high level of morphine all day (unlikely for chronic pain, by the way, as this is used more for hospice patients), and another could be on just a few opioids once a year. The point is that the category of “opioid” covers a wide variety of medications and doses. And additionally, someone could be on a medication that is a small percentage opioid and a much larger percentage of some other OTC pain killer. For example, Norco is 5 mg Hydrocodone and 325 mg acetaminophen (1.5% and 98.5% respectively). Additionally, everyone that I’ve talked to who is on an opioid every day has a dose designed for it to be safely taken every day.
Type – Again, all types of medications have various categories. Within the general category of opioid, there are 4 different categories: natural opioid analgesics and semi-synthetic opioid analgesics (morphine, codeine, hydrocodone, etc.), methadone, synthetic opioid analgesics (like tramadol and fentanyl), and heroine (x). You can read more about that here, but my point is that often people hear opioid and think morphine or heroin when that’s not always the case.
Use – Some people have doses to take every day, and others have doses just to use when their pain is extra high and it’s to keep them out of the hospital. It differs for everyone, and it often depends on the opioid they’re on, what causes their chronic pain, what other medications they’re on, and the severity of their illness. There are plenty of people who have a prescription and only use it when absolutely necessary, and there are people who use it every day. It depends drastically.
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Process of getting and filling the prescription – This depends on the country and state you live in, but for many in the US, you have to go to the doctor who prescribes it to pick up the prescription every time you need a new one. You don’t get refills, and you have to pick up the prescription in person before you bring it to the pharmacy (because the pharmacy can’t fill it unless you bring it in person). For some states, only pain specialists can prescribe opioids, which can make the process take even longer and be more of a bother because they you need to be referred to the pain specialist, hope they have an appointment available soon, and hope that they decide you do actually need the medication. This can take months, which is torture if you live with the kind of pain that requires you need the medication in the first place.
And this is all assuming that your doctor believes you have severe pain; I can’t tell you how many doctors I’ve seen who haven’t believed me. And I get that with everything going on in the US right now doctors need to be possible that the patient actually needs the medication, and I get that doctors are often under a lot of pressure to avoid prescribing opioids whenver possible. But there are a lot who just don’t get why they’re taken in the first place.
Why they’re taken – Opioids are taken by chronic pain patients because their current medication treatment does not work to the level it should. I have never met a single person with chronic pain who is only on opioids. The thing a lot of people don’t get is it can take a while after you’re diagnosed with a chronic illness to find a medication or treatment plan that actually works. With rheumatoid arthritis and similar autoimmune diseases, it can take 3 months to officially decide if a medication doesn’t work. If you don’t find a working treatment until your 4th try, that’s a year – and that’s a year after you’ve been diagnosed, and if you have RA, you might have had symptoms for years before you were diagnosed.
Additionally, a lot of patients have their opioids as an Emergency Only plan. They have a medical condition, they know what it is, they know what to do about it, but there are ocassionally moments when they have horrible episodes. Instead of taking up a bed in the ER – where every bed is precious and necessary – for a condition they already know about, their doctor prescribes an opioid for those moments.
My point is that there are a lot of reasons chronic pain patients are on opioids, and “on opioids” means something completely different to every patient.