America has a problem with opioids. I am acutely aware of this, due to the fact that many of the people I grew up with have been taken by heroin mixed with fentanyl. It is pervasive and does not discriminate. However, what we are doing is not going to fix it, it will (and already has) only exacerbate it further.
Chronic Pain Patients Are Not The Problem
Yet, we’re the ones being punished. After the CDC came out with their guidelines last year, doctors everywhere have been running scared. Although these aren’t law, they are being treated as such. Patients who are in excruciating pain are having their dosages lowered or being cut off completely. And even though the amount of prescriptions written has gone down, we’re still having overdoses. And even though the majority of those overdoses are from heroin with illicit fentanyl, pain medications are still being demonized.
There is a big difference between being addicted to something and being dependent on something. Someone who is addicted to opioids is always seeking that first high; someone in chronic pain is just trying to survive. Can the two overlap? Of course! However, those who have pain and become addicted are in a minority.
The Real Problem
Now that we’ve assessed that chronic pain patients and the medications we use to be productive members of society aren’t the problem, what is the problem? In my humble (ha!) opinion, the problem is our addiction treatment in this country. It is just…awful. It’s expensive, confusing and unattainable for many. It is guided by 12 step programs that don’t work for the majority of addicts and medication-assistance, which is basically just giving the addict a strong opioid and hoping they don’t get addicted to it.
Because the majority of overdoses are by people who are addicted to opioids, it only makes sense to focus more on their treatment than taking away medications from legitimate patients.
If you are addicted to opioids, you have very few options to recover – options made even more limited if you don’t have money or time.
In general, these have higher success rates than other options, because they take the addict away from their triggers and the substance they’re addicted to for an extended period of time. Depending on the facility, they may use the 12 step program, medication-assisted therapy, detox or all of the above.
However, if you don’t have insurance that will cover it and/or thousands of dollars, this isn’t an option for you. There are places that are cheaper, but they’re usually overbooked and unavailable.
The cheaper and most common form of treatment is outpatient, and it comes with it’s own slew of problems. It involves talk therapy and usually medication, as well. Both of these are expensive and not always accessible. Talk therapy can be beneficial if it involves facing what caused the addiction in the first place, be that grief or depression, etc., but it’s almost impossible to continue treatment. While in therapy, you are required to see a therapist sometimes up to three times a week. That means that you have to find a way to get to them and pay your copay or other costs three times a week. If you work in a job with similar hours and/or do not have the money, you’re not going to go.
Medication-Assisted Treatment (MAT)
Then there’s the medication, which is making a certain few people a lot of money. You can go to a methadone clinic every day for the rest of your life (because they never wean you off) or you can get a month’s supply of something like Suboxone, which in my experience is more powerful than even oxycontin. And again, they never take you off of it. Because you get a month supply at once, you’re highly likely to relapse and take more of it than you’re supposed to because it is an opioid just like the drug you’re trying to come off of.
For some odd reason, it is totally okay to put and keep and addict on a maintenance opioid like Suboxone, but it is not okay to keep a pain patient on a maintenance opioid like Percocet. This is ridiculous.
You could also go to Narcotics or Alcoholics Anonymous, but if you’re at all introverted you won’t last long. The idea of introducing yourself to a group of strangers and then having to find a sponsor is terrifying for an introvert.
But even if you’re okay with all of that, these programs still have a very small success rate. Because they depend solely on your ability to abstain from whatever substance you’re addicted to, they leave a lot to be desired. If you go to a meeting and then go home to people who also use, or triggers of your use, the 12-Step program will not do much good. Of course they help some, I even know one person who was helped by it, but it isn’t for everyone.
What Can We Do?
We can start by legalizing marijuana across the board; recreationally and medically. Then we can make it an integral part of addiction treatment, as studies have shown that intermittent use helps patients abstain from the drug they are addicted to. Not only that, but it helps ease withdrawal symptoms, which is one of the main reasons people relapse. If it’s okay to give patients a stronger opioid than what they’re addicted to as “treatment”, then it’s okay to give them marijuana.
We should stop cutting off pain patients who have done nothing wrong, because by doing so we are creating more overdoses. When a patient who is in chronic, excruciating pain loses the only thing that gives them a semblance of normalcy, they will go to the street to find it.
The problem with this is that the illegal fentanyl that is shipped here is powder and then made into pills which look identical to prescription medications. So when a pain patient gets what they think are 10mg Percocets (which they were prescribed before), but are actually fentanyl, they will take them without even realizing it and overdose.
Stop stigmatizing both addiction and pain patients and treat them like human beings. No more mandatory minimums for addicts. Put more funding into treatment centers and make it less expensive and more available for people from all financial backgrounds.
Let’s stop demonizing and threatening the doctors who write these prescriptions. Stop giving the DEA and pharmacists more power over the prescriptions than the doctors who prescribe them. Leave the decision up to the doctors.
There is definitely a problem with opioids in this country, but it’s not pain patients who are perpetuating it. In fact, when a pain patient is involved, it’s usually because they were cut off cold turkey from a scared doctor.
Without adequate addiction treatment, we will never solve this crisis. There are plenty of addicts who want help, they just cannot access it for whatever reason. If we can make it easier and more affordable for addicts to get treatment – and make the treatment itself better – we can get a handle on this problem.
Addiction is a multi-faceted issue that requires a multi-faceted approach to treatment. Not all addicts are going to respond to the same therapy, and some may need multiple types of treatment. Assuming that because one treatment option works for some that it will work for all is incorrect and – honestly – lazy.
The fact of the matter is that there will always be people who abuse these medications, but harming the majority for the actions of the minority does no good and actually makes things worse. There’s a reason why there are more heroin overdoses now than pain killer overdoses and it has a lot to do with how we’ve reacted to the crisis.