The Real Problem With The Opioid Epidemic

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.

Treatment Options

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.

Inpatient/Residential/Detox

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.

Outpatient

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.

Narcotics/Alcoholics Anonymous

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.

Final Thoughts

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.

19 thoughts on “The Real Problem With The Opioid Epidemic

  1. Finally, an intelligent and truthful article about this situation.I wish our so called leaders would properly inform themselves,instead of trying to take us back to the dark ages!!

  2. Hi Hillary,

    I enjoyed this, and you made a lot of good points. I think in the future you should source some of your claims to really put strength behind the claims. Like you mention that 12 step programs and things like NA/AA are super ineffective. There is real data out there to support that claim, and I think it would be good to link to things like that!

    I believe there is also data out there on the validity of Marijuana treatments reducing Opioid treatment. Good read, I enjoy your style!

    — Irvin

  3. It is really sad what is going on in this country with the opioid epidemic. It is bad for those that have a chronic issue that causes them pain because the doctor sometimes insult them and cut the doses that help them because of someone else that is abusing the medication. I just do not understand why some people that are typically very healthy have to ruin things for those that have medical issues. My doctors office has been giving me a very hard time lately and it is a horrible time for this because I am honestly having the worst flare from the MS that I have ever had.
    This was a great post Robyn and very insightful!!!!

    • Thank you for reading and commenting, Alyssa! It truly is a problem right now and I feel like people are really only discussing one aspect of it while completely ignoring those of us who are suffering and who are on these medications as a last resort.

      I am so sorry you’re going through such a hard time! It’s a perfect example, too. Someone with MS is obviously in pain, not seeking, so for you to be given the run around shows that the pendulum is swinging too far. I am one of the lucky ones so far (knock on wood) and have not had any cuts to my dose, but every month I prepare myself for the worse.

      Thanks again for reading and I’m glad you enjoyed it! 🙂

      • My dose was cut by one last month during seriously the worst flare up I have had, ever. I am going back today to talk to my doctor about it. It really was not a good time to mess with my medication. You are right, I actually need to medication, I am not drug seeking. I do not appreciate them treating me like I am some drug seeking patient. I do not know how to address this with the doctor today, but I know I need to tread lightly.
        I hope you have a good day!! Wish me luck with the doctor today:)!

      • Ugh that makes me so angry! I am so sorry you are going through that. The worst part is that you have to make sure that every word you say and thing you do is deemed acceptable or they’ll treat you even worse. Diabetics or those with high blood pressure don’t go through this discrimination, why should we have to?

        I truly hope your visit today goes well and that they listen to you. Good luck!!

      • Aww I’m sorry to hear that! Well hopefully now that you have better pain control maybe that will help. I hope your night is better than last night and you have a good day tomorrow!

  4. It is refreshing to read another pain patient’s perspective on the opioid problem, and that your opinion is similar to mine. While in the ER the other night, I experienced my first OD a few rooms down. They wheeled thus guy in, barely breathing, gave him two doses of Narcan and less than an hour later, he was his old (I’m guessing) miserable but arrogant self. He is probably going to be a repeat performer at that ER, while my insurance company implements a soft “ban” on my pain medication for next year by making it prohibitively expensive.

    I truly despise being lumped in together with these people, as if pain patients are human debris… at first I felt sorry for that guy, but the more I think about it, the more enraged I feel. We have NO ONE to be our voice, with the insurance companies, with Congress and in the court of public opinion. I surely did not choose a life of chronic pain and the misery that accompanies it, and I’m sick of being made to feel like a criminal for simply wanting a quality life. Thank you for being another voice of reason in the insanity.

    • Thank you for reading and taking the time to comment, Wendy! I am sorry that you have to go through that.

      A lot of times, when someone is brought back with Narcan they are very combative. You are probably right that he will return because I very seriously doubt he will be able to get adequate treatment even if he wants it.

      To lump chronic pain patients in with those who are addicted helps no one and it actually hurts us. I feel for addicts – I truly do – but to say that a chronic pain patient only wants to get high is completely ignorant and unhelpful.

      I have been sending letters to representatives in the hopes that maybe our voices can be heard and I am encouraged to see many articles about the subject. Hopefully those who need to will listen to us.

      Thank you again for reading and I hope you are well! 🙂

  5. Pingback: Underlying Causes of Addiction – Robyn's Reflections

  6. I have been going to the same doctor since 2002. At first he was my workers comp doctor from the company’s list. He stood by me every step of the way. Helped with the legal matters, such as written letters, full diagnosis of my cause of pain and so forth. He is now my primary care doctor.
    When it came time for the state mandated cuts he apologized every time he cut my meds. He explained the new laws from his point of view. And let me tell you he was very angry about it. Now I’m cut back to less than a third of what i was taking to feel almost normal. Still had major flare-ups, from a failed spinal fusion. He referred me to another doctor in 2008 to have a spinal cord stimulator. That thing worked somewhat for about six months. Then it stopped blocking some of the pain. Now, it doesn’t block any pain whatsoever.
    I’m fed up with the major box pharmacies treating pain patients like criminals. Rite-Aid and CVS would have plain clothed security follow me around the store while waiting for my scripts to be filled. They actually followed people outside to their cars. CVS has gone so far as to say “we reached out quota and cannot fill these scripts”. Whatever that means. I finally found a pharmacy that treated me like a human being, and not a criminal piece of trash looking to get high.
    I’m very sorry reading about people worse off than i am. In opinion, and my doctor’s opinion, it is our doctors job and he or she took an oath to practice medicine and to keep their patients as comfortable as possible. Strong pain meds as a last resort.
    Things have gotten so bad with these stupid laws. My father, bless his soul died in July 2018 from esophageal cancer. Would you believe the doctors at the hospice are not allowed to give opioids to a cancer patient on his deathbed. They said the state doesn’t want a terminally ill patient to become “addicted” so they only gave Motrin, aspirin and codeine. He passed thankfully a very short time after he was diagnosed so he didn’t suffer very long. But i strongly believe that had he been given the medication to help him to be as comfortable as possible, he probably would have lived longer.
    All of these chronic pain groups should ban together and start a class action lawsuit.
    But your article was well written and very eye opening. Learned some things i didn’t know. Thank you for such an informative article.

    • Hi David! First, let me apologize for responding so late!

      I am so sorry that you and your dad have been through this. It really is devastating to experience – for yourself and your loved ones. I’ve now joined the ranks of the forcefully tapered. My extended release medication has been cut in half, leading to awful pain. In order to try to combat the effects (my doctor doesn’t want to do it to me, either!), she added more of my breakthrough medication to help the transition. The problem with this is that I have learned that my accident a couple of weeks ago was due to a seizure brought on by serotonin syndrome from the additional medications. I’ve been on the same regimen for over four years with no problem. Yet, because I’m 29 I’m a red flag. I hate it so much.

      I, too, have had issues with big pharmacies. The run around of “we don’t have it in stock, just keep coming in until we do” drove me insane. I finally found a locally owned pharmacy that has been wonderful. They always have what I need when I need it and they never make me feel bad for what I take.

      I can only hope that the pendulum will swing back soon. It’s quite obvious that cutting us off isn’t helping the overdose situation any – as prescriptions have gone down, overdoses have gone up. Not to mention the suicides from pain patients who can no longer have a life. Sure, be more conscientious about who you prescribe to and how much for acute pain, but for those of us who have been doing well on a regimen for years? They should just leave us alone since we aren’t the problem.

      I wish you the best and I hope that you are able to find relief soon. Thank you so much for reading and taking the time to comment! ❤

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