Making a case for the use of opioids

In my 2nd comment to the CDC (under a different name) I tried to make a case for the use of opioids:

* The cause of overdoses is addiction, not the specific drug

A more direct and effective way to address the “opioid crisis” (which is dwarfed by so many other unnecessary kinds of deaths, like hospital errors) is to improve addiction treatments.

Addicts and abusers are the sources of most of the crisis, and they need treatment, not punishment. This would be far more effective than taking needed medication away from pain patients.

Policies focused on controlling the supply of a drug are not effective, because addiction is a psychological issue independent of the drug. Just like they are already moving away from oxycontin to heroin, addicts simply move on to another drug because they need to get “high”.  

* Effective addiction treatment is necessary

If addiction treatment were accessible, affordable, and EFFECTIVE, we would not be having such a terrible drug/addiction problem. The main cause of overdose deaths is the utter failure of addiction treatment programs, not pain patients.

If addiction treatments were effective, addicts would be treated once or maybe twice, and then be able to function in society again. But this is not what happens. Instead, addicts are forced into “abstinence-based” treatment with a dismal failure rate, evidenced by a constant (and lucrative) stream of “repeat clients”.

Addicts should be offered treatments that have been scientifically proven effective, not forced into the spirituality-based AA model. Addiction is a biopsychosocial disease/malfunction, and as long as it’s pursued as a crime, people who need treatment will hide and overdose.

* Untreated chronic pain is damaging too

Too few people understand that pain in itself causes physical damage and that there are serious medical consequences, even death, from uncontrolled pain. This is partly because, in many studies, opioid medications are incorrectly blamed for the side-effects of having chronic pain.

Whether or not it is morally appropriate to let people suffer when it can be avoided, the physical damage from having pain cannot be ignored.

* Chronic pain requires highly individualized treatment

Modern medicine recognizes how much variety there is between individuals – genetically, biochemically, metabolically – and how much this determines the occurrence of chronic pain and the effectiveness of various treatments, including opioids.

Pain and its successful treatment, more than any other medical condition, depend on individual factors, so we need unusually flexible guidelines to provide for the diversity of pain and people.

* Until better treatments are developed, opioids are the only recourse

So many painful “syndromes” are incurable, and those who suffer them are condemned to a lifetime of limitations and misery due to pain. For many, no other currently available treatment except opioid therapy is effective.

Why not have a little compassion and use opioids until some better treatment is discovered, so these folks can have active and productive lives as long as possible.

* Use multiple methods to control pain

I completely agree that we should use multimodal treatment, but I would like to point out that the insurance industry does not cover many or prolonged multimodal therapies. This makes it difficult, if not impossible, for pain patients to get the treatments

This is a huge barrier for patients who want these treatments  that they, doctors, and even regulators agree are good alternatives or supplements to opioid therapy.

* Pain patients don’t get high from opioid medication, just get pain relief

A common misconception is that pain patients get high from opioids, just like abusers do, but this is not true. The opioids we take are almost identical to the endorphins our own bodies produce. Like our opioid medications, and by the same biochemical process, they relieve pain.

In people without pain who have normal amounts of these endorphins, extra opioids from  medications create an excess, and this is what causes euphoria. In people with pain, endorphins are severely depleted, and opioids from medications are used up to stop the pain signals, leaving no extra for euphoria.

People ABUSE opioids to experience euphoria.
People in pain USE opioids to reduce pain.

Any pleasure we feel from opioids is only due to the relief of having less pain.

Years ago, an addiction counselor explained to me the clear difference between abusers and users of opioids:

Abusers take opioids to withdraw from life,
Pain patients take opioids to participate in life.