The Opioid Underdose Epidemic

The Opioid Underdose Epidemic – Thomas Dikel – MediumThomas Dikel – Aug 2017

Mr. Dikel points out a fundamental shift in pain management practice that I noticed several years ago, starting with my experience at Stanford in 2011.

Sometime in the past 10 years or so, psychiatry or psychiatrists were pushed aside as pain management passed over to a new group with a different mentality altogether. “Addiction medicine.”

And when the addiction medicine people took over from psychiatrists, they in some cases sent a letter out to patients that immediately proved that they had not a f — king clue about how to deal with pain patients.  

The letters took a very authoritarian tone and notified “in no uncertain terms” that EVERYONE’S medication would be reviewed to see if they weren’t being dosed excessively, etc., etc., etc.

IF they understood pain patients’ mentality, even a little, or perhaps I should say if they gave a rat’s ass about how patients thought or felt, they would understand that the abovementioned statements would throw the patients into a terrible state of stress and anxiety, especially those who had to go through periods when it was not possible to get appropriate medication and treatment.

It was hellacious.

Maybe what went wrong is NOT something to do with the patients, maybe its something to do with the system — the new mentality, the new regime. Has anybody out there heard anybody asking that question?

at the way these people are approaching pain management may have an unintended but terrible result:

That pain patients who are cut off too soon because that is when the “evidence based” policies say they should be ready to quit, or who try to augment their sub-threshold pain management medication with something else, like maybe marijuana – which shows up in the drug-test cup and causes them to be cut off by their doctor and pain management clinic, those patients may be in tremendous pain without any way of controlling it. 

And if you can’t control it[pain], believe me, it WILL control you.

Of course there are our keyboard commando friends who will pipe in and preach about how THEY’VE been in pain before and they just ignored it.

Or took two Tylenol and it did the trick. Or any other ridiculously ignorant, moronic statement of the same ilk.

I would suggest that they would only be proving that they have absolutely no idea in hell what they are talking about, and that whatever little pain they’ve dealt with is not even the same WORD as what somebody who genuinely needs something as strong as opioid medication to be able to function lives with every day of their lives.

Mr. Dikel then offers an alternate explanation for the sad demise of a famous pain patient. I, too, don’t believe Prince was addicted to opioids, but rather that he needed this medication to continue making his art, his music, and his fantastic performances.

In today’s atmosphere of prohibition and intense scrutiny, he may not have been able to procure his medications from a doctor…

The last thing has to do with Prince, who was found dead in his home outside Minneapolis early one morning from an overdose of Fentanyl.

anyone who was in Minnesota in the 1980s when Prince was first coming to be known, or anyone else who was a fan, knew that Prince was always proud of the fact that he did NOT smoke, drink, or use drugs. And that didn’t change.

Wow. Where do I start.

What did happen to Prince? Let me suggest a different scenario. This much is true: Prince was all of about 5’3″ tall, and always wore platform shoes — HIGH platform shoes. Including when he was on stage during his act — running, dancing, jumping, standing on his feet for hours. By the time he was 50 years old, even before, he was in tremendous pain from all those years of punishment to his hips, his knees, his ankles, his back.

The following is hypothetical. He may have been under the treatment of a pain management doctor, given his very legitimate basis for seeking pain management. It is possible that, even though Prince was in a great deal of pain, after Michael Jackson, Prince’s doctor wanted to make sure he doesn’t give him too much medication and risk an overdose and end his career, like Michael’s doctor.

maybe he decided to set a maximum limit on dosage, telling Prince, as the pain management people are wont to do these days, “We’ll see you in a month. If you still feel its not enough by then, maybe we’ll consider raising your dose.”

So Prince is under-dosed. Maybe this dose mostly takes the edge off, but the pain is always there — it never goes away. And when the pain spikes, it can knock you back like being kicked by a horse.

And for those who have not dealt with this kind of pain, it’s damn hard to function when the pain never, ever, stops.

This is the crazy-making part of having chronic pain: it does not and will not ever end.  The pain is not something that will ever “heal” so the need for pain medication never stops.

There’s no “recovery” from pain like there is from addiction.

Needing opioids for pain relief means our lives will not improve when they are taken away, unlike those who need opioids to get high, who benefit from ending their use.

So maybe Prince tells his bodyguard or head of security, “Get a hold of someone who knows where to get this stuff and tell them to find me something for this pain — on the street if necessary. Just. Do. It. NOW.”

So maybe this someone goes out and finds a dealer with some stuff that he says will take care of any pain ” its some kick-your-ass stuff! Like 10… no 100 times stronger than morphine!”

doesn’t pass any of it on to Prince about how strong it is, certainly not that its 100 times more powerful than morphine.

So maybe he takes the same amount as he would morphine. And it kills him.

So that’s my alternative hypothesis to the pain management physician who claimed Prince was an addict with no proof, evidence, or any solid basis for that statement

If that were the case, then Prince died of an underdose.

This essay is worth reading in its entirety: The Opioid Underdose Epidemic

Author: Thomas Dikel
I am a Developmental Psychopathologist (child development, clinical and forensic psychology, and neuropsychology), focus on child abuse, adult trauma, and PTSD.

Prince is another casualty in the pointless and cruel “war on drugs”.

He had a medical problem called “chronic pain” that is not treated as a medical problem, but as an addiction problem. Any use of opioid pain relievers is immediately labeled a “Substance Use Disorder” and effective pain relief is withheld.

Of course he couldn’t go to a doctor and get effective treatment for his pain.

Instead of allowing him to take a medication that’s effective for his medical condition, he would be coerced into unscientific, unproven, and mostly ineffective “alternative” treatments and drug regimens.

5 thoughts on “The Opioid Underdose Epidemic

  1. DREW5000G

    Who would be the people that replaced the physchiatrists, to be making decisions on pain management? What is their agenda and who do they work for? Would any body do anything if they found a govt dept intending to help some people in a negative fashion

    Liked by 1 person

    1. Zyp Czyk Post author

      Here in the US, our pain care has become a law enforcement and political issue and doctors can no longer treat their patients according to their medical needs for pain control.

      Politicians now decide if and how much pain relief is offered to suffering patients.

      They are advancing their political careers by seeming “tough on drugs”. They crow about the “success” of denying my 88-yr-old mother a few pills that would relieve her incessant pain. She can only sleep 2 hours at a time before pain wakes her to get up and drink warm tea or use more heat packs. The sleep deprivation along with her pain is so extreme that I have to listen to her crying on the phone. That had never happened before, and I’m furious that I’m so powerless to help. Her docs have no idea how much this hardy stoic woman is suffering and I’m not even sure anything would change if they did.

      The callous attitude of doctors toward people in such extreme (and permanent) pain is truly shocking. What happened to the profession that they would allow these limits on their ability to ease suffering?

      They only try to keep patients alive so they can continue suffering, and then call themselves successful – my mother has expressed her wishes to be done with life if she has to suffer like this. I’m just shocked that the medical profession has allowed this without widespread and vocal opposition.

      Oh well, giving patients regular medications isn’t nearly as profitable as cutting into them or providing regular sessions of physical or other useless therapies and treatments for life.


      1. DREW5000G

        Sorry to hear how bad things are over there, the problem is that these politicians are changing laws and people do not realise the changes until it affects them, too late. People need to wake up to the world we live in, peace my friend, blessings

        Liked by 1 person

  2. Kathy C

    The Mainstream Media led public Opinion to their conclusion on Prince. They are controlling the narrative, to benefit the Industries. Take the Insurance Industry, if they can deny the existence of pain in 10 percent of cases postponing or denying treatment, they can save billions. There is nothing these employers resent more than paying Workers Comp or for an injured worker. Denying pain or the existence of an injury generates more profits for the Medical Industry. Just follow the money and ask “Who Benefits.” Pharma wins too, they get to market more expensive replacements. Our Medical Industry does not operate on facts or Evidence Based Treatments, it is all about the profit.
    This was also a tidy way to deny any Mistakes, due to their negligence. They make a lot of mistakes and are rarely sued contrary to what people believe. Often, one of the major complaints after malpractice is pain, they don’t have to worry about that anymore. People with pain are now “Addicts” of “Mentally Ill” they are making it up or Catastrophising. There is very little “Research”: in the incidence of this, they don’t need it. They already have the Media spreading Stories of Hillbillies on Heroin, scamming the system. Certainly if this was such a big issue they would have figured out how often this happens, They did not by design.

    Liked by 1 person


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