The Other Side of the Opioid Epidemic: Denying Treatment to People With Chronic Pain by Kate Nicholson – Feb 2018
When I went into the office one Saturday afternoon in August 1994. At the time, I was a civil rights attorney for the justice department. After 30 minutes of working at my desk, my back started to burn; it felt as if acid were eating my spine.
In rapid succession, my muscles seized and threw me from my chair. I landed on the floor, stunned, as my body filled with searing pain.
What I didn’t know then was that the pain would persist, and that I would unable to sit, stand or walk unassisted for almost 20 years. Nor could I have imagined that I would one day take opioids for pain.
We hear a lot today about opioids. Newspapers run a steady stream of stories of lives lost from overdose and abuse.
What we rarely hear is the other side.
Opioids are the most powerful medication we have for treating severe pain.
For me, opioids were life-restoring.
Proper pain management that included treatment with opioids lifted me from the desperate circumstances of being bedridden and unable to sleep for months at a time to someone who negotiated major settlement agreements, argued important cases in federal court and supervised thousands of matters in U.S. attorneys’ offices across the country.
I still could not sit or stand – I negotiated via video-teleconference, argued from a reclining lawn chair and managed cases from a jerry-rigged, platform bed – but I could and did work and function.
Pain patients today are not so fortunate.
In our effort to thwart the genuine problem of drug overdoses, we are taking life-sustaining pain medicine away from people who are struggling.
Pain patients are denied treatment and involuntarily tapered off of opioid medication, even if they’ve never shown any risks of abuse. The results may include increased suffering, loss of function or suicide.
There is an important but often glossed over distinction between using medication for a health condition in a way that restores function, enabling work and participation in family life, and misusing a substance in a manner that destroys function.
As my addiction-specialist therapist said:
Patients use opioids to participate in life,
Abusers use opioids to withdraw from life.
And, when opioids are prescribed properly with screening and follow through care, the risk of addiction goes down significantly.
The substantial majority of people who have misused prescription opioids never received them in a healthcare setting; they obtained them from medicine cabinets, family and friends or bought on the street.
My condition resulted from a surgery when a doctor severed nerve plexuses in my spine
Treatment with opioids and integrative care allowed me to maintain a job, a sense of purpose and community until I found my way to healing.
Mine is a story rarely told of someone who took opioid analgesics for years and went off them without incident when the pain remitted.
Because my pain level varies from day to day by about a factor of 2, the dose of opioids I take in a day varies just as much.
When I’m not in much pain, I just naturally start getting busy, doing all those chores I cannot when I’m in the grip of serious pain. Only hours later in the day, when the pain finally builds up, do I realize I haven’t taken or even thought about my pain medication.
Given the environment today, such stories may well become extinct.
Author: Kate Nicholson has been a wonderful advocate for pain patients.
I previously posted her TedX talk: What We Lose When We Undertreat Pain and also another article of hers: Opioid deficit epidemic for people in severe pain.