Opioid Addiction AND Pain Treatment

One of us was a pain patient saved by opioids, the other was addicted to them. We both deserve a solutionLos Angeles Times – By Ryan Hampton and Kate M. Nicholson – Apr 2019

This is an excellent article in a popular mainstream publication written by two people on the opposite ends of the “opioid crisis”. They point out that a common solution is needed, not one at the expense of the other, as has been done in the past.

Opioids have figured prominently in both our lives.

  • For Kate, they were a lifeline after a surgical mishap left her unable to sit, stand or walk for more than a decade.
  • For Ryan, they were a gateway to a dark decade of heroin addiction.

many Americans believe that we have over-treated pain at the expense of those who became addicted to prescription opioids.  

Increasingly, the media and politicians all but deny that pain exists, highlighting the blight of addiction and doing precious little to address either.

For too long, the two sides have been battling each other:

  1. Those whose lives have been ravaged by opioid addiction have a zero-tolerance approach to prescribing the drugs for pain.
  2. Those in serious pain, many of whom benefit from opioids, blame the crisis on those who misused the drugs and bristle at the increased barriers they now face in accessing their medication.

The incidence of disabling pain and addiction is on par with cancer, heart disease and diabetes.

Yet only a few thousand doctors specialize in pain management in this country.

And there are less each day due to the danger of being prosecuted for providing truly effective chronic pain management which usually requires an ongoing opioid prescription.

Without any general medical knowledge and without any knowledge of patients’ conditions, law enforcement (DEA) can unilaterally decide (or hire their own “medical expert” to make the decision they want) that a doctor is prescribing “too much”.

There’s no particular dose or number of pills or number of prescriptions that constitute “too much”; it’s just a “feeling” this non-medical government personnel has that it’s excessive.

It’s an outrage that this is considered sufficient cause to then raid the doctor’s office in full body armor as though it were a dangerous criminal they were after, not a law-abiding doctor with a waiting room full of suffering patients.

Showing up bristling with weapons is certainly not necessary for a medical office with waiting patients; I don’t know how they justify these attacks.

If history is any guide, we neglect both conditions at our peril.

People in pain have become the latest victims in this crisis, as regulatory efforts to curb prescribing have made it difficult if not impossible for them to receive opioids needed to manage their conditions.

Physicians who fear liability are abandoning their patients or forcibly reducing or eliminating their medication. Even patients with cancer face barriers from insurance and pharmacy denials. As reporters have shown, when denied medication, patients may lose their ability to function, attempt suicide or resort to illegal substances.

Those who use opioids medically are often seen as “addicts in sheep’s clothing.” This perception has caused some in the pain community to position themselves in stark contrast with the addiction community, by embracing hashtags like #patientsnotaddicts that stigmatize people who are also suffering from a disease and face similar barriers to care.

The addiction community too can be quick to latch onto boogeymen, drawing a straight line from Purdue Pharma’s OxyContin to doctors who “hooked” their patients. Yet most people misuse diverted opioids, pills that were stolen or obtained from dealers, not pills that were prescribed to them by a doctor.

Most overdoses do not result from a single medication but involve multiple substances (both legal and illicit). And the singular focus on pills belies what drives the overdose crisis today: illegally produced fentanyl, its analogs, heroin and, increasingly, cocaine.

Comprehensive policy changes that address the dueling epidemics of serious pain and addiction in this country are sorely needed.

The two sides in the battle over opioid use should band together and jointly work to effect cultural changes in how pain and addiction are treated.

Anything less will only make already drastic consequences worse.

Authors:
Ryan Hampton is the author of “American Fix: Inside the Opioid Addiction Crisis — and How to End It.”
Attorney Kate M. Nicholson served for 20 years in the Department of Justice, where she drafted the current regulations under the Americans With Disabilities Act.

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