Understanding the Roots to the Opioid Crisis
Every time I hear about an opioid-related overdose death, I can only feel empathy for the family of the decedent. Whether it’s the result of using street drugs that are laced with fentanyl or carfentanil, as in the case of a 21-year-old woman from Virginia, or a person in pain who accidentally overdoses, each death is far more to me than a statistic. I grieve for the victims and their families. Our society suffers the loss together.
Why So Many People Fear Overprescribing Painkillers
And yet, ironically, our society has created the opioid crisis. The public has learned to fear drugs through lawmakers, the media, and even some healthcare professionals who have created the myth that overprescribing painkillers has led to an opioid epidemic. The theory holds that overprescribing painkillers leads to addiction, and addiction leads to overdoses as well as violent crime. This idea is championed by anti-opioid physicians and families who have had to experience the heartbreak of an overdose death.
The solution, according to these groups, is simple. Make it difficult for doctors to prescribe opioids, and the crisis will go away. I have to believe that many people who hold these beliefs mean well. However, they are missing critical information. They don’t realize that opioids are a necessary part of pain management for some people. There are patients who will die in agony unless they can use medication to manage their pain. They don’t know this, because the media typically fails to report it. The plight of people in pain doesn’t get adequate and fair media coverage. Instead, typically, the media focuses on feeding the public’s fear about opioids, people with addiction, and violence.
WNYC’s “On the Media” Hits It Out of the Park
There was recently a wonderful exception to the rule. WNYC’s radio show, “On the Media,” aired an hour-long program on April 14, 2017, called “This American War on Drugs.” It should be required listening for everyone who believes the opioid crisis is a recent problem caused by overprescribing painkillers.
The first segment of “This American War on Drugs,” which talks about Attorney Jeff Session’s misguided efforts to demonize people who use painkillers, is excellent. For more information about that, see the Washington Post’s recent article, “How Jeff Sessions wants to bring back the war on drugs.”
The show also tells how our culture developed a perverse view of opioids and addiction. It describes a time, during the Civil War, when people in pain were expected to use opioids, and that need was understood and supported by society. Opioid use by soldiers was viewed as compassionate and necessary. The broadcast explains that, eventually, racism and xenophobia caused a shift toward the criminalization of addiction and drugs, and those who prescribed them.
The Political Pendulum Swings
The political pendulum has swung many times over the years, and it continues to do so. According to CBS News, the Obama administration aimed to “shift away from the decades-old incarceration approach to drugs and toward an approach focused on treatment and public health.” However, under President Obama’s leadership, the CDC developed and published the opioid prescription guidelines that have been making it increasingly difficult for patients to get the medication they need to manage their pain.
Now Medicare plans on adopting the opioid prescription guidelines “as official Medicare policy and taking punitive action against doctors and patients who don’t follow them,” according to Pain News Network. The “war” continues another cycle, leaving behind people in pain as collateral damage.
To live in pain without relief is a type of metaphorical incarceration. Doctors who would prescribe opioids are often targeted by law enforcement, because it is easy (albeit unfair) to blame overdoses on the imperfections of care. In some cases, law enforcement officials actually believe that doctors are the gatekeepers to developing addiction.
The Real Roots of the Opioid Crisis
It is inarguable that the country has an opioid crisis, but the reasons for this crisis are complicated. Overprescribing exists, but it hasn’t been the sole reason for the problem. “The idea that doctors directly cause this [opioid crisis] is a little more complicated,” says neuroscientist and author Maia Szalavitz during the program.
Demonizing the drugs, blaming physicians, or even holding Pharma responsible for the opioid crisis ignores the underlying reasons. The social and economic despair and hopelessness in large sections of our society plant the seeds for the disease of addiction. People at greatest risk of developing addiction are those without social support or economic opportunities. Drugs become the elixir for the social/economic despair.
As Bob Garfield says, ”Despair — alas, illegal drugs themselves — are not in short supply. What is in short supply is nuance, context, and restraint in telling the story of a plague and its grim toll.”
The “On the Media” program provides insight about the meaning of the phrase, “opioid epidemic.” It is a complicated problem with roots that extend from more than a century ago. Hopefully, more journalists will tackle the topic without an agenda and with integrity, as WYNC has done. People in pain deserve to have the true story told without spin or bias. And all of us need to hear it.
That was well written, thank you!
I wish the media would get it right as you did.
Signed a grateful pain patient who has been through the ringer
Jenny
Dr Webster, I can’t seem to get the link of the radio show, “This American War on Drugs” to work. The link may be. Broken? But,..
Anyway, thank you so much for all you do to help shine a light on the collateral damage pain patients are Suffering through.
Thank you for your question. I’m able to log in and hear the interview by clicking this link: http://www.wnyc.org/story/on-the-media-2017-04-14/. You might want to clear your cache and try again, or try using a different browser. If you’re using a mobile device, unfortunately, the link might not work for you. I hope you can hear the interview.
I was on opiods for about 10 years following a broken neck C-1. After recovering from this without surgery I was using oxycontin at a fairly low dose until while teaching one of my students jumped up in the air catching my head under the chin with the top of his head. the whiplash from that undid all of the muscular progress I had made in 2 years of recovery and eventually I had a C-1, C-2 fusion. At that point my oxycontin dose rose to around 100 mg per day and while it made the pain tolerable I really couldn’t tolerate a higher dose without giving up working. One thing I did not know and found out too late was that one of the side effects was a dry mouth which essentially led to my teeth rotting away. I had to have all of them pulled since root canals and other stop gap measures didn’t solve the dental issues. During this time I also had the misfortune to be hit several times by drivers who did not understand the meaning of a stop sign. I finally reached the point that the medicine was no longer helping with the pain and with the help of my doctors at my pain management facility decreased the amount of Oxy until I was completely off of it. Its been about 2 1/2 years now that I have been off of it and while I still have pain I have found that other than a bad day here and there I can manage without pain killers buy using muscle relaxants. My main challenge now is to lose the weight I put on as a result of the inactivity the pain caused. Being diabetic has also provided its own set of challenges though I am on the verge of having that controlled A-1C of 7.1 the last 3 tests. I could use the name of a good diet plan to follow since i know that dropping the extra 80 or so pounds that I put on while on pain killers will help with both pain and diabetic management.
SO SIMPLE! THERE IS A HEROIN EPIDEMIC NOT A PAIN PILL EPIDEMIC. MEDIA DOES NOT DIFFERENCIATE THE TWO. YES THERE WAS A SERIOUS PROBLEM WITH BAD DOCTORS AND BAD PHARMACIES OUT FOR THE BIG BUCKS. BUT AS WE ALL KNOW WHEN PAIN PILLS ARE USED IN STATISTICS THE DEA CDC AND INSURANCE COMPANIES STOP IN 2012. THAT’S WHEN THE DATA BASES CAME OUT, BAD DOCTORS WERE ASSESTED AND MANUFACTURERS WERE HELD ACCOUNTABLE FOR DISTRIBUTION. THIS WAS ALSO THE TIME HEROIN STARTED TO HIT THE STREETS HARD AND PURE. PAIN PATIENTS ARE COLLATERAL DAMAGE BECAUSE IF THE CDC SEA AND INSURANCE COMPANIES ADMIT PILLS AREN’T THE PROBLEM ANY MORE THEN THE FRAND PLAN TO SAVE BILLIONS IN PRESCRIPTIONS WOULD HURT THE INSURANCE CO.PANIES AND THE SEA WOULD HAVE TO ADMIT THEY ARE A COMPLETE FAILURE. IT IS 100X EASIER TO GET HEROIN THEN FOR A REAL PAIN PATIENT TO GET THE HIGH DOSE NEEDED TO RELIEVE THEIR PAIN. THE CDC GUIDELIMES ARE A FARCE. THIS WAS ENACTED TO SUPPORT THE REHAB CO.PA IES. HAVE YOU NOTICED HOW MANY COMMERCIALS ARE ON EVERY DAY. THE MEDIA KEEPS TELLING THE SAME OLD STORY ABOUT A TEENAGER THAT BROKE HIS TOE TOOK VICADIN AND WHEN THE DR STOPPED PRESCRIBING THEM HE OVERDOSED ON HEROIN. WHAT A JOKE. THE KID ATE THEM LIKE M AND MS DRANK PROBABLY TOOK ADEROL OR VALIUM AND DRANK COUGH SYRUP WITH CODEINE. IN OTHER WORDS THEY CHOSE TO GET LOADWD AND PAID THE ULTIMITE PRICE.
NOW WE IN CHRONIC PAIN ARE PAYING THE PRICE BY BEING FORCED TO LIVE IN PAIN. THE REALITY IS THEY WORK FOR US
THEY HAVE BEEN MEDICALLY NECESSARY FOR DECADES AND ALL OF A SUDDEN THEY’RE NOT?
IF WHAT THEY SPEW IS TRUE THEN EVEN 90MG MME IS ROO MUCH. A DRUG ADDICT WILL JUST GET LOADED ON THOSE AND JUST MAUNTAIM WITH HEROIN. IT SEEMS THE MEDICAL INDUSTRY WANTS CHRONIC PAIN PATIENTS TO SUPPORT THE HEROIN INDUSTRY. THE SEA MAKES IT SO EASY TO OBTAIN AND OUT PPAIN GOES IN CARING BY OUR DOCTORS.
WELL IF TJET0 GOT ME ADDICTED TO PAON PILLS THAT WERE NOT MEDICALLY NECESSARY I WANT COMPENSATION FOR TJEM IN THERE OWN WORDS DESTROYING MY LIFE.
The thing about opiates is they work very well for many different types of physical pain, and as street users have shown us they work well for emotional pain as well. There’s a great deal of research that shows their usefulness in treating difficult cases of depression. As a society we’ve ignored the suffering of both addicts with emotional issues and those with physical disability requiring treatment. We’ve turned a blind eye to both groups, ostracized them, choosing instead to legislate what is moral, allowing the lawmakers to be solely interested in the financial needs of themselves and their agenda driven donors. As a person living in a chronic disease state and life destroying chronic pain, I pray everyday that the tide turns and compassionate care becomes available for all who are in need.
I am forced to live in unbearable pain. I have zero quality of life and will more than likely be dead by the time this “crisis ” is resolved. I can’t believe I am still alive right now it’s been so bad and demeaning. I have severe spine damage. I had two spine surgeries this past February. My injuries left me with permanent extremely painful bilateral drop foot and neuropathy in my feet. I have severe vertigo caused by chronic headache/ migraine pretty much daily. I am also not being treated for fibromyalgia. My body’s so tired from the pain I experience nonstop without end in sight. People who’ve died from abuse or missus I guess their deaths are more valuable than those of us still here and bearing the brunt of those poor choices that ultimately took their lives. If we are refused pain relief then I believe it would be great to have the right to die with dignity from medically assisted suicide. My fur baby has better healthcare than I. He can even be euthanized if he was hurt or injured severely. Not me. No I’m forced to start every morning with the same thought “will my pain kill me today?” No amount of mental help can help me because I’ve tried. I’m not clinically depressed. I am being forced to take my life because those that took the Hippocratic Oath to ” first do no harm ” have backed me into the corner with no way out. The medical care in Spokane is my death sentence.