Medical Illiteracy Contributes to the Opioid Crisis

Medical Illiteracy Contributes to the Opioid Crisis was first published in The Hill on December 20, 2016. It was designated by The Hill staff as one of the top 5 health stories of 2016.

I’ve had the privilege of regularly contributing to The Hill since November 20, 2016. My opinions do not necessarily represent those of the editors, nor do all of those who comment on my columns necessarily agree with my point of view, all of the time.

However, I greatly respect the work that The Hill does and the readership it serves. It is an honor to count myself among its contributors and to have the opportunity to address its readers on issues that matter to the pain community.

Medical Illiteracy Contributes to the Opioid Crisis

Language matters. Words and phrases create impressions, and they can shape attitudes that sustain stigmas and generate ill-informed policies.

A recent article in the Washington Post reported, “One-third of Americans who have taken prescription opioids for at least two months say they became addicted to, or physically dependent on, the powerful painkillers, according to a new Washington Post-Kaiser Family Foundation survey.”

The article suggests a shocking new finding which supports a narrative that opioids prescribed for pain in America are more dangerous than most people realize.

However, I am surprised the number of respondents reporting that they were physically dependent was only one-third instead of more than ninety percent.

Physically Dependent Does Not Mean Addicted

Most people who use opioids for more than two months become physically dependent on them. But that doesn’t make them addicted to opioids. Nor does it mean the opioids are harmful to the individual. Herein lies a medical literacy problem.

Addiction is a brain disease that is associated with both physical dependence and psychological craving. A hallmark of addiction is a loss of control that results in self-destructive behaviors. Those behaviors are driven by an insatiable appetite to obtain, and use, a substance based upon a memory of an earlier experience. This is an abnormal medical condition not a character flaw.

Addiction is a disease.

On the other hand, physical dependence is a normal, generally reversible neuro-adaptive process to a drug. Antihypertensives, antidepressants, and caffeine are other examples of drugs that are associated with a normal physiologic neuro-adaptation process. There is no psychological craving associated with physical dependence.

Confusing Withdrawal With Addiction

Our medical illiteracy allows educated, well-intended people to confuse signs of withdrawal with addiction. This, in turn, leads to potentially misinformed policies.

According to a Live Science article on the subject, “More than one-third of American adults have only basic or below-basic literacy in health matters, which costs the United States upwards of $238 billion in healthcare expenditures, according to a government- and industry-funded study.”

Medical literacy requires understanding, and carefully using, healthcare words to communicate clearly and accurately.

If one-third of people prescribed an opioid actually became addicted to them, it would demand a serious reevaluation of the safety and appropriateness for any use of opioids regardless of how judiciously they were prescribed.

Addiction is commonly used as a pejorative word with a social, cultural, legal, and medical meaning. It is intended to be a diagnostic term, but nearly everyone without training in addiction, including many physicians, seems to have their own definition. Education doesn’t seem to alter the embedded prejudices about addiction that have been bred into our culture. The amalgam of individual addiction definitions is part of the illiteracy that shapes views and influences ill-informed public policy.

White House Drug Czar Michael P. Botticelli, MEd and Howard K. Koh, MD, MPH call for “Changing the Language of Addiction.” They underscore the need to use language that avoids biases and that does not perpetuate cultural stigmatizing of people with substance use disorders (SUDs). Improving our medical literacy about the opioid crisis is essential to developing medical and healthcare policies that are constructive and targeted toward the appropriate populations.

An Assessment of Attitudes

Most readers of the Washington Post-Kaiser Family Foundation survey will believe that it is a scientific assessment of the prevalence of addiction when prescribed an opioid for non cancer pain. It is not. Instead, it is an assessment of attitudes.

Unfortunately, most who read about this survey will not realize that. To them, the article will seem to support the common belief that continued use of painkillers leads to an opioid addiction problem one-third of the time.

This is a mischaracterization of the truth, and it’s a piece of the problem we have with medical literacy.

Michael P. Botticelli, MEd and Howard K. Koh, MD, MPH confirm in the JAMA article, “Words matter. In the scientific arena, the routine vocabulary of health care professionals and researchers’ frames illness and shapes medical judgments.”

Hopefully, people reading the Washington Post-Kaiser Family Foundation survey report will ask questions that will improve their knowledge and medical literacy about opioid addiction. To solve the opioid crisis and avoid harming the most hurting of our society, policies must be based on the best available knowledge and supported with clarity. Policies should not be created on the basis of medical illiteracy.

Photo by Marcus dePaula on Unsplash


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