Ignorance, mis-information, dis-information and sensationalism are the gas fuelling the fire of mass drug hysteria spreading across the globe. Hardest hit are those needing the life-saving opioid class of drugs to manage severe pain; drugs such as codeine, morphine, fentanyl, oxycodone/oxycontin, and methadone (which is not just used for drug detox but pain management too). Many, many legitimate pain sufferers experience these drugs to be by far the most effective and safest painkillers with the least amount of side effects. Yet opioids are being demonized and cruelly denied to tens of thousands of people suffering from under-treated pain.
People die from pain all the time, but you won’t see it on their death certificates. Isn’t this one of the worst ways to die, while suffering? There is a significant population of disabled people suffering from chronic pain (i.e. lasting longer than 6 months and unfortunately, sometimes forever and progressive), and their numbers are growing. These voices are isolated and very restricted from advocating for themselves because they are suffering like sick dogs wherein it takes all their energy to just get through each hour of each day with little to no energy/ability to surf the web or make phone calls, let alone walk or drive around. Some of these people end up killing themselves not because they want to die, but because their physical pain is too much to endure and without adequate doses of painkillers, death is their only way out.
Any attempts to address the health crisis of under-prescribed pain patients is silenced and ignored by turning the spotlight on drug abuse. But before you look towards that noisy, blinding light and leave under-prescribed pain patients in the dust, please ask yourself why a population who chooses to abuse drugs is more important than a population who needs the same drugs to manage serious pain. This is the message to chronic pain sufferers because they are treated this way, and it’s only getting worse.
There is intense controversy around opioids because of drug addiction. TV shows like Intervention use scare tactics to make the public believe that opioid pain medicine is extremely dangerous (only if abused!), instantly addictive and life-ruining. These TV shows neglect to balance their hysteria and ignorance with the fact that these very same drugs also SAVE LIVES and PREVENT HUMAN SUFFERING when taken responsibly and as prescribed. The problem is that people who mis-use/abuse the drugs are getting all the spotlight, which leaves pain patients choking in their dust and keeled over in pain, their voices going unheard and dismissed by doctors as being drug-addicted or “drug-seeking” because the public only hears the fear-mongering drug addiction stories.
Pain management doctors are in a real bind too. On the one hand their job is to “Do No Harm”, which for incurable illnesses that comes with severe pain, is simply managing patients’ physical pain – pain levels that are hellacious to deal with. On the other hand, doctors are scared to prescribe adequate opioid doses due to the mis-use and abuse of these drugs. A critical question here that must be asked is, Why should the prescribing of painkillers be based on the behavior of drug abusers? It’s a paternalistic, disrespectful and unjust way to treat people. Doctors should not be held accountable if their patients decide to swallow a whole bottle of pills instead of take the amount prescribed. Pain doctors are not and should not be policing people! But this is what we have. The landscape is especially troublesome in the United States where organization like the DEA go on witch hunts arresting and convicting doctors for people’s mis-use of pain meds. Is this not the height of absurdity?
A major problem around this issue is the confusion and conflation between drug addiction and drug tolerance. “Tolerance” is simply a side effect of opioids wherein your body gets used to the medicine(s) and requires higher doses for the same effect. This works the same for everyone – pain patients enduring horrific pain need gradual increases of their drug dosages to get the same pain relief, and drug addicts also need higher and higher doses to get the same “high”. That said, pain patients respond differently to opioids in that they get pain relief and are then able to go about their business and LIVING LIFE versus getting “high” and *escaping* life, which is what addicts tend to do. So here we have two totally different groups of people bound together by this one class of drugs, and the most vulnerable, marginalized, and suffering group who NEEDS this life-saving pain medicine is being grossly under-prescribed, ignored and made to suffer. One article explains the situation of dosing and tolerance as such:
[T]he dividing line [of dosing] is far from clear and not subject to universal agreement even within the profession. Any patient in need of relief can, over time, develop a chemical dependence on a lawful drug–much like a diabetic becomes dependent on insulin. And, once a treatment regimen begins, many patients’ tolerance to the drug increases. Thus, to produce the same analgesic effect, doctors sometimes need to increase the prescribed amount, and that amount varies from person to person.
Enter Oregon-based Lawyer Laura Cooper, whom in 2008 launched a first-of-its-kind lawsuit:
Laura Cooper, an attorney representing the Pain Relief Network, has initiated a class action lawsuit on behalf of harmed chronic pain patients in federal court in Spokane, naming the Washington Department of Health along with other public health entities and officials (including a group of agency directors), holding them responsible for this medical crisis. If successful, the Pain Relief Network lawsuit would compensate those chronic pain patients for the substantial, categorical harm foisted on them by public health officials and should result in a change in public health policy that would require such officials to take the needs of such patients into account when making policy. [source]
In the lawsuit, Cooper explains opiophobia:
“Opiophobia” is an irrational discriminatory phenomenon that has long been recognized as an impediment to effective pain treatment. It is described in…a textbook of pain medicine issued from the University of Wisconsin [as follows]:
“Opiophobia is the syndrome of failure to administer adequate opioid analgesics because of the fear of producing addiction or toxicity. The etiology of opiophobia is multifactorial: Peer pressure (provider and patient), regulatory agency pressure (real or perceived), and lack of education on opioids and the fundamentals of pain management all contribute to its persistence. Lower socioeconomic groups, younger patients, and other minority populations are particularly likely to be its targets; these patients frequently receive lower doses of opioids but higher levels of scrutiny. All of these factors contribute to the underuse of these relatively simple and very effective medications, due to no fault of the patients.”
Laura Cooper is no stranger to chronic pain; she has multiple sclerosis and intradural extramedullary spinal cysts which significantly disable her and cause her pain, weakness and numbness. Clearly her firsthand experience of chronic pain informs her fierce advocacy work, and I hope she is able to incite the desperately needed changes in opioid pain management. Her work inspires me to seek the same kind of changes here in Canada since no kind of legal action of this nature exists to my knowledge, and this issue strikes my home too as my wife is part of this under-prescribed, pain-suffering population. I’m no lawyer though, so that is one barrier I need to figure out how to maneuver (I’ve reached out to different lawyers but have heard nothing back). Not giving up, but needing to figure out how to navigate this monstrous nightmare with so many political barriers.
On behalf of those of us frustratingly and helplessly watching our loved ones needlessly suffer, thank you Laura Cooper for doing what you do.
AN IMPORTANT NOTE:
People with terminal illnesses aren’t the only ones who deserve compassionate pain relief. Just because this population has an “expiry date” doesn’t make them any more important than those with no death date but instead are living day after day trapped in a pain-riddled boy. This is no way to live. Above all, listen to the pain patients when they tell you what they need and want. THEY are the experts of their bodies and what works and doesn’t work for their pain.
ON PSYCHOLOGICAL DISTRESS & EFFECTIVE OPIATE-USE:
Anti-depressants (SSRI’s) and anti-psychotics are prescribed like tic tacs to treat depression and other psycho-social-spiritual distress. They rarely work and do more harm than good, often causing suicidality, violence and mania (source). Opiates can be a very safe and effective treatment for people suffering from serious mental distress, though there are very few studies on this because it is all political and drug companies who make up a large part of the funding of clinical trials do not manufacture and market opiates, hence no studies or support for their use. Here is a 1999 study showing the effectiveness of opiates for depression. I have come across only one other study done in 2010 showing the same positive results, but can’t seem to find it now; will update if I do.