Opioid addiction is a serious problem in the US, but we shouldn’t oversimplify by simply blaming doctors for over-prescribing. Some of us actually do need these drugs.
We’ve all heard the story. Doctors, clueless or unscrupulous, let Big Pharma talk them into prescribing addictive drugs for every little ache, unsuspecting patients get hooked, then overdose and death. Right?
Sometimes. In pill mills, yes. Scam doctors and pharma giants must be held responsible for the lies they told. But pill mills are fading; they’ve seen the writing on the wall and moved on to some other scam.
Now with opioid prescriptions at a 15-year low, is that really enough? Aren’t these drugs supposed to be for cancer and end of life? Aren’t there healthier choices for people on pain medication, like acupuncture and biofeedback and yoga and cannabis?
As with most questions, the answer is “it depends.” Top prescribers aren’t just pill mills. Top prescribers include legit, ethical doctors who specialize in palliative care for incurable disease and injury. Government pressure to bring numbers down, without full context, does nothing but harm patients with gruesome conditions you wouldn’t wish on your worst enemy.
I’m talking about rare disease: sarcoidosis, where organs calcify. Interstitial cystitis, with bladder ulcers that don’t heal. Sickle-cell disease. Ulcerative colitis, interstitial lung disease, epidermolysis bullosa, CRPS, scleroderma, end-stage rheumatoid arthritis, and plenty more.
I’m talking about permanent injury: botched epidurals causing adhesive arachnoiditis, wounded veterans with lasting pain worse than enemy torture.
While diet and physical therapy and cognitive therapy can help, and insurance absolutely should cover all kinds of therapies, no therapy can make these conditions non-disabling. My bladder is lined with open wounds; it’s unbearable to hold pee longer than a minute or two. No therapy will allow me to work and take care of my kid, without pain medication that blunts the need to pee every minute.
Consider why cancer hurts. Cells mutate and cause damage that fails to heal. Cancer is not the only disease that does this. Palliative care is not only for end of life.
Thanks to pain management, I’ve spent twenty years earning a doctorate and teaching college and raising my kid. After every other treatment failed to help (including an integrated multidisciplinary pain clinic), I had one last option: lifelong opioid medication, or life on a toilet. I’m pretty sure my husband, my kid, and all the students I’ve taught over the years would say I chose well.
Prescription abuse often starts with more pills than necessary for outpatient surgery. But falling prescription numbers, as shown by Dr. Stefan Kertesz of the UAB School of Medicine, don’t reflect reduced prescribing for acute post-surgical pain.* Falling numbers reflect doctors terrified of new regulation, abandoning their sickest patients.
Meanwhile the overdose crisis worsens, because very little of it was caused by legitimate prescriptions. The new epidemic is counterfeit drugs manufactured to resemble prescription drugs, counted as “prescription opioids” only because the government doesn’t track counterfeit pills separately.
Our policy goal shouldn’t be “fewer prescriptions at lower doses.” That’s way too simplistic. As Democrats, we pride ourselves on embracing complexity. We aspire to non-judgmental empathy. We should know better.
Our goal should not be global dose reduction, but patient-by-patient risk/benefit analysis. Our goal should be avoiding medication when alternatives work, knowing that sometimes they don’t. We should reserve lifelong medication for a last resort, while remembering some of us are already on our last resort. These goals may bring lower numbers, but numbers themselves are not the goal.
What about research saying NSAIDs work better? Those studies mostly involve knee pain, not genetic disease. People like me aren’t in those studies. I can’t volunteer to test the effectiveness of the only medication that ever allowed me to leave my bathroom. (Not to mention, NSAIDs kill unsuspecting patients too.)
What about escalating dosage? Some of us keep the same dose for life. Not all of us experience tolerance or hyperalgesia. Some of us just experience raising our kids, working and running errands and going on dates with our partners. Some of us, without this medication, would be permanently trapped in our homes.
Some of us, with doctors lowering doses to conform to CDC guidelines, are already trapped.
Don’t get me wrong, dependence on powerful medication is not harmless. People like me are treated with suspicion in the ER and the pharmacy. We submit to monthly drug tests. We’re not even allowed to keep extra meds in case of a hurricane.
Long-term pain medication is no walk in the park. But it’s sure as hell better than never being able to walk in a park again.
For people like me, pain medication is a disability accommodation allowing access to normal life. “Less medication is better” is an ableist assumption, like saying “walking is better” to a quadriplegic.
Fellow Democrats, let’s fight addiction with targeted action. Let’s close illegal mail-order pharmacies. Evangelize safe disposal for unneeded pills. Honor lives lost to the drug trade, by providing addiction treatment and therapy for everyone who needs it. Restrict how pharma companies can market controlled substances. Teach our children that medicine can also be poison.
But please, let’s be careful with words like “overprescribing.”
Pain patients are among the most vulnerable Americans. Our pre-existing conditions leave us totally disabled, without nuanced policy that takes us into account.
If you care about pre-existing conditions, please don’t forget about ours.