Of course, it makes so much sense to keep sinking billions into treating the folks who get addicted to opioid painkillers instead of outlawing their long-term prescription once and for all. Not.
These drugs will turn any pain into a chronic one because the brain will keep manufacturing a reason to keep getting the drug. There is no justification, none, to keep getting people hooked up on this shit to keep drug companies making blood money from the suffering of these poor addicts.
Clarissa's Blog 
I dont think we would want to completely outaw long-term prescribing of opiates because there really are patients who do need opiates for ongoing pain management — people who have terminal cancer certainly fit in this category.
Ironically, we have made it harder for them to get the relief they need while continuing to supply addicts. I don’t know what exactly we have done wrong but it is a big mess.
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Barbara is correct. I had a close adult family member who suffered for seven years with an unusual and eventually fatal lung disease. Without regular doses of morphine during her final two or three years she would feel as if she were drowning. With morphine she was able to live longer, in less pain, and see her children grow and marry.
Opioid addiction is a real and serious problem. But so is chronic pain, especially in the seriously and/or terminally ill. And our panic over the public health issues of addiction often makes it impossible for real patients to get the pain relief that they need including, when all else fails, heavy-duty narcotics. I’m sorry Clarissa, but a blanket ban of these drugs would be ill-considered and inhumane.
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Exceptional cases, of course. But when one gets a bottle of 30 (!) vicodin for a root canal, it’s very clear that this is being done with the goal of getting one hooked and providing a lifelong customer to a drug company. And once a person gets through those 30 pills, their brain will manufacture chronic pain to keep getting the fix.
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Let’s not throw out the baby with the bath water here. The vast percentage of people who receive pain meds do not, I repeat, do not, get addicted to them.
In fact, some people get catsick or do not like the floatiness feeling that a dosage in excess of pain relief gives them. The current regime leaves many people unable to get proper treatment because their doctor is afraid of the DEA or state-level authorities cracking down on “excessive prescribing”, which is whatever said authority chooses to label as such.
As to the efficacy of Prohibition, I refer you to the career of Capone, Alphonse, and Chicago in the 1920s.
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Have you considered the possibility that “proper treatment” for chronic pain might be something other than opioids? They clearly don’t treat the problem. They just trick the body into believing that the problem isn’t there by drowning out the body’s signal (=pain) that something is wrong. The only reason why people believe that pills are “proper treatment” for pain, depression, anxiety, etc – when it’s very clear that these pills do not even attempt to treat anything – is the massive advertisement and lobbying by pharmaceutical companies. They invent these myths about the indispensable nature of painkillers, sleeping pills, anti-anxiety meds, etc., and people buy into these ridiculous lies. Doctors in this country have stopped even trying to look for a way to treat a condition. All they do is stupidly dispense prescriptions. But that’s not how things should be or how they are anywhere where these drug companies haven’t brought their propaganda just yet.
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It’s funny how someone who couldn’t tell a GABA receptor from a hole in the ground knows how medicine should be practiced.
Are you suggesting opioids be banned for the relief of temporary acute pain after surgery or other painful medical procedures as well? Because that’s what your prohibition would entail.
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If you insist that “chronic” and “temporary” have the same meaning, then I don’t think a productive discussion is possible. I made it abundantly clear that I’m talking about chronic pain and nothing else.
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The FDA is partly responsible for the painkiller crisis. There’s an alternative tool — and electrode implant — approved for use in the EU and Commonwealth countries for treatment of long term head pain, which the FDA has dragged its feet on approving for the US. Personally, I think the FDA is more interested in protecting pharmaceutical profits than it is in protecting consumers.
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“Personally, I think the FDA is more interested in protecting pharmaceutical profits than it is in protecting consumers.”
I agree completely. The electrode implant you mention is one of many great alternatives to highly addictive and dangerous opioids. But alternatives aren’t getting explored because that would cut into the Pharma profits.
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I knew someone with bad back that used some kind of electric implant for pain. That was more than twenty years ago. (Eventually she became paralyzed, and took up drinking too much. I lost track of her but I do remember hearing she had died.)
Part of the problem with doctors prescribing pills rather than alternatives is that it is cheaper to do so, and health insurance companies more or less force people into the cheaper options.
My asthma medicine is somewhat of an example. The insurance company keeps changing what maintenance drug they will pay for. The last one did nothing for me and resulted in an asthma flare that required steroids to resolve. Now I am back on the stuff that works for me but also paying a lot more out of pocket than I would if I took the stuff the insurance company wants me to. Luckily, we can afford the surcharge.
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Anyway, pills are much cheaper than a psychologist or any other type of talk therapy so for garden variety depression or anxiety, that is what patients end up with.
But I wouldn’t necessarily include depression and anxiety in this discussion. People do not become addicted to Prozac in the way they do to opioids. And some types of mental illnesses absolutely do require medication in order for the person to function. Many times medication is the first step that allows talk therapy to work.
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The favorite argument of Putin’s supporters is that there is nobody better. And it’s true. Everybody is worse. Because those who are better are silenced, in jail, exiled, or dead. It’s the same with pills. They are all there is because every other option has been made unavailable. Of course, it’s more profitable to a doctor to throw out a bunch of scrips to a crowd of nameless patienys than to talk to everyone patient individually, suggesting breathing exercises, meditation, relaxation practices. By God, there are people who live for years on sleeping pills! I’d send every so-called doctor who keeps prescribing these shits to jail. A patient’s central physiological function is not working, and the greedy fucker isn’t even trying to repair it. This is inexcusable. Of course, patients are so steeped in consumerist ideology that they want a happy pill instead of learning a way to get better.
And by the way, only a quack will agree to work with a patient who is drunk or drugged. A therapist works with a patient’s personality, and a patient who’s high doesn’t have a personality to offer. He’s not in command. The drug is.
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There is a difference between the relief an anti-depressant or anti-anxiety medication provides and being “high.” There is no comparison.
For some people with certain levels or types of distress, these sorts of medications are absolutely life-saving. Some mental illness really is caused by chemical mis-balances: for one, no one can cure bi-polar disorder through analysis or meditation, though of course either could add to anyone’s quality of life.
This is a long way from the original discussion on the over prescribing of opioids.
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“for one, no one can cure bi-polar disorder through analysis or meditation,”
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It’s nice that you know someone who was able to [shake?] a bipolar diagnosis via analysis. The brain and it’s physical and psychological components are deeply complicated and not often fully understood. But…
As the scientists say, anecdotes are not data. And even if your friend was (a) correctly diagnosed with Bipolar—and was it Bipolar I or II? it can make a big difference to all involved—and (b) managed to become asymptomatic solely via analysis, there are many bipolar patients who are not so fortunate.
Unless you’ve spent years knowing someone fighting off the ravages of a chronic and serious case of Bipolar II, and watched the changes decent medications can make, you just don’t know what you’re talking about. You can’t have talk therapy with someone who is completely out of touch with reality and, sometime, a threat to the health of themselves or others.
Yes, lifetime use of lithium and other similar drugs can have serious and undesirable side effects. But when the alternative is side effects versus suicide or institutionalization, such drugs are a literal life-saver. I am not a shill for “big pharma,” but I have decades of experience with a close family member suffering from Bipolar II. I’ve read up on the pros and cons, and I have decades of experience with the subject. Bipolar disease is not a disease that—in most cases—can be cured by “wanting to” and talking to a therapist. The right meds are essential, and even then, relief of severe symptoms is not guaranteed.
Think about it: if you had HIV, you’d take antiretrovirals every day for the rest of your life, so that you could live that life. Some serious mental illnesses require similar, long-term, pharmacological assistance. Please don’t let personal anti-med dogma stand in the way of lifesaving medicines for those who need them. Thanks.
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@R.
Very well said — thank you for writing this, so I didn’t have to write a less eloquent rebuttal to the anti-medical nonsense that occasionally surfaces here.
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That so many pain-killer prescriptions are being issued suggests that many people have undiagnosed or misdiagnosed medical problems that are not being properly treated by the MD’s. The medical problems that are the cause of all of this pain should be properly addressed if the opiate addiction problem is to be resolved. For some reason, very few blog discussions of the opiate problem ever discuss the medical issues that are the root cause of the problem.
In any case, I’m not sure if there really is an opiate problem in the U.S. If there is, its certainly not an existential problem and, to be bluntly honest, I really don’t care about any social problem that is neither existential or does not affect me personally.
BTW, I had two root canals several years ago and was never given any pain medicine at all, nor did I need any.
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You’re main point may well be correct. Perhaps part of the solution would be to adjust our insurance billing and reimbursement processes to encourage doctors to slow down, listen to the patient more, and come up with better diagnoses and treatment plans. Current policies push doctors to rush through patient visits and are, I think, counter productive.
I’ve had root canals, too. And you’re right, one does not usually need much in the way of pain meds after a root canal. The procedure provides tremendous relief. The intense pain comes while waiting to get the procedure. In my town and dental/endodontic practices, it takes at least a week to get a root canal scheduled. So one is usually prescribed a nasty antibiotic plus a serious pain med, e.g. vicodin. Personally, I find the temporary pain relief essential until the dental work is done, and then I have no need or desire to keep taking the stuff. When you’re fighting off the pain of a nasty necrotic root/abscess, something like vicodin makes getting through the day as a functional human possible. And because the meds were treating real pain, I, for one, did not get some kind of happy narcotic buzz while using the stuff, and that made stopping the meds a non-issue for me.
(That’s my personal anecdote. Which is not actually data. Make of it what you will.)
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Arrggghh. Typos. Should read:
Your main point may well be correct.
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“When you’re fighting off the pain of a nasty necrotic root/abscess, something like vicodin makes getting through the day as a functional human possible.”
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There are actually people who carry a bottle of Tylenol or Advil with them everywhere they go, like Kleenex. For “just in case.” To me, this is both weird and scary. But there is a whole mentality fed by TV commercials around this. People think this is completely normal.
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I agree with Abelard Lindsey. Lazy doctors and lazy, consumerist patients choose the path of least resistance instead of finding the underlying problem and treating it.
And I also never fill the painkiller prescriptions after root canals. It would be a bloody shame not to know how to manage my pain at my age.
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People use whatever is available to them. Here it is more acceptable to take a pill or a recreational drug or alcohol or food to deaden pain or mask symptoms than it is to sit with it.
I fully admit to taking more allergy medication than I prefer simply because 1)I have to leave the house or do work and 2)the full manifestation of my allergy symptoms scares and alarms people. The same happens with severe colds when I get them.
In my experience, SSRIs’ primary effect is to deaden your emotions and nerve endings. This is described as evening out. I suspect the sexual and weight gain side effects are welcomed by more people than admitted.
Novocain always made my face feel weird. I suspect the novocain is as much for the dentist as the patients because I don’t think swearing, chair gripping or tears streaming down people’s faces would be tolerated. The whine of the drill on my teeth bothered me almost as much. My old dentist brought in a tv into his patient rooms which I suspect helped many people relax during cavity fillings. When I had my wisdom teeth removed, I was under but not so much that I couldn’t remind my dentist to get all of my wisdom teeth. I didn’t need medications afterwards.
I can’t speak to drugs for bipolar medication, chronic pain, childbirth or kidney stones, so YMMV. Clarissa may be an outlier when it comes to pain tolerance.
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