by Mark "RxProfessor" Pew
This article originally appeared in the Rx Professor Blog and is reprinted with permission.
I believe that identification of the opioid epidemic is complete. That includes legitimate opioids prescribed by a doctor, Rx opioids bought/stolen and used nonmedically, the continued surge in heroin, the uptick in fentanyl use (directly or cut into heroin, often exported from China), and any other overuse/misuse/abuse options possible.
We know about the problem. From the Centers for Disease Control and Prevention to the U.S. Surgeon General to the federal government to state governments like New York and California; from mainstream media to social media to individual stories; from medical schools to substance abuse treatment options. In my opinion, only a hermit at this point hasn’t heard about the opioid epidemic or knows someone who is dealing with it (maybe even themselves).
The first rule in holes is to stop digging. In that respect, many of the initiatives around the country, from the feds to states to counties to individual neighborhoods, is to proactively protect more people from being impacted. That’s being done by enacting limits on the overall supply of pills and what can be dispensed, better education for prescribers, broader use and inter-connectedness of PDMPs, proper disposal of unused dangerous drugs, workers’ compensation drug formularies and countless other initiatives. Stopping the first pill that is inappropriate for the patient’s condition is a necessary tool.
But what about all of those who have already become dependent upon or addicted to painkillers—not just opioids but drugs such as benzodiazepines, the uber-dangerous muscle relaxant Soma, anti-depressants? Those for whom the destructive cycle has already begun, whether by choice or by chance?
We have to help those whose use of legitimately prescribed painkillers is causing more harm than good to find a less dangerous treatment regimen. We have to help those in chronic pain or with debilitating conditions find a way to manage their condition in conjunction with tapering their drug cocktails. We have to help those whose starting point might have been prescribed painkillers but have moved onto even more dangerous street prescription and illegal drugs to overcome their addiction. We have to help family members and friends who feel helpless to become empowered to help. We have to help prescribers and pharmacists better know their options for pain management (acute, sub-acute, chronic) beyond “opioid Rx.” We have to help payers be willing to pay for detox, functional rehabilitation, cognitive behavioral therapy, physical therapy, “alternative” options like yoga and acupuncture and biofeedback—whatever evidence-based mix that works for that person.
Since the mid 1990s, we, and I mean everyone—Big Opioid Pharma, government, prescribers, pharmacists, patients, payers—created a mess. And, now, it’s time to #CleanUpTheMess.
I posted an article, “52 weeks, 52 faces,” on LinkedIn during the holidays that included an obituary for each week of 2016 that literally put a "face" to those who have died as part of the epidemic. It is a very sobering reminder that addiction is nondiscriminatory. Following is an excerpt from the prologue:
“Some of the writings are brutally honest. The victims were in and out of jail, often for stealing to support their habit. They could be destructive forces, tearing apart families. There were false hopes produced by periods of sobriety following treatment, only to be followed by relapse. The victims were found in the woods, in a low-budget hotel, a dorm room, and at home. On the same day in June, two brothers fatally overdosed. In November, a mother lost a third son to an opioid overdose. Those who succumbed to opioids were also full of hope and promise. They served their country in the armed forces. They were college students, aspiring musicians, athletes, chefs, a race car driver, a high school student, an auto mechanic, a bank employee, and the son of a former US congressman. They lived in every part of the country, from Arizona to Maine. They are predominantly in their 20s and 30s and white. (The obituaries referencing opioid use are striking for the absence of people of color. That may be in part due to the fact that 8 in 10 people fatally overdosing on opioids are non-Hispanic whites, according to government data.)”
In response to my post, someone wrote in one of the discussion groups “You might start by calling it correctly if u want to solve it The correct name is DRUG ADDICTION AND DRUG ADDICTS!!!”
I gathered from the all-caps used that this person felt strongly about it.
I did not post a response because, after thinking about it, that comment raises some very interesting points. And I thought an individual response would get lost on LinkedIn. So, I thought it best to respond here.
I have been an advocate my entire life of personal accountability. You are responsible for you. While others might have influenced you, good or bad, only you can fix you by deciding to fix you. Choices have consequences, but ultimately the choice was made by you and the consequences are yours to bear. Pain is part of the human condition, suffering is how pain is processed by the brain and addiction is a chronic disease.
Are there some “ADDICTS” who made bad choices? That repeatedly make the same mistake and are too stubborn or weak to overcome those bad choices? That don’t know right from wrong? That are manipulative and narcissistic and maybe even masochistic? Undoubtedly.
Are there some “ADDICTS” who were told by their doctor that this is how their pain should be treated? Whose family history was not filled with support? Who were predisposed to addictive behaviors that had not been triggered until that first pill? Who were prescribed the “gateway drug” of a Vicodin or OxyContin that progressed to even more dangerous drugs like heroin cut with carfentanil? Who would do anything to kick their addictive habits but haven’t found their way yet? That just need the proper motivation, and support, to fix themselves? Absolutely.
I used “ADDICTS” to be consistent with the same inflammatory vernacular used by the person that commented. However, that might not the most accurate word to describe many of the individuals overusing opioids.
If you read “52 weeks, 52 faces,” it’s obvious from the stories behind the obituaries that seemingly anyone can become an “ADDICT.” Our responsibility is not to judge someone who is dependent or addicted. Our responsibility is to #CleanUpTheMess.
And that’s now the challenge for our society, for workers’ compensation and the disability mindset. What does that look like? What will it take? How will it be done?