In case you haven’t heard, there’s an opioid crisis in America. Just try googling terms like “opioid epidemic” or “opioid crisis” and you’ll be flooded with information about how bad things have gotten. I’m sure I don’t need to rehash all the gory details, but there are a few things to keep in mind. Obviously, it’s a complicated situation with many overlapping issues, but here are a few key points:
- Opioids are huge moneymakers for Big Pharma. Duh.
- Pharmaceutical companies sign high volume doctors to speaking contracts so they can be paid to make speeches at medical conferences. The payments appear legitimate but are often actually kickbacks for writing lots of prescriptions.
- Pill mills owned by doctors are commonplace in many parts of the country. Appointments are cash-only and you can walk out with a script in a few minutes. The same doctors often own the pharmacy down the street and fill their own prescriptions. So they’ve got you coming and going.
- Drug abusers prefer to use legal drugs that they have a prescription for. They don’t have to worry about going to jail if they’re using legally purchased pills.
- Finally, there are millions of average Americans with chronic pain who legally obtain and use opioids and don’t even realize they are addicts.
We are facing two different problems here: chronic pain and drug addiction. These are two separate problems, but the easy availability of opioid medications is the point of linkage. Patients suffering from severe pain are prescribed opioids, become dependent, and now their problem has doubled. The drugs only treat the symptoms, not the root cause of the pain. It’s a short-term solution that has turned in to a long-term crisis.
Each individual problem (addiction and pain) requires its own individual solution. To help treat addiction, as a society we must provide education and treatment for people who want to get off opiates. The success rate for this type of treatment is only 20-30% on the first intervention, so it must be ongoing and available to everyone.
The problem of chronic pain demands a different solution. The truth is, over the past fifty years, we’ve made little to no progress in treating pain, except for developing stronger and more addictive medications. Alternative therapies like acupuncture, hypnotherapy, massage, and meditation are helpful, but typically not covered by insurance.
These problems need an organized, non-punitive approach if we are to make any progress. Alternative treatments for people in pain and better education for prescribing physicians is necessary. Control and monitoring to identify abuse and overuse is essential. The development of better, more effective, and non-addictive meds is also important.
I worked in addiction treatment in the US and Europe for over a decade. The worst drug withdrawal symptoms I saw came from anti-depressant medications. It sometimes took more than a year for patients to get off benzodiazepines. The treatment involved managing withdrawal symptoms through exercise, nutrition, and therapy.
Obviously, long-term therapy like this is not possible in the US with our current system. No health insurance company would ever approve one-year of treatment. So we do the best we can in three or four weeks and send the patient home with an aftercare plan. It’s no wonder that people abuse prescription meds; it’s the only way to get some relief.
But the answer is obvious: manage the pain, not the pills. As you can see, opioids and antidepressants are very difficult to withdraw from. Both of these types of medication are necessary and effective treatments for chronic pain. Just make sure that you and your doctor think long and hard about your protocol before starting this method of treatment. Because you may find that the pills are the biggest problem, and not the pain.