The Accidental Victims of the War on Opioids

Even before the Washington Post profiled chronic-pain sufferers for whom the war on opioids is having unintended consequences, a student in my narrative medicine class drew on the experiences of his own mother to explain how the crackdown on the opioid abuse has failed to take into account the very people the drugs were intended to help. 

Every day that I have known my mother, Michelle, is a day that she has had to deal with excruciating pain. For years, she has suffered from Tarlov Cysts, also known as sacral nerve root cysts. These cysts are expansions of the nerve sheath, which ultimately causes a sac filled with cerebral spinal fluid to form. Because they are normally found lower on the vertebrae, they can eventually affect bladder and bowel control, and without proper medication, the unceasing pain they cause can eventually become incapacitating. Chronic pain is, by definition, frequently incessant, and leaves sufferers with very few treatment options, one of those being opioids. These few treatment options are what makes the pain bearable enough to go about daily activities. The public hears far more about the negative impact of opioids on our society than the life-changing relief they offer to those without other options. For such sufferers, the current attempt to curb opioid abuse by strictly monitoring and limiting the quantity at which they are prescribed has severe consequences for their quality of life.

America’s opioid crisis is far from the first one. The problem began as early as the 19th century, starting with a drug known as Diamorphine, the first synthetic opioid, marketed in Great Britain as a cough suppressant (Dhalla 568). Since then, the opioid market has expanded tremendously, releasing thousands of new opioids for availability. Because of this and the painkillers’ addictive nature, hundreds of people each year become addicted to opioids, and since 1999 the death rate from accidental overdose has risen over 100 percent and continues to increase. Of the estimated 64,000 deaths caused by drug overdoses in 2016, the National Institute of Drug Abuse estimates that nearly 20,000 were caused by prescription opioids. Because of these shocking statistics, the United States government has made opioids tougher for drug users to obtain.

Due to the severity of this drug, many believe that the prescription of opioids should be strictly monitored to ensure that it does not get into the wrong hands. While this may be an effective policy, it will potentially decrease the ability for many in need to obtain the medicine necessary for their illness. In many cases, doctors are starting to realize that prescribing opioids to patients exposes them to far greater risk than they are willing to take. Therefore, while it may not be illegal, many doctors have started to refuse giving prescription to patients who rely on them, out of fear of being scrutinized. In response to the strict guidelines on opioid prescription, doctors such as Forest Tennant, also known as the “Father of pain management,” face controversy. After more than fifty years of successful practice, Dr. Tennant’s office was raided by a team of DEA agents investigating the possibility of an opioid scandal. The agents confiscated patient reports and suspended Dr. Tennant from practicing, leaving his patients without treatment. Because of this incident, Dr. Tennant has been forced into retirement.  As more cases such as this arise, many patients are left without care, and unable to obtain the prescriptions necessary to treat their pain. Even without investigation, many practices are ceasing their opioid treatment out of fear of similar DEA scrutiny, and as the number of physicians willing to prescribe opioids decreases, chronically ill patients across the country continue to live in pain.

Many cancer treatment centers treat patients with drugs such as Fentanyl and Oxycodone, not only for their comfort, but because it allows patients to sleep more soundly, which aids in the healing and recovery process. But while the needs of patients dealing with severe or even terminal cancer are quite obvious, not everyone who could benefit from opioids can easily demonstrate their legitimate need. As Columbia Quigley explains, “Pain and cancer are not synonymous: at least two thirds of patients experience pain at some time during the course of their illness, and most will need opioid analgesics” (Quigley 825). In many cases, patients across the United States are denied opioid prescriptions from their physicians, not because they do not need the opioids for pain management, but because they are perceived as addicts, relying on opioids for the wrong reasons.

Physicians use the term “drug seeking” to stigmatize patients in a negative way, however, patients who are seeking opioids are usually doing so for pain relief rather than addiction. An opioid addiction, as defined by the American Pain Society, is “a pattern of compulsive drug use characterized by continued craving for an opioid and the need to use it for effects other than pain relief” (McCaffery 77). This definition holds true no matter the dose or duration of use. No wonder it can often be so difficult to differentiate patient from addict! Simply because a patient obtains opioids from multiple providers does not mean he or she is seeking to obtain more of the drug to satisfy their addiction. It could mean that their first provider did not prescribe the right medication and it is not doing an adequate job at cutting the pain. For many individuals, reliance on opioids is not a choice, but a requirement. As my mother explained to me, “Opioids afford me the simple tasks that most people take for granted; getting out of bed in the morning, walking to get the mail, or even cooking a meal.” In many instances, including Tarlov Cysts, opioids do not take the pain away entirely. It simply makes the pain less debilitating. Because of this, many patients ask for a refill before the prescribed time interval has passed, but in so doing, risk flagging themselves as addicts, rather than as people simply trying to keep agony at bay in order to function (McCaffery 78-79). This is the dilemma in which many chronic pain sufferers currently live.

The opioid crisis is real, but so is the need of those who rely on powerful pain medicine, not because they want to, but in order to do the most simple tasks, like getting out of bed, or the larger ones, like taking care of their children. The statistics of abuse and overdose are alarming, but it is important to not allow the harmful effects of opioids to completely overshadow the beneficial and life-changing qualities that they can provide to those, such as my mother, who suffer from chronic diseases.

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Footnotes

Dhalla, Irfan A, et al. “The Prescription Opioid Crisis.” BMJ: British Medical Journal, vol. 343,              no. 7823, 2011, pp. 569–571. JSTOR, <www.jstor.org/stable/23051386>

Jones, Michelle. Personal Interview, 14 Apr. 2018

McCaffery, Margo, and Chris Pasero. “Pain Control: Stigmatizing Patients as Addicts.” The American Journal of Nursing, vol. 101, no. 5, 2001, pp. 77–81. JSTOR, <www.jstor.org/stable/3522407>

“Overdose Death Rates.” NIDA. September 2017. National Institute of Drug Abuse. 30 May,<https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates.>

Quigley, Columba. “The Role of Opioids In Cancer Pain.” BMJ: British Medical Journal, vol. 331, no. 7520, 2005, pp. 825–829. JSTOR, <www.jstor.org/stable/25460791>

“Tarlov Cysts.” Genetic and Rare Diseases Information Center, U.S. Department of Health and Human Services.<rarediseases.info.nih.gov/diseases/9258/tarlov-cysts/cases/27316>