Does Anyone Understand the Opioid Problem, or Even Know One Important Solution?

Does Anyone Understand the Opioid Problem, or Even Know One Important Solution?

There’s a lot of attention going to opioid abuse, overdose and death in the media and government circles recently.  The question is, “does anyone really understand what the problem is, or even a tangible thing to address it?”

In its effort to quell the problem, the CDC has drafted guidelines for prescribing opioids for chronic pain that focuses on selection of the opioid, its dosage, its duration of use, follow-up and discontinuation of use. According to Dr. David Nagel, who wrote this in a recent article for National Pain Report, there is a problem with this simplistic view.

“There is no universal understanding of chronic pain. There is no universal solution to the problem; in fact, there is no solution. There is no universal definition of what chronic pain management actually is. A physician is judged how well his judgment follows the evidence base.  What happens if there is no reliable evidence base?  What happens if a problem is so complex that that it defies study? Who defines what the reliable evidence base actually is.”

The media, including a recent story by 60 Minutes, and the White House are lumping heroin use and abuse with pain management. According to a column in National Pain Report, author Kerry Smith writes, “They (the media, and the piece by 60 Minutes) focused on the over-prescription of narcotic pain meds as the reason behind the heroin epidemic.” While heroin and legal pain medicines share being labeled as opioids, their use and purpose are vastly different.

There is a strong disconnect between pain sufferers who rely on legal opioids to help manage pain and the media and government who are trying to rebound frightening statistics about abuse, overdose and death from opioids.  So, what should the public focus on?

Well, many say there needs to be a decoupling of drug abuse (either of heroin or illegally obtained opioids) and the legal and necessary use of opioids in pain management in the public discourse. But, that’s not happening, as the voice of the pain sufferer who needs opioids rarely gets heard. Government says it’s a prescribing problem.  Pain sufferers say it’s a drug abuse problem. The media says whatever sounds most salacious.

Even though the public discourse likely won’t decouple the good from the bad with respect to the topic of opioids, there is a campaign that recently started that makes sense for all.

It’s called “America Starts Talking,” which is an initiative created to call on anyone taking an opioid, as well as their loved ones, to learn more about safe use, potential side effects, and how to recognize and respond in an opioid emergency, such as accidental overdose.

One of the key messages from the campaign – something many people have no idea exists – is to have the antidote to opioid overdose – naloxone (Narcan®) – at the ready to rapidly intervene in the event of an opioid overdose.  Naloxone can be administered by a non-medical professional, as the drug only affects people who are using opioids. The drug puts people in immediate withdrawal of opioids, but does not otherwise in danger.

AmericaStartsTalking.com is the output of a partnership between Kaleo, a privately-held pharmaceutical company, American Academy of Pain Management, American Chronic Pain Association, The Pain Community and U.S. Pain Foundation.  Its goal is to empower patients and their loved ones to work together with healthcare professionals to have these potentially life-saving conversations pertaining to safe use of opioids before an accident may occur.

“Many people think an opioid emergency could never happen to them but the truth is it can happen to anyone where an opioid may be present,” said Dr. Anita Gupta, Vice Chairman and Associate Professor at Drexel University College of Medicine in the Department of Anesthesiology, Division of Pain Medicine and Regional Anesthesiology. “Recent survey data show that starting conversations on this topic is not always easy to do and therefore is sometimes avoided – on both sides. Now is the time to foster lines of communication, bring this issue out in the open and help people impacted by pain be prepared in the event of an opioid emergency.”

This message is for drug users / abusers as much as it is for those legally taking opioids.  In fact, research from StopOverdoseil.org shows that drug users / abusers are willing to give naloxone to one another.

So, while the media, government and public opinion sway in different directions, and some believe they do not represent the real problems or possible solutions, one thing is clear:  No one wants to have a loved one or friend overdose or die from opioids, and if everyone taking an opioid (legally or not) knew about naloxone, perhaps those very real and sad statistics from the CDC might start falling.

Editor’s Note: Doug Lynch is a former chronic pain patient who worked in the pain industry for ten years. He is a partner in the National Pain Report.

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Authored by: Doug Lynch

There are 12 comments for this article
  1. Heather Jacoby at 9:39 am

    Could it possibly be that part of the problem are the people who bloat the pain scale? The ones that when you ask them what their pain is, they say it’s an 11 out of 10?

    Yet, they’re sitting at their keyboard and typing.

    I live with a pain level of 2-4 most days. I live with it. People want their pain to be at zero. Don’t we all want that?

    Sorry, but if we’re going to have a united voice, I think we have to address how we look to providers. Maybe that’s why we’re lumped together with abusers.

    Granted, we feel like we have to shout to be heard, and that’s probably why folks think they need to say they’re 11 out of 10 on the pain scale, but is that really helping us?

  2. Heather Jacoby at 9:25 am

    This article seemingly went off on a tangent. It started out great, really fleshing out that there are multiple issues being lumped into one. When it mentioned the initiative, I was getting ready to grab a pen and paper. But “America Starts Talking” does NOT help the chronic pain patient be heard.

  3. Linda at 4:49 pm

    I don’t necessarily agree that everyone taking opioids will have an opioid crisis. I actually worry that this topic plays into the hands of the government agency responsible for lumping prescription meds in with heroin and fabricating the need for the new war on prescription drugs.
    I also worry the media will likely use it to say “told you so.”

    Chronic pain sufferers need a voice – we need and should be heard on the issue. But, isn’t there any other topic that can be used to organize chronic sufferers? Another way to give us a voice in the national discourse?

  4. Jeremy Goodwin, MS, MD at 1:54 pm

    Yes, I do feel that I can contribute meaningfully to a political agenda masked in poor science that is hurting patients with intractable but opioid tesponsive pain, the prescriber’s of such, and even those who have no pain but a significant chemical dependency problem that is subject to judgement and out of date ways to address it.

    The biggest problem is the involvement of politics via lawsuits and state medical board interference and the inability of most vocal clinicuans to apply appropriate critical thinking skills and / or understanding of the philosophy of science to this multifaceted problem.

    Those who can does with authority are not. It is selfish but understandable because of thr risk to their jobs and well being by inappropriate use of medical board pressure and poor journalism in all areas of the media.

    It is exhausting to read and to hear the near rubbish espoused by clinicians and journalists alike as it is the despair exhibited by those who have done very well for a long time with the only class of medication that has worked for them that has now been senselessly taken away.

    Insurance companies and public expectation play a large role too. But it is too complex to address in detail here.

  5. Kristi at 4:05 am

    I suffer from a genetic disease called Ehlers-Danlos Syndrome, which is very painful and affects almost ever body system. I am also in the middle of being tested for Hodgkins Lymphoma right now.
    I have lived half of my life with chronic pain. I am very thankful for the Pain Dr.’s that I have had in the past, which I saw 1 for 8 years until we started to have different view points, and I’m only on my 2nd Pain Dr. right now. I’m on a Butrans 20mcg patch that I have to change every 5 days instead of 7 and on Morphine 15mg twice daily.
    I live with a daily pain level of 4-6 and that’s tolerable to me. When it goes over that, then I have to turn to my Voltaren Gel, Lidoderm patches, pain compound cream and heating pad and if none of those work, then I will smoke some weed and I am not ashamed to say it because my pain is gone within minutes!
    Politicians still think there needs to be more scientific research on medicinal marijuana, but there has been plenty of research done.
    I do believe people with chronic pain should be on some type of narcotic and then medicinal marijuana combined to provide better pain relief! Medicinal marijuana alone would cost way too much for us poor people living off of Social Security!

  6. Nicole Jones at 3:36 am

    I have endometriosis and now arthritis. The arthritis cycles with my endo. I basically have head to toe pain monthly, sometimes bi-monthly, but it is chronic, debilitating and there is no cure. I just finished my last prescription for Tramadol. I have taken a total of 40 pills in 18 months. There are days that without it, I cannot make it to work because I am in too much pain. Yet because of all of the “crack downs” my doctor is hesitant to refill my prescription. Medical marijuana would be an acceptable alternative, except it is not legal in my state. Unless someone has lived with chronic pain, they cannot understand how life changing it is and therefore are not willing to listen or offer any relief. I am not an addict and not an abuser, but I am a sufferer.

  7. lynch at 7:58 am

    Nancy:
    I appreciate the levity you added to your comment, and how poignant it truly is.

    I am one of the few, very, very lucky ones who are be able to say “former chronic pain patient.” You see, I have a rare autoimmune disease called Relapsing Polychondritis, which attacks different organs and structures in my body in months-long battles of decimation, destruction and horrific pain. The disease ultimately rendered me completely deaf (i use a cochlear implant now), nearly blind and having to suffer painful autoimmune attacks on my trachea, back, ribs, nose, joints and other places. I am only able to say “former” because I found solutions that enable me to turn off / down my immune system before the excrutiating pain continues too long and before permanent damage is made.

    Having experienced real pain for decades, and having worked in the field of neuromodulation for many years, I saw what we all see — pain sufferers do not have a voice, and are therefore, poorly undersood by the public and government. And, that is why we started National Pain Report.

    I wish everyone was as fortunate as I have been. I’ll put it this way, I’d trade any human sense for the ability to have a way to manage pain, any day. Wait, I did. And, I wouldn’t want my hearing back in exchange for long-term chronic pain.

    Thanks for engaging, Nancy. Your voice matters.
    Doug

  8. Judith Bruno at 6:42 pm

    As an individual who has dealt with Chronic Pain for over 40 years, 2/3rds of my life, when I found myself sitting at home in front of the TV on 165 Mil of Slow Release Morphine every day plus two Percacet every 4 hours, not living the life I wanted, I learned the hard way what to do and not do to keep my narcotic intake as low as I can and to have a good quality of life while doings so.

    The problems, especially with the VA and their years of just throwing Narcotic Pain med’s to ever Veteran and now blames the Veteran for being on too much, abusing Narcotics is to take control over your medications and how much you take in a day. If you take Narcotic Med’s like Morphine and do so everyday as prescribed, your system will start screaming it needs more and more to handle the pain. I will never allow them to put me on a Slow Release drug again as then I have no control of the amounts I take in a day but instead with an Instant Release Morphine which I only take when I really need and not as prescribed, I don’t need to take it everyday, all day long. Of course there are those days when I have overdone things and need to take more but I continue to try my best to keep my intake as low as I can.

    Everyone is different and some people, I know, have a very low tolerance for pain while others like myself who have dealt with it for so long, have a much higher tolerance on how much pain we must and can live with. You can’t take enough Narcotic Medications to take the pain completely away without just being stoned on it and not having much of a good quality of life while doing so. It’s up to the individual to take control over the amount you take and it’s a fight each and every day to not give in and just take more.

    A doctor at the VA put me on a Fentanyl Patch for a few months and I will admit that during the time I was using that patch, I was in less pain but it was slowly shutting my system down, it’s 80 times stronger than Morphine so I took myself off of that medication as again, I had no control over the amount I took in a day. I dealt with more pain after doing so but wasn’t about to again sit in front of the TV just being stoned all day long.

    I keep my pain level around a 4 on the scale of 1-10. If my pain reaches that 6 level, then and only then do I take more Narcotic medication to deal with it. If you don’t need it right then, stretch out the time in between as long as you can and don’t take it just because you are told you can or again as I said, soon your body will be needing more and more Narcotics to deal with it.

    With the help of Medical Marijuana which I only use in the evenings when I have nothing else I must do that day, I can get by without taking that 4th Morphine for that day. That was the proof I showed to be allowed to use Medical Marijuana through the VA and still receive my Narcotic Med’s when I need it. If your one of the patients who is sitting around waiting for the time to pass when you can again take another pill, you need to try your best to stretch out that time instead of just taking it because it’s prescribed that you can do so.

    I know some of your readers and again, every one is different, will say they need more and more as the pain levels are getting worse after being on the same amounts every day but it’s truly up to you, personally to take control over your medications and not allow the Narcotics to control you. If you don’t and don’t accept the fact that in order to take enough to not be in any pain, you must watch the clock for when it’s time to take more, then the Narcotics are controlling you. All I know is that I will never again be on so much pain medications that I can’t function and have a best quality of life and do the things I want and need to do.

    Try exercise, stretching and any other ways to fight your pain than just taking more Narcotic medications. Of course if that is all you want is to be stoned all day long on anything you can get and this is not a judgement call as it’s your life but you are truly the ones in danger of overdose. The same with using Medical Marijuana. If you want to be a “Pot head”, want to be stoned all the time then they will never take you seriously and have no choice but to cut your medications to try to keep your intake down to a safe levels. Each patient must be able to show that 1, you need Narcotic pain medication and 2, that you will only use it when you really need to do so.

    We can all blame the laws, the ways our doctors are trying to cut the levels we take but it’s truly up to us as individuals to take control over our lives, our pain and how much narcoticc med’s we each need.

    It’s also not a contest to see who has more pain than another. When its your pain, it makes no difference that someone else is dealing with worse or less pain that you. It’s your pain and only yours and you must be the one again to take control over it and the amounts of anything you take for relief of that pain and your lives.

    Thanks

    Judie Bruno

  9. Unhinged at 4:09 pm

    It’s interesting to me, that people don’t remember that after the Vietnam war, there was a Heroin epidemic. This happened decades before Opioids were ever prescribed long term for chronic pain. (Most people, I assume, drank and drugged themselves to death, if their pain was uncontrolled & ignored by the medical community….much like it is NOW).

    I live in MA, North of Boston, and as a child I remember that Gloucester, MA (a beautiful seaside town filled with generations of fisherman), was considered the heroin capital of the “world”. It was brought in, undetected, on boats, for many years. What we didn’t do, however, was blame the hardworking fisherman who dedicated their lives (and often lost them at Sea), to provide fresh seafood every day for their communities and well beyond. A few bad apples were running a huge heroin distribution ring, right under the noses of government authorities.

    To blame legitimate patients who suffer from debilitating, diagnosed, health conditions for the “opioid epidemic” is like blaming all of the Gloucester, MA fishermen (& women) in the late 1960’s and the 1970’s for the Heroin epidemic that occurred then. Addiction is a disease. Addicts will abuse whatever they can get their hands on. Recovery is possible for them. Yes, it is a lifelong chronic disease. But abstinence, and recovery happen for millions and millions of addicts. They have the ability to move on, start over, and engage in life again… Successfully. Unfortunately, for people with intractable pain conditions with NO CURE, there is no recovery or remission. It is a lifetime sentence that can be managed safely with opioids, when all other treatment modalities have failed. They are not ideal, and certainly not for everyone. However, many people have used them safely for decades. This WAR on the disabled, sick, and incapacitated people who suffer from devastating pain conditions is inhumane, cruel, and unjust.

  10. Mark Ibsen MD at 3:43 pm

    The patients understand pain.
    The addicts understand addiction

    Let’s ask them!

  11. Kurt W.G. Matthies at 10:20 am

    To answer your question. .. does anyone understand the opioid problem … The answer is YES,

    but they are not being heard.

    Instead, we’re being fed a steady diet of a hypothesis that relies on coincidence, and being told, by experts — Americans love experts — that this hypothesis is science.

    Most high schoolers understand that hypothesis is not fact — or have we stopped teaching the scientific method in public education?

    This is why journals like NPR are so important — our experts present facts, not Orwellian slogans that support the bottom line.

    Ask Terry Lewis about epidemic. Ask Bob Twillman about opioid mortality data. Ask Forrest Tennant about opioid efficacy. Ask our readers about their opioids, how the support function, and why they’d throw them in the trash tomorrow if it weren’t for certain facts…

    People living with daily pain — stand up and be counted.

    @kwgmatthies

  12. Nancy Ribok at 10:07 am

    How did Doug become a former chronic pain patient? Sign me up! I think it is a good idea for opioid users for chronic pain to carry Naloxone. An accidental extra dose could happen and sometimes when you are in pain your brain isnt always working well.
    I have had a pharmacy telling me they can’t fill my prescription because they have met their “quota” of narcotics for the month. This is a pharmacy I have used for over 20 years. I had to pharmacy shop to fill my prescription. I felt humiliated, frustrated, exhausted and had to wait 3 days to fill my prescription. With all the stress I had from this incident made my pain escalate and I was so fatigued. What a terrible position for a chronic pain patient to be put in. I’m glad that some people are trying to get the message out that chronic pain sufferers are not addicts, we would gladly give up our meds for a cure!!!