It was a normally, scheduled visit to the pain management clinic this week to refill on my opioid medication. The opioid medication that I’ve been taking for roughly four years, without incident or issues. My visits alternate between seeing Doctor and Nurse Practitioner and I saw the NP that day. A normal visit in all respects as there was nothing new to talk about. My pain is being “managed”, not successfully, but in a way I can tolerate right now and because I will not consider any more surgeries, we’re at an impasse. Just as I thought we were good on the refill; she uttered the word I’d actually been waiting to hear for a long time: Narcan®. For those of you who may be reading this who are family of pain patients, and may not know, let me explain.
Narcan® (naloxone HCl) Nasal Spray: is the first and only FDA-approved nasal form of naloxone for the emergency treatment of a known or suspected opioid overdose. It counteracts the life-threatening effects of an opioid overdose; since most accidental overdoses occur in a home setting, it was developed for first responders, as well as family, friends, and caregivers—with no medical training required. (Because this is a brand, I will just refer to it as naloxone.) Narcan
Signs of opioid emergency are:
- Unusual sleepiness
- Breathing will be slow or absent
- Slow heartbeat or low blood pressure
- Skin feels cold or clammy
- Pupils are tiny
- Nails and lips are blue
When she uttered that word to me, so very casually and with a smile, I shut down and I cut her off. I was angry that suddenly patients are being treated like junkies and that we’re being told that along with our prescriptions, that we need to pick up naloxone in the event we OD. The truth of the matter is, the first thing I did was Tweet my frustrations about it, and what I had heard her say was that she was going to send the Rx to my Walgreens. I was worried about the cost, having heard some of my followers paying upwards of $100 for it in the past and then when my pharmacy app was not working, I took matters into my own hands and began to Google it, come to find out naloxone is now available over-the-counter in at least 48 states. I actually had a moment where I’d felt like I’d been living in a closet or something. Where had I been that naloxone was suddenly available in 48 states at your local pharmacy over-the-counter? Oh yeah, I was just going about my life, taking my pain meds according to doctor’s orders.
The ease of accessibility with which you can now obtain naloxone makes it a perfect weapon of skirmish warfare, but in the end, does nothing to win this war against illicit opiates in our country. Naloxone will save some lives, but for how long? Saving a person after an initial overdose is great, but if they can’t get into rehab afterwards then what? Contrary to what people might think you can’t just walk up to a rehab facility and knock on the door and see if they have a room available like a motel. It doesn’t work like that. Not to mention, that you have to want the help and you have to want to be clean in order for all this to work. Naloxone does not cure you of the drug addiction, only the symptoms of the drug overdose. You have to do the work needed if you want to be rid of a drug addiction problem, and you are never cured. But naloxone sure does make it look like the government is doing something, right? Saving drug addicts, saving your kids from potential drug overdoses, even saving pain patients from potential drug overdoses. What naloxone doesn’t do, and what we have never done is tried to understand the root cause of drug addiction and stop it before it even starts. It’s just easier dumping money into a drug that stops you from OD’ing. It’s easier to criminalize everyone. Meaning: making little to no difference between chronic pain patients to people on the streets looking for drugs, re-framing the chronic illness story so that it is no longer about real pain, but about drug seeking behavior, and lastly, taking away any sympathy there might have been for the chronic pain patient and shifting it to anger and loathing.
When you make it so that these people have a choice to be a victim or victor in their chronic pain, and they choose to be a victim, people no longer have sympathy and people no longer want to help. People want to punish them and inflict hurt upon them for perceived wrongs.
We are entering very dangerous waters when we tread here, and chronic pain patients are being surrounded by sharks.
This isn’t just about buying naloxone. That may be the first stop, but this is about the future of pain medicine and about the future of millions of pain patients out there who may find that the next stop is having their pain medication ripped from them. They may be left in intolerable pain, forced into withdrawals from a medication that was working fine for them for years. Not only that but they may suffer the indignation of being called an addict, forced into a program, forced to admit that their years with pain was some kind of fabrication or some kind of result of weak will. They may be shunned by family, they may be rejected by a spouse, their lives may be broken and they will live the rest of their lives in pain.
I’m scared and you should be too.