There is a steady and continuing drum beat in the press and from researchers and commentators warning of the dangers connected to prescribing and using opioid pain medicine. In this mix are the usual research reports proclaiming the same debatable results.
There are two converging lines of research inquiry:
1) That prescription opioids are the gateway drugs to dangerous street drugs, most especially heroin.
2) That high doses of opioids are dangerous to pain patients, and the long term use of them doesn’t help reduce pain and exposes the patient to likely addiction.
The second line of inquiry conflates dependency with addiction. This confusion continues the canard that opioid medicines are extremely addictive and thus dangerous.
I interviewed Janice Reynolds, a member of the steering committee for The Pain Community (I was briefly, and will become again, a member of this committee), who is a retired pain care nurse.
I asked Ms. Reynolds why certain members of the medical profession and some researchers believe that legitimate prescribing and consumption of opioids are linked to addiction and the use of street drugs like heroin.
“Twenty years ago OxyContin was known as ‘hillbilly heroin’ because it was so much cheaper for addicts to use than heroin. Addicts will always look for the cheapest drug,” she told me.
Ms. Reynolds believes the notion that OxyContin leads to street drugs rests on a bias that many commentators and researchers have against prescription opioids. She believes drug abuse doesn’t start with prescription opioids, but has antecedents in other substances, such as cigarettes, alcohol, or other commonly available substances.
If most heroin addicts have a history of addiction to cigarettes prior to their addiction to heroin, are we at liberty to conclude that cigarette smoking leads to use of hard street drugs?
It’s as if the researchers are sitting at a railway crossing watching a very long cargo train go by, boxcar after boxcar. When they see the boxcar named OPIOIDS, they begin their research or commentary, ignoring all the other boxcars that preceded the opioid car. This distorts the picture of opioids and addiction.
Ms. Reynolds echoes a common complaint: Most of the criticism of legitimate prescribing and use of opioids comes not from physicians specializing in pain, but from addiction specialists.
The “sexiness” of opioids, addiction and death may have roots in what Ms. Reynolds sees as largely a media creation. As pain patients finally began to obtain better treatment through opioid therapy, the media began to run story after story about the rise in opioid prescribing and the increase in the numbers of people addicted to opioids, especially the now widely used medicine, the bugbear OxyContin.
“This was great advertising to drug addicts, who were until then buying more expensive street drugs,” Ms. Reynolds stated.
Sure enough, we saw addicts move from more expensive heroin to cheaper OxyContin.
However, more recently, cheap heroin has flooded illegal drug markets. And consequently, those engaged in the war on pain patients claim that opioid prescribing is leading to more heroin use.
This is specious. Any consumer will opt for the cheaper product in the marketplace, and that cheaper product is now heroin. We are witnessing the reverse of what happened twenty years ago, when addicts switched from more expensive heroin to cheaper OxyContin.
One of the mistakes researchers and commentators repeatedly make is viewing the rise in opioid prescriptions as causative, or at least correlated, with opioid addiction and accidental death rates.
This is a fundamental mistake that researchers are routinely warned against. Just because A and B happen simultaneously doesn’t mean that A causes B, or that B causes A. There are always intervening variables that need be accounted for.
Ms. Reynolds also spoke of her experience that deaths were frequently blamed on the presence of opioids in the system of the deceased, even though the person died of a disease. This clearly belies a prejudice with grave consequences for pain patients.
This practice obscures the real cause of death while pilloring opioid medicines. It is like saying that the cause of death of a body found in the desert was a rattlesnake bite, when the deceased had a large bullet hole in the head.
Ms. Reynolds also referred to the painfully obvious fact that physicians as well as the public at large do not believe in something they can’t see or quantify: namely pain. When she complained of pain after brain surgery, her surgeon dismissed her — saying she shouldn’t be in pain at that point.
Her surgeon was basing his opinion on “experience” without taking into account Ms. Reynold’s lived experience.
These prejudices have real, debilitating consequences. Across the country, and especially in Florida, people with pain have to continuously shop for physicians who will treat them and pharmacies willing to fill their prescriptions. Untold numbers of people with pain suffer stupidly due to lack of education for health care providers, biased science and commentary, and misguided government crackdowns that make viable pain treatment for millions of us a living nightmare.
Ms. Reynolds believes, as I do, that it is imperative for those of us living with pain to tell our stories publicly to offset the ignorance, arrogance and prejudice that seems to rule the market place.
To this end, I invite all of my readers who have met with this kind of prejudice to contact me here at the National Pain Report so that I may bring to the public the real stories of people like you and me who live with the twin scourges of pain and prejudice. Telling our stories is the most effective means to bring about change.
You can send your stories to firstname.lastname@example.org.
Mark Maginn lives in Chicago where he is a poet, writer and social justice activist. Mark suffers from chronic pain and was a longtime volunteer with the American Pain Foundation. His blog “Left Eye Blind” can be found here.
The information in this column is not intended to be considered as professional medical advice, diagnosis or treatment. Only your doctor can do that! It is for informational purposes only and represents the author’s personal experiences and opinions alone. It does not inherently or expressly reflect the views, opinions and/or positions of National Pain Report or Microcast Media.