Thursday, November 3, 2011

End the War on Patients

"If I take this addictive substance, it will turn me into an addict!" This is a myth I hear all the time from friends, from family, from the TV, and from well-meaning but uninformed health professionals. Despite all they hype and propaganda, both the FDA and the National Institute of Health state that: "Studies have shown that properly managed medical use of opioid analgesic compounds (taken exactly as prescribed) is safe, can manage pain effectively, and rarely causes addiction." (A Guide to Safe Use of Pain Medications, FDA) But for some reason we're all being taught that if you take a nice, church-going housewife and give her oxycontin, she'll turn into a back-alley dealing junkie with a spike in her arm. But this simply isn't true.

An estimated 12.8 million Americans, about 6 percent of the household population aged twelve and older, use illegal drugs on a current basis (within the past thirty days). This number of "past-month" drug users has declined by almost 50 percent from the 1979 high of twenty-five million -- a decrease that represents an extraordinary change in behavior. Despite the dramatic drop, more than a third of all Americans twelve and older have tried an illicit drug. Ninety percent of those who have used illegal drugs used marijuana or hashish. Approximately a third used cocaine or took a prescription type drug for nonmedical reasons. About a fifth used LSD. Fortunately, nearly sixty million Americans who used illicit drugs during youth, as adults reject these substances.
(Substance Abuse and Mental Health Services Administration, Preliminary Estimates from the 1995 National Household Survey on Drug Abuse (Rockville, Md.: U.S. Department of Health and Human Services, 1996), emphasis mine).

In the year 2000, drug abuse cost American society an estimated $160 billion. ...Health care costs for drug abuse alone were about $15 billion.
(US Drug Enforcement Agency)

Now compare this to the epidemic of chronic pain in this country.

Serious, chronic pain affects at least 116 million Americans each year, many of whom are inadequately treated by the health-care system, according to a new report by the Institute of Medicine (IOM). The report offers a blueprint for addressing what it calls a "public health crisis" of pain.

The reasons for long-lasting pain are many, from cancer and multiple sclerosis to back pain and arthritis, and the chronic suffering costs the country $560 to $635 billion each year in medical bills, lost productivity and missed work." (Report: Chronic, Undertreated Pain Affects 116 Million Americans, Maia Szalavitz, June 29, 2011)

Right now, we are punishing the many for the actions of a few. There are 116 million people undermedicated for pain because of our war on drugs, to try and fix the behavior of 12.8 million people, half of whom outgrow drug abuse. So really, we're punishing 116 million---who have done nothing wrong except be the victim of misfortune---to try and curb 6.4 million addicts.

We're spending $160 billion on the war on drugs, but in the meantime we're losing four times that amount for not treating our chronic pain patients. Those skyrocketing Medicare costs? New non-narcotic medications can cost as much as $30 for one pill, they don't always work, and they come with a host of side effects. Narcotics, which have been manufactured for decades, are more tolerated by the human body, are more understood by science, and can cost as little as $4 for a month supply.

It makes sense to make these people productive with quality of life. Sure, we don't want folks to settle for just managing the symptoms, but that's true with any disease. But we don't leave the patient there to bleed to death while we try to figure out how to treat the wound. Why then do we have pain patients suffer while they search for a more suitable solution to their pain? When we deny patients adequate pain control, the pain can become its own disease.

Among the important findings in the Institute of Medicine report is that chronic pain often outlasts the original illness or injury, causing changes in the nervous system that worsen over time. Doctors often cannot find an underlying cause because there isn’t one. Chronic pain becomes its own disease.

“When pain becomes chronic, when it becomes persistent even after the tissue and injury have healed, then people are suffering from chronic pain,” Dr. Mackey said. “We’re finding that there are significant changes in the central nervous system and spinal cord that cause pain to become amplified and persistent even after the injury has gone away.”

The institute emphasized the importance of prevention and early treatment, a novel concept for many doctors who try to diagnose the source of pain before treating it or advise patients to wait it out in the hope it will go away on its own.

“Having pain that is not treated is like having diabetes that’s not treated,” said Ms. Thernstrom, who suffers from spinal stenosis and a form of arthritis in the neck. “It gets worse over time.”
(Giving Chronic Pain a Medical Platform of Its Own, Tara Parker-Pope, July 18, 2011)

Our current policy on narcotics is literally crippling people. Not letting people have adequate pain control is destroying bodies and lives at a rate of 18 times worse than addiction. We didn't ask for this pain. We did nothing wrong to deserve this kind of treatment. We are the uncounted casualties in this "war" on drugs.

I'm just a simple blogger. But I think we can realize, as a society, that we are sophisticated enough to treat our patients with mercy and curb the consequences of addiction at the same time, without sledgehammer tactics. Right now, the wisdom of the FDA is being trampled by the DEA. Doctors and patients are stuck in the middle, suffering. This needs to change.


  1. I agree with you 100%. And unfortunately instead of making progress over my 13 years with ra and pain treatment, I believe we took one step forward and now three back. Yes, things need to change. The question is how? Great post!

  2. The only way I see is by changing our attitude towards. Making it more like an illness to be treated instead of a criminal behavior to be punished. England did this with their heroin program. The drug was decriminalized and you could register as an addict to get your fix. Then addicts wouldn't need to fake being sick to score drugs, and the people who really *are* sick can get the attention they deserve. Rates of new addicts dropped overall, especially among teens. It's counter-intuitive, but seeing those junkies cue up and then puke their guts out afterwards took all the glamorous rebellion out of it. When we stop hiding it in the shadows, people can see it's not a choice they want to make for themselves. When we stop locking people up, then they can be honest about what they're doing.

    I don't see that happening any time soon, unfortunately.

  3. I checked all the reaction boxes because I love this post.

  4. My sister sent me a link to your site. I was born with Spina Bifida and for the past 18 months I asked my nurse to take me off Vicodin and put me on something less addicting.

    It has sucked pain wise. My spinal cord is damaged in 3 places and it is stretched a foot too long (tethered). Pain is a constant throughout my body. When I was on Vicodin I was having a much easier time at work. I was more productive and happier. The only thing Tramadol has done for me is barely take some of the burning in my legs away.

    I also take a lot of Neurontin, which does it's job well. But I have wrestled with the whole Vicodin my whole life.

    Thank you for writing this informational post.

    I have had it with people making all these drugs seem evil. I am scared that in a few years, the holy rollers and bored folks are going to take this option away from us.

    I am listed as chronic moderate to severe pain on my good days. Please help stop this hillbilly heroine hysteria that is running rampant in the media.

  5. I am so sorry for your pain! I can only imagine what you're going through. :(

    People think that because we're sick we *get* access to this stuff. What they don't understand is that people like you with visible damage aren't getting access because the DEA is so out of control. Doctors are scared to write prescriptions. They don't want to lose their job or worse! They're supposed to be our advocates, but because of the scrutiny, they can't risk it! It's insane.

    And we shouldn't be suspected of criminal activity just because we're ill.

  6. Amazing post. As a RN and a chronic pain patient living with endometriosis, I have seen firsthand from both sides the way patients in pain are being treated by physicians, pharmacists, and society. We need to do better...

    1. Thank you so much for your comment! Yes, we do need to do better, and we need to educate medical staff about the realities of addiction rather than the myths that surround opioids. Just taking a pill won't turn someone into an addict, yet everyone acts like it's that simple, including doctors who should know better, but few of them even study pain, let alone addiction. Education must trump propaganda!