Opioids: Friend, Foe or… Neither?

Crack-down on kitchen knives!

New law limits number of kitchen knives per household: Measures protect Americans, save lives!

Need a new knife? Show ID!

Hardware stores reduce number of kitchen knives to 15 per month, refuse to sell all in stock to any one individual. “What would happen to others who needed a knife to prepare dinner?” says Carl 

Andrews, owner of Carl’s Hardware in upstate New York.

No, these aren’t headlines and quotes from actual newspapers — I made them up. They sound quite ridiculous, don’t they? But if you substitute the word opioids instead of knife, all of a sudden, they are very familiar.

So what’s the point of my knife exercise? I’ll get there in a minute.

The original goal of the War on Drugs was to deal with illegal drugs. We could have a fun debate over several beers about how successful it’s been — or rather, unsuccessful — but let’s save that for another time. At some point, the Powers That Be decided to include opioids in the list of dangerous drugs that should be battled. Soon after that, the lines between illegal and legitimate use of opioids became blurred. These days, anyone who uses these drugs to deal with high levels of chronic pain is looked upon with suspicion (by doctors, pharmacists, lawmakers) or deep concern (from family and friends).

The way our society deals with opioids has become so mired in rhetoric and fear mongering that it’s almost impossible for sanity to prevail. We have to show ID to get a narcotics prescription filled and when you can find a doctor to prescribe these medications — which can be far from easy — we are required to sign treatment agreements and do random drug tests. The latest bit of brilliance is Dan Malito’s experience with a new law in New York State under which pharmacies are only allowed to order a certain amount of narcotics per month. Since his prescription would require the entire monthly stock, they refused to fill it!

But everyone knows opioids are incredibly addictive. Aren’t they?

Not so fast. When prescribed and taken correctly, the rate of addiction is actually one quarter of one percent! If you include people who have previously been addicted – the highest risk factor for addiction to painkillers — that number rises to three percent. Three percent! There is a significant disconnect between the facts and what “everyone knows” about opioids, as well as between government initiatives curtailing use of opioid medications, even in people who need them to function.

The key words are when prescribed and taken correctly. Who is responsible for this? Of course the person who needs the drugs must use narcotics responsibly, just as every other medication should be used responsibly as prescribed. But we’re not the experts. If doctors do not pay more attention to prescribing these medications correctly, they are neglecting their responsibility to provide quality care and making it more likely that their patients misuse narcotics. How many doctors really take the time to find out what’s going on in their patients’ lives, to fully educate them about how to take medication properly? Do doctors receive training in medical school or as continuing education in how to teach their patients on how to use opioids? Perhaps if the government used as many resources to provide high quality education about the correct use of narcotics as they do to curtail use of these drugs, addiction rates wouldn’t be as high.

Which brings me to back to the knives.

Knives are a tool used every day in a variety of ways by millions of people. They are also potentially dangerous. Home accidents involving knives requiring a visit to the ER was an astonishing 330,000 in 2011. That means 0.1% of the population has had an accident in the home involving a knife so serious that they needed urgent medical attention. Shocking, isn’t it? Add to that the numerous incidents that didn’t send someone to the ER, plus the times knives were used in a crime and the number gets much higher. Yet the government does not curtail the use of kitchen knives. Why? Because knives are commonplace tools that are necessary for us to function.

Just as opioids are a tool that allows people with high levels of chronic pain to function.

Tools are neutral, not inherently safe or dangerous. Knives can help you cook dinner, but if you don’t use it safely, you can lose a finger. So you learn to use it safely and if you don’t, you see a doctor. No one judges you if you lost part of a finger while cutting up a pork loin.

One hundred million people in the US live with chronic pain. That`s one third of the population. It is reasonable to assume that a significant percentage of those require opioids to function effectively. It’s also an unfortunate fact that chronic pain is undertreated, which means many of us cannot function effectively. The war on drugs comes with a significant cost. There is the personal cost to individuals who have to live with intense pain causing disability, depression and isolation. The cost to society because of lost productivity, use of healthcare system and so on ranges in the billions every year.

Doing the same thing over and over again and expecting a different result is the definition of insanity. Perhaps it’s time we look at the failure of restrictive and criminalizing efforts to address the issue of opioid addiction (which rises annually) and change the way we deal with this class of drugs. Perhaps policy initiatives regarding opioids use should be primarily guided by the 33% of the population who live with chronic pain, rather than the 1.5% of Americans (5 million) who are addicted to painkillers (while of course also helping the latter group).

It’s time to take a step back, breathe deeply and look at opioids simply as a tool with a sharp edge. I believe that we should approach the “problem” with compassion and a healthy dose of practicality, rather than suspicion. By focusing on teaching people – both doctors and those who live with chronic pain — how to use this tool safely, it’s entirely possible that more people would live in less pain and less people would become addicted.

This post also appears on my CreakyJoints blog.