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.


Marietta said…
Thanks for posting about this (again). Opiates are a necessary tool in my toolbox for treating and coping with my disease. The continued criminalization and restrictions on them is so infuriating to me.
Anonymous said…
Thank you for this post. I've seen both sides. Both my husband and I have high levels of pain and require opiates for anything like a normal life, The pain doctor we just just re-located an hour away, and it's proving hard to find another one. We may ending driving to his new office.

On the other hand two people close to me have problems abusing opiates, that started with a necessary prescription for pain, that they chose to abuse. One of them was recently in rehab because she "graduated" to heroin, which was easier to get. It's come close to ruining her marriage, and her life.
Anonymous said…
By the Grace of God, I have been sober for 35 year. I will be 71 2-3-2014, at 68 started have awful pain in hands and feet. I was scared to take pain medicine. I had to have some relief, after talking with nurse friend of mine, I realized I had to have something for pain. First RA doctor did not believe in pain medicine. Changed to another RA doctor, I realized first doctor was not aggressive enough with my treatment. Second question Dr. ask me was what do you take for pain, I told him 10 mg Lortab when pain was so severe. He said I needed to take lortab on a prescribed time table. Only way to stay ahead of pain, not let it get so severe. I am on Butrans pain patch now, which I like better. I give myself ONCE WEEK injection of Methotrexate .5 ml,- 1 5MG tablet Xeljanz daily,- 1 tablet 200MG PLACQUENIL.
Whit said…
Great article! I couldn't agree more. I have lupus and I require pain meds to live something close to a normal life. I also inject chemo once a week and take a few other medications for my lupus treatment. I think patients miss out so much on life because they are scared to either ask their doctors for the medication, get the prescription filled, or they're scared of the stigma attached to them. I am not scared and I'm not going to let anyone tell me how to live my life! Do you know why? Because I'm the only person who has to live it.
Fabulous post, Lene! Thank you for putting this important information in such an easy-to-comprehend manner. Kitchen knives/opioids: both tools, both sharp edged, both useful and even vital for quality of life.

Excellent. :o)
mary said…
It appears we have gone way overboard with the war on opioids. I recently had a very involved foot surgery that has left me no weight bearing for 12 weeks. The surgery required fusing bones, realignment of toes, the realignment of my left foot so it pointed forward instead of collapsing to the left and removing bone from my leg to add to donated bone. As you can imagine it was a painful surgery. I was given opioids for the first 3 days but after that Tylenol. I found that I just could not bring myself to ask the doc to extend the pain killers by 2 days. To make a person in legitimate pain suffer is cruel. To threaten a docs license if he prescribes for a legitimate reason is criminal. I am well aware of the dangers of addiction and we have experienced it in our extended family but I believe this knee jerk reaction has gone way overboard. We see so many stories on the addiction problem but few on chronic pain sufferers who rely on these drugs to make their life bearable.
Thanks for writing about this difficult problem.