Ontario Joins War on Pain Patients: Opioids, Stigma, and Human Rights
I used to start the day crying in the
shower. The pain was so great that waking up and beginning to move was torture.
So I sat in the shower, salty tears mixing with the fresh water. Every day.
And then my doctor gave me a prescription
for opioids and the pain subsided. No longer did I start the day by dissolving
in tears. Instead, I hummed in the shower, looking forward to my day.
I have used opioids for 12 years now and at
no point have I been addicted or stoned. I take these medications for strong
pain, which means they have something to do other than make me high. Namely
control the pain so I can get on with my life. Because of these and other medications,
I am able to be an active part of my family, nurture my friendships, volunteer
in my community, and do the kind of work that enables me to pay taxes and feel
that I am a productive member of society.
I’m not alone. For thousands of people who
live with chronic pain, opioids are a literal lifesaver. Without them, they
would not be able to live their lives, instead drowning in pain. Many would be
suicidal.
The many ways of stigmatizing pain patients
And we are increasingly stigmatized. It is
assumed that we are addicted. In a Toronto Star article about an
opioid abuse survivor cycling across Canada to raise awareness, the
reporter used the term opioid user in
a context where they should have written opioid
abuser or opioid addict. At best,
it is lazy journalism. At worst it is an indication of how profound the stigma
has become.
The doctors who prescribe these medications
are viewed with suspicion and regulated so tightly that they have limited
options for treating their patients. And the medication that controls our pain
is becoming ever more restricted.
Case in point: in six months, the Ontario
Drug Program will stop paying for certain high-dose opioids, in an attempt to
reduce accidental overdoses and addiction. According to statements made by
Ministry representatives, this will deal with the problem of “overprescribing”
that contributes to addiction.
Many of the articles about this piece of news
included comments from the Ministry of Health, as well as addiction
specialists. Only the Globe and Mail included a quick quote from a palliative
care specialists, and followed up with a more in-depth article about the impact
of this news on people who live with the kind of pain that warrants these
kinds of medications. None of the others included the point of view of people who
use these medications legitimately (Toronto
Star, CBC,
I’m looking at you. The Toronto Sun gets smacked, too, for belittling
the concerns and needs of people who have chronic pain or receive
palliative care).
Lazy journalism that colludes in creating
stigma.
Real facts about opioid addiction potential
The fact that opioids inevitably cause
addiction has become a truism. But guess what: it's not inevitable. One
meta-study showed that when prescribed and taken correctly, opioids result in
addiction in one quarter of one percent
of cases (1). Another (Canadian) meta-study showed that when the sample
included people who had previously been addicted — the biggest risk factor for
addiction — rates rose to a whopping 3.3 percent (2).
In other words, when these medications are
used correctly by physicians and patients, 97 percent or more do not become addicted.
And that’s the crux of the matter here.
Correct usage. Prescribed correctly. Quotes from doctors and Ministry officials
indicate that this policy change is designed to limit overprescribing by
doctors, a legitimate problem.
The Ministry of Health had two options. One
was to educate doctors so they know when and how it is appropriate to prescribe
opioids, and so they can educate their patients on how to avoid overdose and
addiction. The second option was to remove access to these medications for
people who live with high levels of pain, or who may be receiving palliative
care — the populations also more likely to require the Ontario Drug Plan.
Not surprisingly, they went for option two.
The Ontario Minister of Health calls it an
“important
first step” by Ontario’s Minister of Health. Clearly more changes will
follow that further restrict access to the kinds of painkillers that have a potential
for addiction, but also a great potential for enabling people who have high
levels of pain to function, even enjoy their lives.
One such change could be the adoption of an
opioid
prescribing policy, such as thone much lauded one recently developed by
British Columbia, which is based on the national prescribing policy in the US.
These policies urge doctors to focus on non-medication treatment of pain and if
stronger medication is required, to start on a low dose and only give patients
a few days` supply.
Again — and really, do I have to say this?
— the realities of living with high levels of pain are not considered at all.
If you have the kind of health conditions that cause this kind of pain, non-medication
treatment may be part of what you are doing for pain, but it does not take the
place of medication. As well, coming back to your doctor after a couple of days
is next to impossible. And, quite frankly, unreasonable. Likewise if you are
taking opioids for palliative care.
Pain patients and human rights
And I could go on. In story after story
after story, pain patients are ignored, excluded, and their needs dismissed.
This level of repeated and concerted stigmatization of a group of people who
have done absolutely nothing to deserve it is heinous. Restricting access to
treatment results in those of us who live with these kinds of medical
conditions being exposed to the kind of pain that can only be called torture.
The kind of pain that make people take their own lives.
The Declaration
of Montréal bit found that “pain management is inadequate in most of the
world.” It declared that access to pain management is a fundamental human
right.
Opioid addiction is a problem that needs to
be addressed with a great deal of thought and understanding of the issues
involved. Not by bulldozing across it, in the process trampling on the rights of
people in pain to have that pain treated in the best possible way, a way that may
include high doses of opioids.
References:
(1)
M. Noble, et al., “Long-term
opioid management for chronic noncancer pain,” Cochrane Database of Systematic
Reviews 1 (January 20, 2010): CD006605.
(2) The National Opioid Use
Guideline Group, Canadian Guideline for Safe and Effective Use of Opioids for
Chronic Non-Cancer Pain (2010): 10.
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