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The pain pill problem: Opioids are deadly in the “War on Pain”

Pain pills and addiction: What’s the problem?

“I take what I need because I don’t want to be in pain.”

Stephanie K. has dealt with pain for nearly her entire life. Diagnosed with rheumatoid arthritis at 10-years-old, she managed the constant throb in her knees and toes with over-the-counter Motrin all the way through the high school and into college. In 2010, her pain changed, spread all through her body and resulted in a trip to the emergency room. The attending physician, Stephanie says, put her on a staggering amount of Vicodin, a powerful narcotic painkiller. No exam. No review of her charts. Just a prescription and quick shove out of the ER.

Stephanie’s story, which isn’t over by a long shot, is a typical one from the early days of the “War on Pain”, a medical movement that’s created hundreds of thousands of opioid dependent patients across the United States. Today, these drugs kill more people every year than heroin and cocaine combined. How did we let things get this out of control?

Firing Blanks in the War on Pain

Twenty years ago, prescribing opioids in the United States was taboo for all but terminal cancer patients. The fear of dependency was too great, and healthcare providers never had the opportunity to study the long-term effects of these meds because those taking them, tragically, tended not to survive. That changed when Dr. Russell Portenoy, a prominent New York pain-care specialist, argued that doctors could prescribe painkillers derived from the opium poppy without limit, and that the likelihood of addiction in patients would be minimal. He pointed to studies, gathered followers, and before patients knew it, scripts for OxyContin, Tramadol and others soared in number.

“We [doctors] saw a tremendous increase in the use of opioids for non-cancer patients,” says Dr. Adam Sackstein, medical director of the Pain Management Center in New Jersey. “Sometimes in startlingly high doses.”

These high doses touched off a medical arms race where doctors ended up chasing patients’ pain up a scale with no foreseeable end. As patient tolerance to pain medications increased, doctors ratcheted up the milligrams only to see, according to Dr. Sackstein, less and less effect. Patients were still in significant discomfort, and in some cases, their agony got worse. Overdose deaths became more common as patients’ bodies buckled under the suppressive effects of long-term opioid use. The U.S. Centers for Disease Control and Prevention estimates that 40 people die every day from overdoses of prescription opioids.

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Pain on All Sides: Trying to Quit Opioids

Stephanie knows what it’s like to be on a ton of pain pills. Her two Vicodin a day regimen escalated to four, then to 12 or more. “I ended up getting OxyContin on the side because I couldn’t get to work,” she says. Doctors tried a host of meds in addition to the opioids, including Plaquenil, Methotrexate, and Prednisone. Fearing that her system would shut down from all the pills, she tried to quit, only to end up in the hospital in writhing misery. Doctors went to the pill cache again, trying large doses of Gabapentin to quell her pain, which had debilitating side effects.

“I was drooling,” she says. “I couldn’t walk. I had a horrible stutter…my brain was in there and nothing is coming out of my mouth. My Mom is feeding me soup and I’m thirty-eight years old. That stuff was horrible. It turned my brain to mush.”

Doctors and Patients Pumping the Brakes on Pills

For pain management doctors, the challenge now is lowering doses of opioids or completely eliminating the medications from their treatment plans for their patients. The difficulty, says Dr. Sackstein, is managing those patients who have already been on opioids for a number of years. “If I get a patient who’s been opioid dependent for the past five years, that patient is very, very, very difficult for me to succeed with,” he says. “If I get a patient whose not been placed on opioids, ever, or at least not in any meaningful amount, I have a much better chance of managing that patient without long-term narcotics because they’ve not gotten used to, or their bodies have not gotten used to seeing those medications on a daily basis.”

Patients panic at the prospect of going off their medications. Fearful that the pain will return at unimaginable levels, they fight the process. For those who tough out the detox, it’s possible to lower their discomfort and preserve their long-term health.

Stephanie has kicked the Vicodin, and is now on a much lower dose of pain medication than she was on three years ago. “I’m going to go down to none [pills],” she says, “and we’re going to see what happens…I think it was all the painkillers.”

The problem with pain pills

Have you experienced a similar story? Do you think that doctors are over-prescribing pain pills? How can we make sure that the “War on Pain” treats pain instead of creates a new generation of addicts? Weigh in here. We invite your opinions, feedback, and experience in the comments section below.

Photo credit: bayat

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11 Responses to “The pain pill problem: Opioids are deadly in the “War on Pain”
Celeste Vaughan
4:21 am July 30th, 2013

I’m a pharmacist and was blindsided by narcotic addiction! You can read my story at Celestial Prescriptions [dot] com. Please feel free to contact me if you have any questions!

someone in pain
1:01 am November 20th, 2013

What a horribly misinformed, ignorant article. I’d argue point for point…but what’s the point? I’m tired of defending my pain. It’s not my job to talk sense into people like this author.

Teresa
2:27 pm July 15th, 2014

2006, I was a healthy, active 58 year old kinder teacher. Major car wreck. 4 days in hospital mostly unconscious on morphine drip, sent home with script for 12 Norco 10/325 a day. Four years later I learned that the pressure on my spine likely could have been eased with “vertebroplasty” (unsure of spelling), though the attending neurosurgeon never suggested ANY treatment, not even physical therapy–I had to ask for it. Now 2014, disabled, on fentanyl 25 patch and 4 Norco/day for “break-through” pain. I was dying, mentally, emotionally, physically. A knee injury woke me up. Used the pain to kick off the Norco—I will NEVER go back. The fentanyl will be harder, but I Will BE OPIATE FREE. I am very, very afraid of the pain. Before the patch, I had to wear diapers at night, because pain prevented me from getting out of bed to pee. I told the doctors from the start that my family was riddled with abusers, alcohol, pills, etc. Still they kept giving me more drugs. I thought I was in control. Hah! Through the excruciating pain of the knee ( I doubled up on my Norco for 3 days, which didn’t really help much) I saw the “hook” in my brain and the totally false illusion of pain relief. I have not slept more than 1-2 hours/night for more than a week, but I know I will survive, and eventually my knee pain will ease. Look out fentanyl, I know your game, and I WILL KICK YOUR A… OUT OF MY LIFE!!
Still, I know now there are millions of serious pain sufferers out there (my junkie sister is not one), and I cry for you all when I cry for myself. Come ON you medical professionals, researchers, scientists. HELP US! There are better remedies for chronic pain management. DO YOUR JOBS! HELP US GET OUR LIVES BACK! Stop turning us into drug addicts!
I wish you all true relief and good life.
My name is Teresa Marie, and I WANT TO LIVE! SCARED but DETERMINED to get back to a real life!

Eileen
5:21 pm September 3rd, 2014

I think all the families affected by these drugs should be able to sue the doctors and pharmacies that are getting these people addict to them. I can not count how many people I know that get a little boo boo and then become addicted to pills. Of course these doctors and pharmacists don’t want this problem to stop, they are making loads of money off our loved ones. Let’s fight back and sue their stinking asses!

April Green
3:27 am September 5th, 2014

I think the doctors need to prescribe pain meds but to tell their patients to only use the meds as a last resort and to do other things as well. The doctors can really only do so much man. People just blindly listen to their doctors and do no research on their own? Really? Come on. When prescribed an opiate or other narcotic, patients should be educated, cautioned about use and side effects, and given options to choose from themselves. Ultimately, the decision to use or not use narcotics should be up to the patient. We are responsible for our own bodies for Christ sake. So easy to blame the doctors.

Teresa
3:14 pm September 5th, 2014

Lawsuits are not the answer. The lawyer who should have arranged a financially comfortable retirement for me lied, cheated, and bullied me out of a fair settlement (the driver who hit me was cited for illegal lane change). When I was totally confused and crying, the lawyer said he was not there to help anyone, but to make money for himself. I tried for awhile, when I finally learned that my injuries were permanently disabling (the neurosurgeon told me for 3 years that I would be back to normal, it was just taking longer to recover because of my age, he lied), but could find neither doctors nor lawyers who were the least bit interested in helping me. We can only help ourselves, and live the best we can in spite of those who would steal our lives and keep us down. I for one choose not to wallow in misery, but each day push myself beyond it and find a reason and purpose in my life. I will survive.

Teresa
12:58 pm September 25th, 2014

Just for the record, I kicked the fentanyl and am now opiate free. No thanks to any doctors, I did it all by myself, and like the little red hen will reap all the rewards. I will not return to that nightmare again. I have issues to deal with which made me susceptible to hiding in a fog of drugs, but I will face those down as well. Also for the record, you doctors, drug addiction is not the disease!! It Is A Symptom Of An Inability To Deal With Life As It Is!!!!! You cannot eliminate a person’s defenses-drugs or whatever-until and unless the person can recognize, acknowledge, and come to terms with their fears. Chronic pain wears one down over time, the body doesn’t work right, and seems not to fit. Inability to do the things we want and need to do is terrifying, and extremely Depressing. Just a little relief can be so welcome, it makes it easy to step into the opiate pit. For what it’s worth, the best revenge is to live as well as we can in spite of everything.

1:42 pm September 25th, 2014

Thank you Theresa for the update. I hope everything is good now. It just keeps getting better. But, knowing you’re not dependent on a substance, that you, yourself control your actions…it’s very rewarding. Congradulations!

Britanny
3:04 pm July 11th, 2015

I was in a car wreck.Almost all of my vertebrae were cracked or partial fracture.Not to mention the ribs.arm leg and face. My dr. put me on Hydrocodone and Morphine . 10mg of 1 and 15 mg of the other. I was in agony but my Dr. still insisted that was plenty. So I believed him. I saw a nuerologist he almost freaked out.He could not believe i was placed on such a low dose. He quickly upped me with 25 mg oxy to take along side the others. this put me in a very comfortable life.I was able to sleep and eat w/o much pain. unless i banged my arm. Or moved wrong. But I am now 16.the wreck was 2 years ago.If that nuerologist had been a soldier in the war on drugs. I would of had 2 years of agony. 2 months ago they started weanning me because I was getting better. I finished the wean. and am living my life again with a little physical therapy

2:49 pm July 21st, 2015

That’s great news Britanny. I wish you a fast and complete recovery very soon, and a productive, happy life afterwards.

Teresa
7:29 pm October 29th, 2015

Doctors are darned if they do and darned if they don’t prescribe pain killers.
Unless one undergoes chronic pain, they don’t know what the hay they are talking about. My good doctor has empathy and that compassion allows me a somewhat tolerable life despite side affects of morphine. We have all heard the unthinking term “oh, she/he drank herself to death”…some people’s only way of combating pain which takes away all joy and ambition. Many doctors will not prescribe any relief. Quality of life is more important than quantity.
Listen to your family and friends who suffer….they will feel less alone and useless. Dale Carnegie wrote an entire book about that one word “listen”….it helps ourselves and everyone we meet our entire lives.

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About Richard P. Console, Jr.

Richard P. Console Jr. is the founding and managing partner of Console and Hollawell, one of the most highly regarded personal injury law firms in New Jersey and Pennsylvania. Since 1994, he has dedicated his professional life to protecting the rights of individuals that have been injured in motor vehicle accidents, medical malpractice, wrongful death, and other serious injury claims.

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