A pill is an easy solution given form. Just take two every six hours, your doctor says, and the pain goes away. No other treatment necessary – fill the prescription and go about your day.
That instant gratification has wormed its way into our culture surrounding the management of pain steadily wearing away our fears about addiction and the effects powerful opioids have on our bodies. These drugs kill tens of thousands every year. And signs of painkiller addiction are pervasive in the 20+ million people who need addiction treatment. How did we as a society allow this to happen? And who’s responsible for painkiller addiction?
Heroin and Oxycodone Come from the Same Plant
Heroin and oxycodone – one legal and one illegal drug – both derive from the opium poppy, yet have very different social connotations when it comes to acceptance and addiction. The image of a heroin addict is the gaunt drug seeker living on the streets or in near-squalor unable to stop using. Someone taking oxycodone with a prescription from their doctor may be just as addicted, but with a full-time job, a house, and family responsibilities. While the signs of painkiller abuse may be easier to mask, the realities of addiction are the same.
The view from the outside is that there’s no stigma surrounding opioid usage when it’s under a doctor’s care. There are no track marks with a pill, no messy paraphernalia to hide. That belief discounts the fact that the vast majority of overdose deaths from prescription opioids are by those using them under a doctor’s advisement. Heroin and cocaine use combined doesn’t kill as many people a year.
All Opioids Induce Euphoria
The ‘high’ those addicted to opioids talk about is the sense of euphoria created through the large release of dopamine in the brain while under the drug’s influence. Pharmaceutical companies thought to reduce the feeling of euphoria caused by opioids, and therefore their addictive properties,through time release elements in their pills. No sudden rush of dopamine to the brain, no addiction.
Of course, that turned out to be far from the truth. Needing ever increasing strengths of opioids to manage their pain, patients circumvented whatever time release elements in their medication through sheer dosage alone. In some cases, crushing the pills or heating them inhibited or destroyed any time release safeguards drug companies thought were in place.
Changing the Conversation about Pain
Culture surrounding how we deal with pain and manage it needs a drastic shift. The growing number of overdose deaths from prescription opioids – 15,000 per year – needs to be that alarm bell. Because all opioids produce euphoria and present a significant risk of addiction, we can’t look at patients and addicts as any different. Both populations need continual treatment and alternative therapies to kick their dependencies and reduce their discomfort.
Many patients are dealing with legitimate medical issues that require treatment, but painkillers aren’t the sole means of tackling them. Physical therapy, non-opioid medications and counseling are all proven methods of pain management that don’t involve drugs derived from the opium poppy.
When we reach a point where the prescription pad isn’t the first thing doctors reach for in treating pain, we’ll be much closer to shifting our societal perception about opioids and their acceptance in our daily lives. We as patients and consumers also have a responsibility to know the risks of the drugs recommended to us, and to say no when the painkiller sounds like just another problem, and nowhere near a cure.
Richard P. Console Jr. is the managing partner of Console & Hollawell P.C. Since 1994, his firm has represented thousands of victims of negligence, including those suffering injuries because of prescription opioids and other forms of medical malpractice.
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