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.
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.