Things To Know About The (US) Opioid Crisis

PapaversomniferumAs a Druid, a big part of my obligations falls under the wide umbrella of “teaching”. Therefore, much of my blog entries, talks, and workshops are about my personal interest of traces of Celtic traditions in Alpine folklore and customs. My obvious target audience for this are other Druids, but also Pagans in the widest meaning of the word.
Sometimes, though, I need to equate “teaching” with “informing the general public”, like here.

The difficulty in writing this was to walk the fine line between being open to suggestive correlations hinting at a major system failure, and not falling into the trap of conspiracy theories. And no, this is not about the Queen of England being a lizard from the Draco systems, as one major conspiracy theory claims (and which I poke fun at all the time).

The article is about the unprecedented surge of opiate related deaths in the US. This is a brutal fact, not a theory, and it is demonstrated visually by the graphs below, issued by the Center for Disease Control (CDC). You can see that until the early nineties, the rate of death by opiate overdose was still at about 2 per 100.000 people, roughly what it has been for two decades. Then it began to rush upwards.

CDC1

The first graph only goes until  2007, and shows all drug-related overdose deaths (including cocaine, roughly a third). The newer data in the second graph (only opioid related overdose deaths) shows that the rate is now (2014) at 9 per 100.000, 4.5times the level of 1992.

CDC Overdose
Deaths from overdose are only the tip of the iceberg, though, because for each single person dying from that, there are 10 people in treatment, 32 in ER treatment for heavy use, 130 people having an opioid dependency, and 825 are casual users. So, if there are roughly 1,000 opioid users per 1 overdose death, there were approximately 2,000 opioid users per 100,000 people in the US in the 1992. In 2014, where there were 9 such deaths, extrapolating the number of users from 2,000 to 9,000 per 100,000. That’s 9% of the US population using some form of opioids. Or, if you are at a party with 30 people, there may be three folks in the crowd you are hanging with who use such drugs. Even worse, if there are 29 friends of your kid partying in your house, there may be 3 rummaging through your medicine cabinet, looking for opioid pain killers. Statistically speaking; which is quite an important qualifier!

For those not familiar with the term “opioid”, it means any drug that is either manufactured from the natural sap of  Papaver somniferum, the opium poppy (like morphine), semi-synthesized products such as heroin, and fully synthetic drugs like Fentanyl. One can fatally overdose on any of them, prescription or not.

These are just the not-so-fun facts about this epidemic. And while I am empathetic with anyone dying of such an overdose, and with their families, this is not what angers me. I am not mad at the active users either, throwing their lives away, some because they have a compulsive disorder commonly known as addiction. I am also not angry at the physicians who, in many cases, are forced to clear the way to such an addiction. We’ll learn in a moment why they often have no other choice.

I am furious at the system that is behind this surge of deaths. And that part of this system are corporations which we trust in creating products that keep us out of harm’s way!

But let’s look at a few facts first that correlate – timewise  – with the rise of overdose deaths in the 1990ies:

  1. Medical professionals are now required, by law, to treat pain as a separate part of any of the pain-causing diseases that they are treating in the first place. For example, if one has arteriosclerosis, the physicians are required to treat the physical reasons for this disease, plus the pain that comes with it.
  2. Prescription opioids like Oxicontin hit the market.
  3. The Faces of Pain, a scale with emoticons developed for children (!) is widely adopted by hospitals and physicians. Look at the sample below, and you’ll see that there is no frown until the scale goes beyond five. painfacesTen, the worse pain, is reserved for childbirth, passing a kidney stone, and dislocation of bones. 8 and 9  is when the feeling, i.e. pain returns for a limb has been severed, or when vital organs are ripped apart by bullets (hence the morphine shots for soldiers). Now, without emoticons, people would rate their headaches or joint paints at 3 or 4 maybe. If you use the scale with emoticons, that would mean you’d still be in the smiling section. But nobody smiles when having pain! Ever. So, while this works for children (because you can stillmake them giggle when they have some pain) most adults overestimate their pain level and rate it above five. Way closer to “unbelievable pain that doesn’t go away” than necessary. Go back to the first point, and you’ll see why doctors have to prescribe hammer-drugs containing opioids when their patients rate their  arthritis pain or head-aches with 6 or 7, similar to large flesh wounds after a bear attack for example. It’s not that they aren’t hurting, it’s just that the scale coerces people to rate their pain according to the emoticon, leaving the whole section from 0 to 5 untouched.
  4. Consumer targeted advertising of pharmaceuticals hit the air waves. That’s the worst of the four. These are all the commercials on TV that ask you to talk to your doctor if you feel “x”. Like during the evening TV programming, they’ll ask you, after you have come home from a long day at work, if your back hurts, or your joints. Duh! Whose doesn’t? They show you people like yourself, aching and making frowning faces (like on the Faces of Pain  scale). And they suggest you should talk to your doctor to prescribe you pain meds.

Well, these are just four things that happened right before the curve of opioid related overdose deaths spiked in the US. Many in the Substance Abuse field say that this is not only coincidental, but a cause-and-effect correlation. And I concur with them.

So, is this a conspiracy? Nah. Nobody is secretly trying to kill people to rule the world, to establish “The New World Order.” Pain should definitely be treated, for it could be – and most often is – counterproductive to the healing process. But then physicians and patients need a way to make the right choices, and not be guided by the fear of violating law. The nurses who invented the scale of pain did so with the greatest of intent, help little kids express their pain accurately and trustworthy. The adverse effect of possible overestimation of pain levels need to be known and communicated, though. Even if that means that Big Pharma makes less money because they can’t sell the more expensive stronger drugs. But subliminally suggesting to use dangerous drugs is just plain wrong.

We do need the pharma industry, obviously. But there is a very large range between “normal” capitalism and ruthless, neo-liberal capitalism. The one where maximizing profit (also a law in the US, by the way) makes CEO decisions reckless and cause large numbers of people to suffer and die. Something folks who make “free, unregulated enterprise” part of their  campaign should consider (just saying, in an election year).

Again, this is not the fault of anyone person or any particular group. It’s a system issue. Bet let’s not forget one  thing: We are not only The People, we are also the market. We are the system.
I am aware that systems don’t change that fast, so here are a few ideas how you can safeguard yourself against this particular issue. It may just keep you or your loved ones away from addiction and all that comes with it (loosing all your money and all your friends and family, criminal behavior, prostitution, Hepatitis C and HIV from needle sharing, homelessness, infections of the veins, brain damage, and possibly an agonizing death due to respiratory failure (the cause of death in an opioid overdose)):

  1. When your doctor or the ER personnel shows you the Faces of Pain scale, take three deep breaths, and think about your pain in numbers, not in smiley faces. You might just end up about two notches lower than the smiley face suggests. And you may still arrive at a painful 4.
  2. Ask your doctor about non-opioid pain treatment. There are other drugs that do not cause addiction.
  3. Have an “ER-buddy” who knows of your opioid-related wishes, even when you are incapacitated. As a parent, make sure you are the “ER-buddy” of your child, protecting them from opioids whenever possible.
  4. When you need opioid medication and you’re done with your treatment, bring your unused meds back to your doctor or pharmacist. Some communities even have places to collect them. Having them in your home is dangerous, for you, your kids (remember, they may have friends who don’t make good choices), and it may just lure criminals into your home.

There is one other thing that we all can do, over time. When your doctor suggests surgery and you don’t want that, there is a form that says that you were advised of the benefits and risks of surgery, and then you sign it stating that you decline it.
There is no form to decline pain management with opioids! If you indicate to your doctor that you have a high enough level of pain, they must prescribe the adequate meds. Opioids in many cases. If they don’t, if they have no record of the prescription, they committed malpractice, technically. You can rip up the prescription, but your doctor has to write it.
Let’s all ask our doctors if they have a form to decline pain management with opioids. Every time. All of us. Until they get so sick of this question that they pressure their lawyers to come up with something all can agree upon, even Big Pharma.

A little waiver here: Pain management with opioids can sometimes be the only valid option. Especially with cancer, or in cases where the pain is really high up on the scale. But it should be the last resort, not the first go-to. Not with the danger of fatal drug overdose at its end. And let me also tell you this. I did once pass a kidney stone. The opioid meds that I got (they didn’t have to use the Faces of Pain scale; with that pain you’re automatically a 10) where useless for me. I couldn’t keep the first one down, for my stomach reacted adversely, if you know what I mean. I didn’t even try another one. But there was an Ibuprofen alternative that worked. For a classic 10 on the pain scale.  For me, I should mention. I’m not saying this  this to show off. My body simply didn’t accept opioids, now matter the law. Couldn’t do anything about it. But I listened to my body, and sought an alternative. So, no, I am not saying ‘cancer – schmancer’ or ‘walk off your broken vertebra!’ I am saying: be aware and know you have choices.

The best prevention against death from drug related overdose is awareness, communication , and having a plan.

 

Christian Brunner
Druid
Concerned dad
Equally concerned community member
And also Dir. of Program Evaluation (i.e. cruncher of numbers and statistics) at the Pine Street Inn (a homeless service provider agency in Boston, MA)

 

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3 Responses to Things To Know About The (US) Opioid Crisis

  1. David says:

    well written…and mostly agree!

  2. Bruce E. says:

    I have several thoughts. I have to slightly disagree with the faces of pain. Number four really isn’t smiling. Its more of a straight line, just before a grimace. What i am bothered by is that the faces could be more closely modeled on faces experiencing actual pain. Humans seem hardwired to express pain a certain way, and humans interpret pain, no matter the culture, similarly. I think faces modeled on actual pain expressions would lead to more accurate self reporting.

    As a massage therapist, i had to educate my clients on the difference between “uncomfortable” and “true pain”. First time clients would report any feeling other than pleasure as “painful”.

    My wife went to the local urgent care, and the doctor kept insisting she was “under reporting” her pain level (she has a high pain tolerance). He finally gave her morphine, which actually made it worse. I researched the use of morphine and discovered that its use for head pain is actually contraindicated (it temporarily increases fluid pressure in the brain, hence increasing my wife’s pain level). I found it strange that the doctor was pushing my wife to accept the morphine.

    Deaths from opiate overdose are often associated with post incarceration. Addicts often detox in jail to the point where their tolerance level is lowered. Then, upon their release, they take an amount of drugs they were used to before incarceration, often resulting in an overdose. I wonder if your statistics would also track with increasing incarceration rates for addicts.

    Lastly, it was my understanding that no drug is of itself addictive. Its their effects that are addictive. Opiates are usually highly effective at blocking pain, both physical and emotional.

  3. If you haven’t seen it, check out the George Carlin skit about prescription drugs.

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