I want to paint today. Instead, I am writing about pain, advocating for palliative care that I should be receiving, care that I used to receive without incident for years – care that actually allowed me to complete my college degree, but I am currently, inexplicably denied.
I have a long, well-documented history of multiple painful, chronic, incurable diseases, failed surgeries, and diagnosed genetic disorders that cause widespread pain and affect every system in my body and every aspect of my life. Yet I cannot get access to ethical, vital, and appropriate medical care. How did this happen?
I will give you two words: opioid hysteria. It has swept the nation as we have been pummeled daily with messages telling us that this evil class of drugs is highly addictive, and people are dying en masse as a result of using them. We see endless images of pill bottles, pills counted by pharmacists, doctors vociferously castigated for no other crime than prescribing pain medication to patients who desperately need them, and drug companies demonized for creating medications to treat the pain in the first place. But there is very little truth or rationality present in any of it.
To have an honest conversation, we must first acknowledge that the problem – the reason people are dying – is addiction, plain and simple. As Dr. Ginevra Liptan aptly put it, “Ultimately the ‘opioid crisis’ is not about opioids, it is about addiction and mental health and societal despair.” She goes on to conclude, “We cannot win by playing an eternal game of ‘whack-a-drug’ without addressing the underlying societal ills driving substance abuse and addiction. Responding to a substance abuse epidemic by taking opioids away from those in chronic pain simply creates an epidemic of undertreated chronic pain.”
There is a very clear divide between addicts and pain patients. Both deserve appropriate care, and far better care than they are receiving now, but their needs and health issues are not the same and cannot be conflated. You simply cannot hear about the plight of pain patients without the follow-up that inevitably demonizes the very prescription medications that they need to have any tangible quality of life, while erroneously lumping them in with the addicts who are dying – overwhelmingly – due to illicitly and illegally obtained substances, in various, poly drug combinations. These overdoses have nothing to do with pain patients and never did. These conversations must be separated if helpful solutions for both addicts and pain patients are ever to be reached.
Which brings us to patients suffering acute, chronic, and intractable pain who are being massively undertreated or refused care outright. We do not have an addiction problem. We have a pain problem. Study after study has shown that medical patients being treated for pain do not end up addicted. In a review done of 4,893 patients taking opioids for pain, “signs of opioid addiction were reported in 0.27% of participants.” Clearly, there is only a very low risk of addiction when opioids are prescribed to pain patients. Someone is lying, and it isn’t the data.
The destructive effects of pain on long-term health are well known and well documented. As one physician, Dr. Mark Ibsen appropriately states, “Pain is a terrorist.” Pain causes a host of cascading physical health issues: brain damage, deterioration of the endocrine, cardiovascular, immune, neurological, and musculoskeletal systems, and increases the risk of sudden, instant death in long-term pain patients.
Will we let opioid hysteria win? Will we continue to deny pain patients the vital care they need and deserve based on lies? We must decide how we, as a society, value human life. Because it isn’t just addicts who are dying. Patients in pain are dying too. From heart attacks, strokes, and suicides when they can no longer take the unrelenting torment of their daily lives, as their health and ability to function deteriorate. Don’t their lives matter too?