Part 2. Drug users aren’t the bad guys: Opioids treat emotional pain too

Point of clarification: I didn’t mean to imply that people who take opioids for reasons other than physical pain are to blame for the opioid “crisis” or the overdose epidemic. Let me retrace my steps.

I recently pasted and posted my article, published in The Guardian, arguing that opiates prescribed for people in pain are wrongfully blamed for the overdose epidemic. All true. But I also stipulated that the illicit use of pharmaceutical opioids was a link in the chain to opioid addiction and, in the current fentanylized environment, to the overdose epidemic.

So what does that say about us former and still active opioid “abusers” and addicts? I have a pretty good sense that most of my readership, like me, went down the path of pilfering …e.g, stealing, buying, faking, or otherwise getting pharmaceutical opioids that weren’t prescribed for our physical pain. We found those pills any way we could, because we needed them to soothe another kind of pain.

I thought, since sharing my article with you, that you might feel I’m pointing the finger of blame at “you addicts” who’ve found a loophole in the prescription opioid cycle, who’ve found a way to acquire pharmaceuticals “illicitly.”

No way. Having had two spinal surgeries in the last seven years, I’m definitely attuned to the pain relief issue. In fact, though my back’s been in quite good shape since the surgeries (praise be to physio, Tai Chi, and a great healthcare system here in the Netherlands), I had a horrific episode a couple of years ago. I was attending a conference in Geneva (focused on addiction, somewhat ironically) and my back went into gridlock spasm. The pain was so intense that I literally couldn’t move, couldn’t walk, couldn’t sit. Loud noises came out of my mouth that I seemed unable to hotellobbycontrol. I had people coming up to me while I stood rigid, paralyzed, in the middle of a busy hotel lobby between session, and carry or drag me to the nearest sofa (it was a pretty plush hotel). And even sitting, I could not unspasm; my body seemed like a lighting rod that would not stop zapping. People I didn’t know — strangers — found me a wheelchair, wheeled me to the elevator, got me down to the street level and called a taxi to take me to the hospital. And the next day, at a doctor’s office near my own hotel, I was howling so bad that the doctor and his assistants dragged me out of the waiting room because I was scaring the other patients. They then lifted me into a taxi — back to the hospital again. When all I really needed was a shot of morphine or a substantial dose of oxycodone. Getting high was the furthest thing from my mind.

ongurneySo why couldn’t they provide that? Even at the hospital, I had to lie on a gurney intermittently screeching in pain for over an hour before the morphine came. People passing by had pity written all over their faces. Has the opioid scare infested Europe too? Not as much as the US, but yes, seemingly, to a degree.

So physical pain is one thing, and I have immense sympathy and empathy for those who experience it regularly. (For me, thankfully, this was a rare episode).

But I’ve also experienced the other kind of pain, the overwhelming darkness that invades your thoughts and feelings to such an extent that you are paralyzed in another way. You can’t think, or feel, or communicate, because it hurts so much just to exist. Opioids can provide enormous relief verysadfrom that kind of pain as well. But of course no doctor will prescribe opioids for your depression, unless you’re getting methadone or Suboxone because you’re a “registered” addict, whatever that happens to mean in your corner of the world. Maybe just lining up at some seedy clinic, maybe being sneered at, maybe not being able to get a job, maybe having your license revoked…hell, in the Philippines it means being lined up and shot.

dreamymanWhen we’re in that kind of pain, and if we’re pretty sure that opioids can help relieve it, we’re trapped. We can’t get an opioid prescription for emotional relief.  (Don’t get me started on “antidepressants” — SSRIs — which are so much less effective than hoped, which carry their own batch of side effects, and which require as much tapering as opioids to minimize withdrawal symptoms.) So we buy, borrow, steal, forge, or do whatever we have to do to acquire the medication that can bring us back to some semblance of normality, of peace.

I just want to clarify that I don’t see you, me, us addicts — former or “active” — as villains in this scenario. Yes, we do “divert” pain pills to deal with our (sometimes enormous) psychological vulnerabilities. But we only do that because our back is against the wall. Only because there’s no other choice.womanattable

That struggle was not the point of my article, and you (us) were not the audience I was targeting. But I am so with you, you don’t even know it. And if your diverted pharmaceuticals have led to (or replaced or complemented) heroin, which might have led to fentanyl, which might kill you, I see that as a shameful tragedy. But I don’t blame you. I blame the system that has vilified, isolated, and abandoned you. I don’t blame you. In fact, the risks you (we) face are so very grave, simply because we can’t (through normal channels) get the pharmaceuticals that can help us, we move to the front of the line of sufferers.

If I had to choose between battling emotional anguish and physical pain, I’d be hard pressed to decide which to try first.

There is no reason why either kind of pain should be left untreated in this age of pharmaceutical evolution. But I’m not going to be able to convince the head of the DEA, the governor of Maine, or Donald Trump that both kinds of pain qualify for care. I’m just starting with the most obvious.

 

 

11 thoughts on “Part 2. Drug users aren’t the bad guys: Opioids treat emotional pain too

  1. Guy Lamunyon November 10, 2017 at 10:15 am #

    This is our modern approach:

    Psychological approaches to chronic pain management: evidence and challenges.
    Review article
    Eccleston C, et al. Br J Anaesth. 2013.
    Show full citation
    Abstract
    Psychological interventions are a mainstay of modern pain management practice and a recommended feature of a modern pain treatment service. Systematic reviews for the evidence of psychological interventions are reviewed in this article. The evidence for effectiveness is strongest for cognitive behavioural therapy with a focus on cognitive coping strategies and behavioural rehearsal. Most evidence is available for treatments of adult pain, although adolescent chronic pain treatments are also reviewed. It is clear that treatment benefit can be achieved with cognitive behavioural methods. It is possible to effect change in pain, mood, and disability, changes not achieved by chance or by exposure to any other treatment. However, the overall effect sizes of treatments for adults, across all trials, are modest. Reasons for the relatively modest treatment effects are discussed within the context of all treatments for chronic pain being disappointing when measured by the average. Suggestions for improving both trials and evidence summaries are made. Finally, consideration is given to what can be achieved by the pain specialist without access to specialist psychology resource.

    PMID 23794646 [PubMed – indexed for MEDLINE]

    And the URL referred to in my previous post:

    http://www.cnn.com/2017/06/29/health/opioid-addiction-rates-increase-500/index.html

    • Marc November 11, 2017 at 6:37 am #

      Maybe this is the link you intended, Guy? But probably not.

      What you refer to here makes a lot of sense, but note that effect sizes appear to be weak. I have personally treated a client in psychotherapy who had been attempting psychological interventions for her chronic pain for over a decade. The overarching message she heard (whether it was intended as she heard it) was: It’s all in your head. That can be a deadly idea for people in pain. And in fact she was seriously considering suicide until her doctor starting prescribing a sufficient dose of oxycodone to control her pain. (I take it as a given that physiotherapy, stretching exercises, and either yoga, Pilates, or Tai Chi and related disciplines are crucial tools as well.)

  2. matt November 11, 2017 at 4:15 am #

    There is no need to clarify, my friend…

    I sit on an interdepartmental committee at a local hospital that is desperately and fecklessly trying to produce responsible prescribing guidelines that work for all physicians and patient populations. This is to provide medicine to those who need it, to provide treatment to those having difficulty, to reach the “addict” still struggling while they are being treated in-hospital for other medical issues. The committee can’t even decide on how to refer to these phenomena in patient records in a way that won’t expose the hospital and practitioners to legal issues, defame innocent patients, keep medicine from people who need it, or even refer to “addiction” in a way that doesn’t mire the hospital in regulation and red tape by having to register as a legitimate “treatment facility”— even though they already have an established addiction psychiatry department for this very purpose.

    It’s like chasing full bore down the rabbit hole followed by a steady stream of quick drying cement.

    Pointing fingers of blame, pointing fingers at etiology, at most effective treatment modalities, at obstacles, at moral failings, at social ills, etc. They all get fossilized and factionalized and miss the point. People are driven to find relief, comfort and solace for themselves and others, but also by the unhelpful need to be right in a domain where there is no right or wrong– only individual suffering.

    Remember the old Bruce Lee movies and kung fu TV shows that often had examples of the buddhist parable about “the finger pointing at the moon?” At least those of us who were alive at around the time when dinosaurs were done roaming the earth? We have too many people fixated on way too many flailing fingers pointing at the moon. It’s important to have fingers to point the way but also important to remember they are not the moon. Moving away from “addiction”, whatever the f– that is, is about finding purpose, about finding one’s own truth. It’s about looking at the moon, not all the fingers. How do we help turn people’s faces toward the moon? How do we help them to find and negotiate their own truth?

    • Marc November 11, 2017 at 5:59 am #

      What an exemplary comment, Matt. If there was a comment-of-the-year prize, you’d be in the winner’s circle. I have nothing to add — just to urge people to think about the big picture in all its complexity, in the way wrong-headedness evolves from personal to interpersonal to systemic, the way contradictions and conflicts not only add up until they reach some critical mass but also consolidate into impermeable dead-ends. Nowhere but in addiction is this tendency so clearly manifested. Matt’s comment sums it up beautifully.

      • Carlton November 18, 2017 at 9:29 am #

        Marc, urging people to think about the big picture in all its complexity, is well meaning, but there is a simplicity too.

        This blog is also peppered with people mentioning that the struggle with themselves has ceased, and the addiction is no longer a desire.

        Although some may say these people were never addicted in the first place,

        This could be scientifically studied via MRI, brain scans, etc.

        It is not an area that currently gets attention, but it may provide a breakthrough in the understanding of addiction.

        I needed to add this for any readers currently struggling with addiction.

        The feelings of hopelessness and destitution that perhaps you have an complex, progressive, chronic problem can undermine self-trust that may develop during the recovery phase.

        Carlton

  3. Jan Winhall November 13, 2017 at 8:28 am #

    Addiction is a dead end, and how we are reacting to it as a culture is a dead end. We are going around in a deadly circle. Yes, we need to get some distance, to turn towards the light of the moon, together.
    This blog is part of a movement to shift paradigms. Thank you for making it happen Marc.
    Jan, from Toronto.

  4. Cheryk November 15, 2017 at 7:35 pm #

    Opioids were never my thing. When on them for pain for a week. They really didn’t help my pain, and they made me queezy and nauseous.

  5. Thrive Treatment November 21, 2017 at 1:51 pm #

    I have had an opiate problem for close to 8 years now with intermittent lengths of sobriety during that time. I am close to a year clean and sober now and i can attest to the fact that opiates DO treat emotional pain and it has been hard getting sober and facing that pain and walking through it.

  6. Carlton November 24, 2017 at 6:06 pm #

    This was 48 minute broadcast was on Public Radio station in the US today:

    Addiction Nation: Understanding America’s Opioid Crisis:

    http://www.wnyc.org/story/addiction-nation-understanding-americas-opioid-crisis-rebroadcast

    Carlton

  7. Joanna "Nicci Tina" Free November 24, 2017 at 8:04 pm #

    I’m going to paste this here because it was so well-said, Marc:

    “Addiction is not caused by drug availability. The abundant availability of alcohol doesn’t turn us all into alcoholics. No, addiction is caused by psychological (and economic) suffering, especially in childhood and adolescence (eg abuse, neglect, and other traumatic experiences), as revealed by massive correlations between adverse childhood experiences and later substance use. The US is at or near the bottom of the developed world in its record on child welfare and child poverty. No wonder there’s an addiction problem. And how easy it is to blame doctors for causing it.”

    If we’re going to solve this, my sense is it will require each one of us seeing addiction for what it is, and recognizing, too, that recovery from it is entirely possible, once we each – all – address these root causes, including the pain of isolation. Most of us are far too isolated, from each other and even from ourselves.

    Blaming anyone will not take us where we want to go. Individual and collective engagement could and, in many cases, does transform lives.

    • Marc November 25, 2017 at 5:56 am #

      I completely agree with you, Joanna. Isolation is what sucks joy, safety, excitement, meaning, and a sense of okayness out of far too many people in today’s world, especially in the West and especially in the US and northwestern Europe.. Homo sapiens evolved to connect with each other in families, tribes, clans…and that’s what we did for tens of thousands of years. Trying to build a workable society on the backs of isolated individuals is an impossible task. And that’s what I see as the root cause of addiction. I’m sure Bruce Alexander would agree as well.

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