Also in trying not to demonize chronic pain patients who need opioids (which is not all chronic pain patients), try not to demonize addicts along the way. Addicts seek drugs from the medical system not because they’re bad people who cause all the problems for doctors and legit pain patients and emergency departments, but because our approach to addiction is fundamentally backwards, fucked up, and flawed from the ground all the way to the top. If our way of dealing with addiction weren’t so screwed up, none of this would be an issue to begin with. Addicts wouldn’t be in the position of having to lie, cheat, and steal to get drugs.
I saw a TED talk where they talked about that famous experiment with the rats given access to various hard drugs like heroin or cocaine. And how the rats would nearly always drink the drug water until they died of overdoses. Then they want on to describe a much lesser-known set of experiments where instead of putting the rats in bare cages, they basically made a rat heaven with everything rats could ever want – toys, intellectual stimulation, exercise, other rats to hang out with, everything a rat could want. Not only did the rats not prefer the drug water, they actually avoided the drug water and went for the regular water and even the ones who drank the drug water didn’t overdose.
Knowing things like that, Portugal, which had an enormous drug problem, decided to throw all its resources into not acting like America, basically. And they put all their resources into making sure that when addicts got back into society, they had social connections, people were incentivized to hire them at jobs, they were back connected with the world around them. And their addiction problems went down in huge, huge, huge amounts very rapidly. Because a lot of addiction has less to do with the drugs and less to do with the person and everything to do with feeling disconnected from life. And if people live happy and connected lives they abuse drugs less often. Rats too.
So like, I see a lot of people in this regard sort of passing the buck – first it’s addicts that are the problem, then it’s pain patients who take opioids (who are not all pain patients by a long shot, either, and peopel forget that – although many pain patients are prescribed wildly inappropriate and dangerous drugs to avoid opioids in a fear of getting them addicted or the doctors legitimately afraid of losing their license because that’s happened even when prescribing medically appropriate doses for clearly diagnosable diseases), or the doctors who prescribe opiate pain meds, and it all goes in circles with everyone finding someone else to blame. When the entire way we deal with addiction is to blame, the entire way this society results in disconnection and poverty and oppression is to blame, there’s all kinds of legitimate things to blame but it’s not addicts and it’s not pain patients and it’s sure as hell not going to help to have addicts and pain patients at each other’s throats (although that’s certainly how people higher up want it I’m sure because that absolves them of any responsibility to do anything and keeps the rest of us busy).
Mind you, there are actual dangers to opioids that are only coming to light lately. But they’re not addiction, for the most part. They’re things like long-term damage to the body that was just not known about 20 years ago when it became more common to prescribe them long-term. (It’s the same old story – they don’t do long-term studies when the next generation of drugs themselves come out because that would take too long, and then they’re shocked when there’s long-term effects.) But even in that case, compared to NSAIDs and Tylenol and anticonvulsants and the like, opioids are still probably safer on average long-term than anything else is. They’re just not as near-completely non-damaging to the body as was once thought. Unfortunately because people are already on a hair-trigger about addiction, I fear that the long-term damage being discovered now will only trigger more moral panic about opioids out of proportion to the actual damage being discovered, especially as compared to other pain drugs.
I also worry because like… I happen to have a pain condition that responds super-well to anticonvulsants. (And weirdly enough, to the exact same kind of anticonvulsants that are specifically good for my particular kind of epilepsy, so I can basically take the same drugs for two totally different reasons and get very extensive good effects on my life. When I first took this class of meds it was for epilepsy, and when I was tentatively able to tell them it took pain away, they told me the pain had to be part of my seizures, because that was before they understood the role of anticonvulsants in treating neuropathic pain.)
But this kind of anticonvulsant – Neurontin, Lyrica, Trileptal, etc. – has been over-marketed to pain patients to capitalize on the fear of prescribing opiates.
Like, this kind of drug basically works on neuropathic pain, really really well. Not all kinds of neuropathic pain, but many kinds. More kinds being discovered to be helped by it all the time – like first they were very cautious and said it only worked in post-herpetic neuralgia or things like that, but then they slowly slowly started recognizing – like pulling teeth almost – each condition it actually worked for. And when it works on neuropathic pain, it works miracles. And opiates often work very badly on incompletely on neuropathic pain, so even if a neuropathic pain patient is on opiates they’ll probably do best also on anticonvulsants.
As I said, over marketed to pain patients who don’t have anything approaching this kind of pain.
Neuropathic pain is pain coming from the nerves (sometimes also used for pain originating in the brain like central pain). Certain anticonvulsants work on neuropathic pain because they have a specific effect on neurological functioning. They don’t just magically treat a thing called “pain” – they treat a specific neurological process that results in specific kinds of pain ONLY.
But because of the moral panic around opiates.
And because drug companies love to capitalize on things.
These drugs will get given to people for pain that is not AT ALL related to neuropathic pain.
They’ll be given to people with muscle pain, joint pain, musculoskeletal pain of all kinds, all kinds of pain that have no prayer of ever being helped even a little by any dose of any kind of anticonvulsants.
And that’s just twisted and fucked up to put people through that. Especially since anticonvulsants are heavy-duty drugs with heavy-duty side-effects that nobody should be taking unless they need them, especially long-term. Neurontin’s manufacturer actually got sued for false advertising over things like this.
Which had the obnoxious effect of people telling me to go off of Neurontin because “it only treats post-hermetic neuralgia and everything else is false advertising” which is bullshit too. Yes they did false advertising but post-herpetic neuralgia is hardly the only kind of pain it treats. It treats lots of kinds of neuralgia and other neuropathic pain syndromes.
And I have the most foolproof evidence that it works for me that I can possibly get – it worked for me in 1995 before I knew I had pain. In fact it taught me I had pain by taking away pain I’d had constantly my entire life up until the moment I took it. And in 1995 they didn’t know it treated the kind of pain I had. So the doctors didn’t know this would happen, I didn’t know it would happen, I didn’t even know I had pain, but when I took Neurontin my pain went away. I actually got my first adult Neurontin prescription by telling that story to a doctor, minus the name of the medication. She said “I know what medication you mean and I’m writing you a script immediately.” (As background – I was in a pain crisis when I saw her that time and was describing my past experiences, I hadn’t got around to telling her the name of the medication yet.) Like, it can’t get clearer than that, when a medication you’re taking for something else treats something you didn’t know you had and makes it go away so thoroughly that you suddenly understand what you had.
But despite that, and despite plenty of evidence that post-herpetic neuralgia is not some totally unique kind of pain with some totally unique mechanism that Neurotnin manages to hit without hitting any other similar kind of pain through the same mechanisms – I’d still get well-meaning friends trying to tell me that all Neurontin prescriptions that wern’t for that one thing were people trying to sell me a drug and that I was being victimized by being on it and etc. etc. etc.
But plenty of people were and are victimized by over prescription of anticonvulsants in pain situations that could not possibly ever in a million years be helped by any amount of anticonvulsants.
And plenty of people are being prescribed NSAIDs who would be better served by opiates or a combination of NSAIDs and opiates. Among other things NSAIDs rip your stomach to shreds. I have a long-term bleeding ulcer (it’s not bad enough to be dangerous from blood loss but it’s bad enough to cause me plenty of other problems in combination with my other medical conditions) so i can’t take NSAIDs for any length of time ever and it’s kind of obnoxious. Like, I took a child’s dose of ibuprofen once last year because I’d injured myself and was desperate for something, and the next day when I drained my stomach fluid out my feeding tube, the toilet was so full of blood clots it looked like a tadpole convention in there surrounded by red and brown murky water from half-browned liquid blood, and I had a constant metallic taste in my mouth from the blood refluxing up. That’s just one dose of NSAIDs – and not even a full adult dose, or the maximum child’s dose even – plus an existing bleeding ulcer. You can get a bleeding ulcer when you didn’t have one before, just from taking NSAIDs long enough, FFS. The stuff is just nasty to your body.
But there’s still doctors less afraid to prescribe long-term, high-dose ibuprofen than they are to prescribe long-term, low-dose opiates achieving the same effect. Yes, they’re finding opiates have long-term effects on the body that are not fully understood – including potentially sensitizing people to pain. No, that doesn’t mean that opiates still aren’t safer as far as they know than anything else out there. People whose pain is treatable by opiates, whose pain is best treated by opiates, should have opiates unless they have some good reason not to want them.
And there are apparently even ways to treat addiction such that people who need to take opiates for pain, and yet are also addicted to opiates – which does happen, even if it’ s less than 5% that’s still a lot of people who do in fact exist and need to not be disregarded because of statistics and fear of other kinds – such that they can get their pain treatment and not abuse the meds at the same time. This can happen. I don’t know how it’s done, and I don’t think it’s some kind of magic bullet of any kind, but it’s a situation that can in fact be navigated with enough careful support.
Situations like addiction to prescription pain meds when it does happen – the fact that everyone’s so hair-trigger about it on all sides – that makes it harder for people to come out and ask for help. Which makes it harder to get help. Which makes addiction worse. Not better. So everyone freaking out about this in that particular way, isn’t doing addicts OR legit pain patients (not to mention addicted legit pain patients, who may be rarer but are hardly unicorns) any favors.
