The Opioid Mess: Who’s to Blame for the Pain?

Yeah, I know. It’s been four months since American Waypoints got off the chair to write a post. Did you think it was because my candidate won the Presidency, so I just didn’t care anymore? Heck no. Here’s the thing: my alter-ego has been busy writing and publishing a second book. In my other life I’m a physical therapist for animals. But before that, I was a physical therapist for people, times 30 years. I know a little something about it. And I have something to say about the huge opioid mess we are in as a country.

Way back in the 1960s, 70s and 1980s, we in the medical profession did not focus on our patient’s pain. In the war years of the 1920-1950 era, pain meds were used with heavy doses for injured military. It was a necessity. But, back to the 1960-mid 1980s, less focus was put on pain and use of chemical treatment for pain symptoms. There were exceptions such as immediate post-op pain, intractable pain, incurable pain, terminal illness management, etc. Otherwise, prescribing Morphine, Codeine, Percoset, Vicodin was discouraged and ‘pain management’ consisted of healthy things like Physical Therapy modalities (TENS), Exercise therapy, Deep breathing, Acupuncture, Biofeedback, nerve blocks, etc.

Why? Because pain is subjective, you cannot easily quantify it. And because prescription  pain meds were known to be highly addictive. A slippery slope on both ends. That doesn’t mean a medical professional disbelieves a patient complaining of pain. But it does mean that the professional cannot afford to take only the patient’s word regarding the amount of pain and simply prescribe meds to solve a problem which cannot be verified as to degree of severity. This was how we protected patients. We believed them but offered many solutions other than, or in addition to modest dosages of pain meds. But this meant patients had to work through their pain and learn alternative ways of pain management. It also took more time. It also took dollars away from medication-prescribing doctors and toward allied health professionals such as physical therapists, acupuncturists, biofeedback technicians, etc. It also took money away from the pharmaceutical industry.

By the 1990s, someone found a way to shift dollars back to the prescribing doctors and the drug companies. That someone WAS the doctors and the drug companies.  A particular drug/PHARMA company found a way to formulate opium in a ‘synthetic’ way which was heralded as safe, having no serious side effects, yet a strong pain medication> Oxycontin. Wonderful. In 1996, a letter was circulated and published, giving doctors the all-clear to prescribe this drug. Did any of the doctors know the ‘if it is a snake before it bites you it’s still a snake’ story? Sure they did, but if PHARMA says it’s okay–I guess ‘we’re off the hook’. Money starts flowing into the drug company.

Now the doctors want some of the action. Many doctors sit on hospital boards and accreditation commissions and somehow, in the late 1990s and early 2000s, hospitals start having a change in thought on pain. Addressing a patient’s pain has now become a priority. Almost like a vital sign–though one which cannot be measured objectively. Other vital signs, like respiratory rate and pulse, are easily quantified. But pain is measured on a pain scale, rated by the patient. Wow, that was easy. You need surgery, go to the pre-admission testing center, and there is a nurse assuring you that your LEVEL OF PAIN will be a high concern to all of the staff. Yes, you will be asked to RATE YOUR PAIN at multiple intervals throughout your stay. So comforting!

A few years later, a new specialty of medicine appears: Algiatry. WHHAAATTT? Oh, that means Pain Management Specialist. But that doesn’t mean you will be taught alternative ways to deal with pain–well you might, but it will be less emphasized than using drugs.

Combine this with the “Mindfulness” movement and “be in the NOW’ idiocy of the last few years. Let’s all never get over ourselves, and focus on how we feel and how much we hurt. Hey it’s all about me, and I’m in a hurry. And I deserve to feel good all of the time in the easiest way possible.

By 2012, PHARMA makes prescribing new generation pain meds even more appealing by changing the formula of Oxycontin to contain ‘abuse deterrents’. Seriously, how has that worked out? Oxycontin is still opium. Heroin is opium. Opium is a seriously addictive and harmful substance. Our country now has a huge crisis on our hands and people are dying.

Who is to blame? Why try and find someone or something to blame? Because I believe it is part of the process of fixing it. Are the drug dealers to blame?

No. They are opportunity-seeking bottom feeders but I don’t issue blame to them.

Are the patients to blame? Yes- a bit. People are responsible for knowing about drugs they are prescribed and not simply leaving their common sense at the door to the doctor’s office. And sadly, many folks simply prefer taking the easier path to easing their pain. Pain should not be crippling, but we need to learn to adjust our threshold and take the time to work through it responsibly.

Are doctors and drug companies to blame. You’re darn tootin they are. Easy path to more revenue.  I’m praying that the paradigm shifts back to the days of working through pain by minimal use of chemistry and maximum use of physics.