Don’t talk about the ‘prescription drug epidemic’ without pain patients

Chronic pain is an incredibly persistent, frustrating condition to treat — and it’s also one of the most stigmatised. Several things are bound up in why chronic pain has become such a subject of derision, including the obvious and the more subtle. The obvious has to do with stereotypes about people who struggle with substance abuse, and the assumption that people who use opiods for chronic pain management are ‘junkies’ and ‘users.’ The second has to do with misogyny, because chronic pain is a condition that disproportionately affects women, and like many conditions associated with women, it’s not taken seriously as a result.

So, some facts: Chronic pain is very, very real. It can be the result of an underlying disability or an acquired injury. It can be spontaneous, with no apparent cause. It can be debilitating, interfering with the ability to work or function. When you’re in pain, it’s hard to focus on anything — not just working, but reading at home, watching television, caring for children. In addition to persistent low-level pain, flareups can cause a dramatic spike in pain levels. Pain management, meanwhile, remains in the 19th century, making it extremely difficult for patients to get their pain under control.

One of the cornerstones of pain management is that in order to be effective, it needs to be proactive. Thus, a patient who waits until a pain spike manifests to medicate will have a harder time controlling her pain than one who uses a base level of medication to keep pain levels low, and supplements when necessary. Sometimes pain will break through no matter what, but when patients can access the meds they need to address flareups before they happen — e.g. actually taking a pill every eight hours instead of waiting until they hurt, they’re more comfortable. Evidence also suggests that good pain management is better for overall health.

Yet, patients struggle with access — it’s difficult to get pain medications thanks to their status as a controlled substance, with doctors and pharmacies alike locking down on prescriptions. And they struggle with shame, because the common stereotype that they’re ‘junkies’ leads many to deviate from medication regimens, and they pay a high price. Instead of taking their medication when scheduled or as needed, they try to tough it out, which is not a pleasant existence. At all.

There are a lot of things to say about how society marginalises people with substance abuse issues, and how shaming people for something that can be the result of a quirk of genetics, circumstances, and other factors is singularly unhelpful. There’s a lot to say about how we don’t have good social supports for substance abuse counseling and addiction treatment, making it very difficult for people who want help to actually get it. But it’s important to note that pain patients don’t have a substance abuse problem. They need medication to function — just as diabetics need insulin and asthmatics need their inhalers, just as people with SMI depend on their medications to survive, just as patients with tons of medical conditions need medications.

Opiods are medications. If they are withdrawn, people can experience terrible symptoms, including death. Over time, patients grow tolerant and need higher doses or switches to different formulations. These things are true of many other medications — for example, I take a drug that can cause seizures if withdrawn abruptly, and another medication that constantly needs to be adjusted because I grow tolerant and stop responding to it, and eventually, I won’t respond to it at all and will need another drug. These are all things we acknowledge and accept about nearly every class of medication except opiods. We don’t say that diabetics are addicted to insulin or that access to inhalers should be limited.

Opiods are also used recreationally. I’m not going to lie. We should perhaps examine why recreational drug use is so stigmatised and why it troubles people so much — if someone’s drug use is not harming anyone, why do we care about which drugs that person uses? If someone’s drug use is causing social harm, then it becomes a larger issue, but is berating and shaming people really a good solution to that?

I bring all of this up by way of talking about the ‘prescription drug epidemic’ that periodically garners fearmongering headlines in the media as people talk about the ‘tragedy’ of overprescribed pain medications and the horrors of opiod abuse. And opiod abuse is terrible, and potentially deadly. But it is not the same thing as using opiods for chronic pain management. And people should not be having a conversation about the social role of opiods while leaving chronic pain patients out, which is exactly what they are doing, from the media to the government to members of the general public.

When people hear ‘opiods,’ they think ‘black market oxy.’ But for a fair class of the population, ‘opiods’ means ‘relief from the pain that would otherwise make it impossible to live a full, productive, and happy life.’ They mean ‘a reason to keep living instead of committing suicide,’ because, yes, pain can be so severe that people would rather die than continuing to endure it, and I know this from personal experience. They mean ‘medications I use to manage my needs.’

There are a lot of reasons why recreational users turn to opiods, why these drugs can be addictive, and how their abuse can have tragic consequences. But contextually, there are a lot of settings in which opiods are lifesaving and critically important — so let’s not forget that. And let’s not forget either that when you take opiods for pain management, you aren’t getting high. You’re feeling your pain recede. So when someone pops a Vicodin or washes down a Perocet, maybe don’t assume that you know how and why they’re taking that medication.

Image: Tiffany, Flickr