Unless you’ve been buried under a rock for the last few years, you’re probably aware of the ‘opioid epidemic.’ I put the phrase in scare quotes because it’s an incredibly complicated issue that has been vastly oversimplified in the media, and that oversimplification has also served to demonise chronic pain patients, people addicted to opioid medications and/or street drugs like heroin, and clinicians attempting to address pain. The latest brilliant idea from the great minds of the ‘opioid epidemic’ is a proposed tax on medication that would be used to fund addiction treatment programmes.
Before I delve into the problems with the tax, a few things. Addiction is a very real and very serious issue. Opioids are addictive compounds, and some people who use opioids for pain management or recreational purposes grow addicted to them. If they struggle to access medication, they may turn to street drugs. Some people overdose and die. This is a terrible problem, and there is a discernible uptick in overdoses, illustrating that we have a public health issue we need to deal with.
Here’s who’s not responsible: The vast majority of the medical community, which attempts to prescribe pain medications for patients who need them while still using their best judgement to offer these medications, and support, responsibly. Chronic pain patients, who have serious medical conditions that cause extreme, debilitating pain that needs to be treated — untreated pain complicates physical health and can make people suicidal. Addicts, who are victims of biology, circumstances, stress, and a huge number of other factors.
How do you treat a problem like a growth in addiction? The government thinks that the way to do this is to crack down on availability of the addictive substance by terrorising chronic pain patients and doctors, setting up barriers to medication access, and now, creating a sin tax. I use the term sin tax advisedly here — because the government genuinely seems to think that pain management is a luxury, rather than a necessity. There’s a reason that pharmaceuticals aren’t subject to tax in almost every state in the union. Like food, they’re considered a basic necessity.
Taxing them sets them up as something optional, recreational, exceptionalising them from all other medications. We don’t tax boner pills, even though people take them for a recreational purpose, because we acknowledge that impotence is difficult and frustrating, and a serious drag on quality of life. So why are we proposing a tax on medications that people need to survive? The only effect is to penalise patients, and that’s why the tax is being put in place — they say it’s to fund addiction programmes (because apparently such funding isn’t available through other sources?) but it’s clearly calculated at shaming patients and making them bear an unfair cost burden for their medication.
There’s so little acknowledgement of chronic pain patients and their needs that when the subject of opioids comes up, they’re demonised if they come up at all. When the CDC released new recommendations for opioid usage, there were miles and miles of commentary about a ‘doctor driven epidemic’ and how we need to cut out access to these vital and powerful medications. With the tax, everyone’s celebrating at the idea of raising funds for addiction treatment off the back of patients obtaining medication they need to survive.
If people are really concerned about an ‘epidemic,’ and I’d argue that one overdose death is too many, they’d approach this situation from a rational standpoint that explores the root causes of addiction. The government wants us to think that the ready availability of opioids is triggering this problem, despite the fact that said medications aren’t nearly as easy to obtain as the government makes out. The real issue here is that addiction is complicated and highly stigmatised. People who experience the early warning signs push the issue to the back of their minds because it’s humiliating to be an addict, because society sneers at addicts. Consequently, at a stage when it would be easy to intervene, patients aren’t talking to their doctors about options. By the time their addiction becomes inescapable, it’s too late.
We should be destigmatising addiction. Creating an environment where doctors and patients can talk openly about medications and concerns. Building a framework for helping people get treatment that doesn’t penalise or stigmatise other people. In the case of chronic pain patients, doctors should totally be evaluating addiction risks and encouraging their patients to be open with them, stressing that they won’t be punished by having their medications yanked away. People need to hear that if they’re experiencing a need that has turned into a want, a craving that becomes all-consuming and intrusive, they’re in a danger zone, and there are options for them.
And we should be taking a look at the conditions that drive people to addiction. Untreated mental health conditions. Poverty and the desire for escapism. Unemployment. Oppression. Addiction doesn’t occur in a vacuum. It’s not as simple as a doctor handing a patient a script. It’s a complicated interrelationship of patterns that build on each other to create circumstances ripe for the development of addiction. We could punish chronic pain patients and make opioids into landmines, or we could confront the real problems here: The way this society treats addicts, and cultural conditions that feed addiction.
Image: Recovery, Michael Coppola, Flickr