In the 80’s the medical field was moving toward treating pain more aggressively, essentially with the intention of alleviating pain altogether – a goal that is both impossible and reckless. Pain was conceptualized as the “5th vital sign” and was measured as part of a standard exam (except that the other vital signs-blood pressure, heart rate, body temp and respiratory rate – are all actually measurable. Pain is subjective, which makes it really hard to say with absolute certainty what someone is experiencing on a scale of 1-10. This led to aggressive marketing campaigns for medications like OxyContin and much misinformation regarding the likelihood of becoming dependent upon these medications. By the early 2000’s, the Unites States represented 80% of the world’s Oxycontin sales and millions of people were addicted to opioids.
Many of these addicted patients were not “addicts” in the stigmatized, stereotypical sense of the word. They were “regular people” who were prescribed a medication by their doctors, and then became dependent. A few years later, medical providers started to panic because they had inadvertently created addicted patients, and their response in many cases was to simply stop prescribing the medications. These patients (often referred to as “opioid orphans”) were left to fend for themselves and either endure withdrawal (usually with no idea what was happening because they were told these medications were safe) or to buy these meds off the street. But when a single Percocet costs $20 and a bag of heroin costs $5, there was little choice. Hence, the opioid crisis was born.
Opioids are now intended as a temporary treatment for acute pain and do a lot more harm than good in long term. In fact, pain can actually be much worse after you stop taking opioids because your body is constantly trying to find equilibrium. If you are flooding your body with opioids your body will try to compensate creating a tolerance and withdrawal symptoms. When you stop taking these medications, everything hurts a lot more than it might normally, and it takes a long time to find that equilibrium again.
Regardless of whether or not someone is “abusing” their medications, using opioids regularly to treat pain is not a good treatment strategy. What these patients needs is:
education regarding the medications they have been prescribed and the effects of those medications
when applicable, providers should gradually taper these patients off of opioids and provide resources for addiction treatment if applicable
providers should explore other treatment options for pain such as physical therapy, acupuncture, yoga, meditation etc.
if patients are cut off from their medication suddenly, they need easy and non-stigmatizing access to drug treatment, including safe injection stations.