Painkiller Lesson #1: People who use opiates for any long period of time will develop a dependence on them. This means they will go through physical withdrawal if they suddenly stop taking their meds.
Note: By the way, if you are on serotonin-based antidepressants, and you discontinue them suddenly, you will get sick (known as “serotonin discontinuation syndrome”) – because you have become dependent on them. Call it what you like, pharmaceutical companies, it’s still withdrawal.
Painkiller Lesson #2: Here is where the similarity between addiction and dependence ends. With addiction, you will become anxious even thinking about running out, will spend a lot of time trying to figure out how to get them or the money for them, and basically become obsessed to the point of wrecking your life and the lives of those around you. As well as committing crimes.
“But,” you interject, “people who take antidepressants don’t act like that!” Well, you’re right. When was the last time you heard of someone holding up a gas station so they could buy an antidepressant?
Painkiller Lesson #3: People who take opiates for chronic pain do not hold up gas stations, become obsessed with drugs, lie, cheat, steal, etc in order to get them. They take them as directed, for pain. They do not get high on them. They are dependent on them, but they are not addicted to them.
However, if you look up deaths due to these drugs via prescription, illegal or not, you will sometimes/oftentimes find that the person took more than they were supposed to, very early on, and used the pills to get high. I qualify that because the human interest stories trotted out to support drug laws, I notice, have that component to them – misuse of the medication.
It is not the medication’s fault. It is the decision of the user to misuse them to the point of addiction, and THAT, my friend, is a personality issue. Having worked with this population, I have heard the story/lie that goes like this:
“I went to my doctor because I broke my foot, and he prescribed me Percocet. After the prescription ran out I realized I needed more, but my doctor wouldn’t give me any more because he didn’t think I needed them. So I went to the emergency room, but they wouldn’t give them to me either, saying I was drug-seeking! Well, my Aunt Jane had some spare oxycontin so she gave me some because I WAS IN SO MUCH PAIN! All of sudden, I realized I was addicted! So Auntie Jane introduced me to some friends who could get me more oxy, but I couldn’t afford it so I had to buy heroin! Had to! I couldn’t take the pain! After I got arrested for possession I decided to come here for help.”
Actually, the court ordered them to go for help (in the case of my last job, the court-ordered help was a methadone clinic, and THAT job will be a blog entry for another day) or they would go to jail.
Should the doctor have initially prescribed the pain meds? I don’t know. What I do know is the patient should have taken them as directed.
What I also know is the patient had added benzodiazepines to his/her drug regimen (“from my psychiatrist, because I have so much anxiety”), that were prescribed by a psychiatrist who either didn’t know the patient was on pain meds or didn’t know that benzodiazepines (Xanax, etc) combined with pain meds gets you really, really high.
So high you can stop breathing and die.
I know this because I have come across at least 3 psychiatrists who did not know that those 2 classes of drugs, when combined in a sufficiently high dose, can kill people, and/or are a classic combination amongst addicts. When a psychiatrist knows this, alarm bells should be going off.
I am not saying that shrinks should never prescribe benzodiazepines to people who are taking prescription opiates. All I am saying is he/she should use caution in prescribing, explain the dangers to the client, and keep a close eye on other symptoms of addiction.
It’s of course a tragedy when someone dies from a drug overdose, no one with a heart would dispute that. And I don’t write this out of anger for the hoops I have to jump through every month to get my medication, because it’s no big deal to me.
I am also familiar with the persistence of fake pain patients screaming for opiates and making everyone miserable in the process, because who wants to look like an asshole who doesn’t care if someone is in pain?
Perhaps this is where the naive doctors come in. Overworked and already stressed, I can see how someone could just write a script so they don’t have to argue endlessly with a patient when there are other, sicker patients waiting, and they want to give the insistent patient the benefit of the doubt.
I get it – addicts can be annoying, angry, manipulative, persuasive jerks who really only care about themselves. They take up a lot of a doctor’s time by arguing, and one way to deal with it is to just give in. I don’t blame the doctor for this. He/she wants to help people. It’s easy to get sucked into an addict’s orbit. It’s easy to believe addicts because they are so very insistent.
“Maybe you shouldn’t be a drug and alcohol counselor,” some may be thinking. That will be addressed in another blog, but suffice to say, yeah you’re right. My professional opinion is that, unless the personality component of addiction is addressed – and by “personality”, I mean “personality disorders” like narcissism, sociopathy, and borderline personality disorder – the high recidivism rates will not change.
Unfortunately, one of the hallmarks of a personality disorder is that the person doesn’t think anything is wrong with them. They know their behavior is different from other peoples’ but they think the rest of us are just chumps who don’t look out for #1.
And it’s kind of understandable in this culture, just look at people who are successful and I think you will find that a percentage of them are entitled and self-absorbed. The only reason anyone sees these folks in treatment is if they are forced to into it, either by threats of jail or some other huge personal loss (I don’t mean like death of a loved one, I mean losing their house or bank account – sounds cynical but I have seen it time and time again).
But I have gotten off track…
It’s not the fault of the medications themselves. Opiates are really good at what they are intended for – controlling severe pain, acute or chronic. There are no “moral” and “immoral” medications, so why treat opiates any differently than antidepressants?
The problem is some people – a minority of people – want to get high. They will use pain pills, heroin, cocaine, meth, alcohol, diet pills, cleaning solution, aerosol sprays etc to get high. Passing more laws isn’t going to help that. Making it harder for some pain patients to have access to pain meds (I am thinking specifically of rural patients, who don’t have the kind of transportation and other help we here in PA are so lucky to have) is not going to stop an addict.
Addicts are very resourceful and relentless. They routinely find ways around deterrents.
People who are sick with chronic pain can’t, though. Most of the time they are in too much pain to argue, advocate for themselves, hustle up cab fare to get to the doctor, or any number of things some lawmakers seem determined to put them through. It’s bullying, pure and simple, and these folks are easy targets.
So then Dr. Whatever and Mr. Legislator can tell everyone how they’re saving lives with their laws…and to heck with Granny who stopped eating and died because she couldn’t deal with intractable pain.
These people need to educate themselves.
Weirdness of the week is brought to you by the Sidney Morning Herald, via a link from the Fortean Times:
An invisibility cloak (sort of). I will get excited about this when they figure out how to embed it in a pair of jeans, to cloak the fat on my hips…
And today’s recommendation is for a book:
Accredited Ghost Stories by T.M. Jarvis, published in 1823. You can read it for free here:
Or you can download it free for Nook (and probably for Kindle too). I like this book, despite the errors (missing words and so on) that I guess are from scanning problems. It’s written in the style of that era, and it’s interesting to see how the narratives about ghosts have changed throughout the years.
In this book, the ghosts apparently return to either tell their friends/loved ones if their religion on earth is “the true one” (book doesn’t say which religion that is), or they want to right a wrong about land rights, treasure, etc. The veracity of each story is judged by the experiencer “being of good moral character” or an upstanding citizen. Simple, wonderful ghost stories from a simpler time.