I am a retired service provider in mental health and addiction services. We adhered to the Tough Love method and using twelve-steps for years. Then one day after decades, I watched while an older, untrained, coworker worked two jobs, seven days a week to support treatment for her doctor son. He had lost everything. His practice, family, self-respect, extended family, you name it. Against the criticism and judgment she faced, she persevered for two or three years. Her partner, an older man, went after a fellow who stole her son’s car and was met with a knife. He said to the fellow, “I don’t care about the car. Keep it. I just want to know where to find my son, “Bob”.” Then this older man pulled “Bob” out of the squalid shooting-up den once again. Well, “Bob” found success in a spiritual, farm treatment program. Today, Bob is a distinguished doctor with a family, healthy and happy. I have known too many people who have lost loved ones. I quit smugly assuming that some people just do not have good boundaries! Then I did some research. I found out that medcation-assisted-treatment works. The numbers do not lie. Having used antidepressants myself, just who am I to judge! It seems to me that locating comprehensive treatment centers outside of major cities with homeless problems could work. It will serve to cut down on homelessness, litter, and paraphernalia, criminality, and save lives!
11
I have nothing constructive to add to all these posts. This is an extraordinarily difficult problem, and all the "solutions" presented thus far don't seem to be a "magic bullet". Re-hab is a joke, with the recidivism rate much higher than the "for profit" re-habs will ever admit to. Anecdotal evidence abounds, and the percentages of success are again highly suspect.
I feel that whatever "works" for an addict, works. Be it a 12 step program, auxiliary drugs, whatever. But it really boils down to whether an addict is willing to make a life change or not. If you really, really want to change, you can. It's a lifestyle change, and not easy-no one should ever say it is. But, in the long run, it's in your hands. All the other things are just a bandaid on a hemorrhage. Whether you find Jesus, or Buddha, or move somewhere else, it really comes down to what you want to do......for the rest of your life. Pessimistic yes, but a high cure rate.
3
I find this all very two-faced now that the face of addiction is white. Let's go back to what we said when it was "those low-life black addicts". Just because the addicts are white and not necessarily from the other side of the tracks, does not make them any better now that it is labelled a "disease". Most did not start with a legitimate prescription, they started because they wanted to by faking a terrible back-ache or toothache. They should be clean, not addicted to some other drug. They are still addicts if they dependent on buprenorphine. The only struggle most of the addicts have is where to steal money for more drugs. Society should't have to foot the bill for their bad choices.
1
At a risk of being called paranoid, I would not exclude a plot to promote artificial selection of the healthy people, by letting the opioid addicts die off.
1
suppose you are on a medication that allows you to keep living and that withot it you would sicken and perhaps die. maybe it is insulin or a blood pressure drug. nobody seems to make a big deal about it (other than paying for it, which is a different, related topic). but if you take a pain killer, especially an opiod, it is itself a disease and you are criminalized and denigrated because the pain you are treating is either all your own fault or is emotional rather than physical. you can be a fine person if you can't live without something to control your blood prssure, but you are the worst sort of lowlife scum if you can't live without painkillers. is this because pain is seen to be a symptom and not an ailment, or is it becausethe idea that to be freed of pain, and maybe even to enjoy life (even when by chemical means) is sinful? is this a medical issue, or a religious issue. compassion or judgment? Pasteur or Calvin?
13
Here's an interview in the New England Journal of Medicine with a doctor who treats patients with buprenorphine for opioid addiction. She describes the problems that are caused by needless legal barriers. Her article is behind a paywall, but the interview is free.
Perspective
Opioid Use Disorder and Incarceration — Hope for Ensuring the Continuity of Treatment
Ingrid A. Binswanger, M.D.
https://www.nejm.org/doi/full/10.1056/NEJMp1900069
Interview with Dr. Ingrid Binswanger on gaps in treatment for opioid use disorder for people who are incarcerated. (10:16)
5
The Editorial Board deserves credit for informing the opioid patient of the possible benefits of methadone and buprenorphine. The article states, "This denial of care is so pervasive and egregious, the report’s authors found, that it amounts to a serious ethical breach on the part of both health care providers and the criminal justice system."
We need to understand exacly why this is unethical. Is it merely that doctors are providing substandard treatment, or does this go much deeper?
The ethical issue is lack of Totally Adequate Informed Consent (TAIC). This is not possible in a power relationship. This is nowadays recognized in the case of slave owners having sex with slaves -- that is rape. Yet, when the regulatory system, the legal system and doctors exercise power over patients, TAIC is not possible.
The ethical argument for patient's access to methadone, buprenorphine, etc., is that obstructing patients from making their own decision violates TAIC. These violations are egregious and warrant the correct penalties -- these are not optional, but required.
12
I just wanted to correct a misstatement in this article. I have been an opiate addict for forty years and have been on buprenorphine for 12 years now. You state that methadone and buprenorphine do not give the euphoric high that other opiates do. That is only half right. Methadone gets you very very high. Just as high as heroin will get you. Methadone is much harder to kick then heroin because of its extrememly long half life. Methadone is a full agonist opioid. Buprenorhine is a half agonist opioid so you dont get the same high as a full agonist opioid. Methadone is by no means a cure all and is only useful because it is legal. I felt the need to clarify because for some reason people are ill informed that methadone “doesnt get you high like heroin” etc. when nothing could be further from the truth.
6
Thank you for your continued coverage of this health crisis, which continues to quietly metastasize across our country due to shame and stigma. Doctors need to be able to treat patients with substance use disorder based on evidence based treatment, including medication assisted treatment for opioids. Opioid use disorder is a chronic illness like asthma, hypertension or diabetes. It requires medication assisted treatment. It would be a cruel thing to tell someone with asthma "just breathe" or "go to a meeting" but not give them an inhaler. Why is patient medical care being driven by ideology and politics. Seems like the dark ages, sadly.
5
I am a MAT( Medication Assisted Treatment)RN and therapist working fulltime in the community with opioid addicts. I absolutely agree that not all opioid addicts are the same. Indeed they are snow flakes; each unique in chemistry and medical and psycho/emotional history. What works for one doesn't always work for every one. 12 step programs and all other recovery options and treatments are not right for every one either. We all have to find our own way in recovery. I can say that 70% of my clients have benefitted incredibly from Suboxone. In their words: " I feel like I can live again", " I feel like I can function and start my life over." "This is a wonder drug." " I can get on with my life I am not stuck any more in a horrible cycle."MAT programs work bets when they offer wrap around support services-- providing; counseling, case management and regular and consistent face to face unconditional support. It is unfortunate that the recovery community cannot get the science right and stop discrediting & ostracizing their brothers and sisters who have found real relief by using MAT and other medications to support their recovery. The stigma, misinformation and institutionalized discrimination are apart of the problem. Addiction and other medical diseases must achieve PARITY. To that end,I believe in and adhere to the Disease Model in my work. If addiction was seen as a chronic disease like diabetes or COPD there would be no discussion about the need for medication treatment.
7
OK, so many people in prison are addicted to opioids, and alternatives are not being made available to them. That begs the question, How are they getting the opioids? Why is nothing being done about it? It's not like nobody has noticed, or is it?
4
I made a comment supporting total abstinence in treating drug addiction. After reading more about this subject and talking to my friends who have kicked the habit, I’m even more convinced that any long term success depends on a cold turkey treatment sooner or later. Otherwise, addicts continue to be addicted to these substitute drugs. Full recovery depends on a total clean approach so that underlying emotional causes and conditions can be treated.
4
The comments make it clear that this story is more about decades long battle over how to treat addicts, not the decision to provide the two drugs mentioned in the op ed. Going back through the op ed, I could detect allusions to this battle that did not make much sense n the first reading. The author should have made that battle clearer in the outset before launching into a campaign to provide more drugs. I found it unusual how all these groups could be so wrong, in the author’s view. Every level of government, in every region of the country, city and rural, all are deficient. In 2019, you do not see that happen very often unless something else, much bigger, is in play.
The op ed should likely have addressed why giving drugs to addicts is better than X, Y or Z. Then the author could address, if you are giving drugs, why these drugs are the ones to give.
1
My sister in law has a prescription for methadone, to treat chronic pain from a stroke. She doesn't have to go anywhere every day to get it, so I'm confused, why does the article say you do? Is that just if it's to treat addiction? That seems strange.
1
This editorial was insightful and right on the mark. It's completely relevant to Stop Stigma Now (SSN), a nonprofit that looks to break the stigma of medication assisted treatment, and where I currently serve as its president. We are a public information group of dedicated drug treatment professionals determine to eliminate the stigma for opioid addiction treatments, which negatively impacts anyone taking methadone and other medications used to treat opioid addiction. Our mission is to inform the general public, the court systems, medical, nursing and counseling professions, public officials and the media about the overwhelming scientific evidence supporting the success of medication assisted treatment for opioid. If anyone needs more information, and/or literature, please look us up.
3
If I didn't know better, I'd guess the FDA and DEA are in collusion with the Big Pharma manufacturers of opioids to prevent addicts from receiving proper treatment that might reduce the bottom line and "shareholder value." The overall corruption legalized bribery in the form of campaign donations throughout our political system, along with the money corrupting the Drug War and the prison-industrial complex, makes such a theory highly plausible. But it can't possibly be true, can it?
5
American conservatives are not pro-life. They are only pro-birth.
5
This is not an Opiate Epidemic.
It's an Obama Epidemic.
He and his team saw a shortcut to get some cash to poor areas of the country when he took power in 2008 by making it easy to file for Social Security Disability Income.
Problem was, to get approval for SSDI, you had to have a legit reason. Turns out in the poor areas of this country, there are tons of doctors who will take you as a patient and declare you to be in 'pain'. Problem is..once they do that..they have to prescribe pain meds.
So...good intentions creating bad results...again.
Give those who are truly in pain their pain meds. Make them show up once a week to get refilled with a new prescription. Move as many as you can off of OxyContin onto Flexirel or Tramadol (nerve relaxer/nerve block) and show some tough love.
Pain sucks. Been there with a massively herniated L4/L5. Took OxyContin for 1 month and got off. Who wants to live their life in a fog?
3
This message should be on the front page.
3
I disagree that the solution for the drug abuse and other crises in health are other "miracle" drugs. I attend 12 step meetings where long time members consider the solution to be really working the program with a sponsor, serious attendance at meetings after rehab treatments and not more drugs. A good diet, and exercise routine as well as other program activity is enough for many.
15
So glad a 12-step approach worked for you, as it can for some people and some forms of substance use disorder. Congratulations on your sustained recovery. Unfortunately, most people with moderate to severe opioid use disorder are not able to quit or avoid a return to use without medications, leaving them at high risk for overdose. More research is needed to understand how these approaches may best be integrated and for who, after starting meds.
40
@Nutmeg There is enormous enthusiasm for any of the 12 step type programs, and in some cases they work.
However, I've observed that many of those enrolled in such programs are barely hanging on to sobriety, and often at enormous cost to themselves and their sponsors. Those remaining sober will attest to feeling better off, but certainly no walk in the park and for some, only minutes away from a return to their addiction.
The other part of the 12 step programs is that they really are a form of religion, and not a very popular one at that. I guess if I were faced with following an addiction or being forced into practicing a religion seemingly for foreign and immersed such as from atheism to hard core Catholicism, Muslim or Orthodox Jewish practices (as examples stereotypically seen as being incredibly devoted) I might consider it. But folks I've talked with say that if you don't buy the 'higher power' spiel that the rest doesn't stand on it's own, and there are those who feel more intelligent than buying into some fables, even if it is to regain sobriety.
Addition is a disease. We do not have any or many answers. We need some breakthrough understanding in ways to determine those who are genetically or otherwise predisposed to becoming addicted, and develop a 'vaccine' to block those initial triggers.
37
@Nutmeg
I 'm reaaly happy your approached worked so well, but it clearly does not work for everyone. People's minds, bodies and life situations are never one-size-fits-all. For people not helped by your method, we need other solutions. There should be no moral stigma attached to any medically sound method.
I encouraged a friend with serious obesity-related health problems to get a gastric bypass when no other weight loss method had helped her. I heard other people criticize her for "taking the easy way out" - - an inaccurate and pointless judgment. 15 years later, she is healthy and happy and alive, and I can't see that it matters how she got there.
81
This is fabulous. Except of course if you are in a 12 step program such as NA or AA. One of their favorite chants is "SUBOXONE ISN'T CLEAN!!" That's what they say - if you are taking this maintenance medication, even as prescribed at a VERY low dose (1 mg/day) to battle opiate or herion addiction you are not even permitted to talk at their meetings because they still consider you a drug addict. I attend NA meetings regularly but never breath a word about my Suboxone prescription. Nope, no way. They SHAME you publicly. It's very sad.
8
What about junkies who hoard their buprenorphine so they can be clean during the week and party with heroin on the weekend? That, and reselling buprenorphine to other junkies to pay for heroin, are some of the reasons these drugs have restrictions.
March 27, 2019
A pill is a pill is a pill......
Those wanting a quick fix for whatever aliment put themselves at risk and indeed the medical community is mishandling the patient that needs remedy emotionally and physically - Worst is the inability to know how to write laws that are best understood in like of today's Editorial
1
Wasn’t OxyContin thought to be the medication that people needed?
1
Want to Reduce Opioid Deaths? Legalize cannabis. Oh, but wait, then the big drug makers like Purdue Pharma wouldn't be able to addict an entire nation to their deadly lifetime drug schedules.
22
From someone with years clean from opiate abuse and years experience working in this field, the first thing I want to say is I do agree with this article but I do have some things to disagree with. This is pushing for the 3 drugs methadone, buprenorphine and naltrexone as alternatives for heroin or opioid abuse. The article is pushing funding as this is a healthy alternative that will take down death rates making the crime and danger of heroin use go away by using these instead. I do agree with this and would promote it myself. The one thing I disagree with is by saying that treatments dismiss this idea because they are choosing one addiction for the other. From my experience opiate addiction is mental and when someone just continues to use these maintenance drugs they overlook the underlying issues of why they are using in the first place. Instead of confronting the trauma or low self esteem of the individual you just focus on being addicted to a substance. I am not so close minded to not agree with this article and still promote more access to these drugs but just want to defend the ideals of some recovery institutions that will not administer it to their patients long term.
2
This article certainly does a good job of addressing part of our current system’s contribution to opioid overdose. However, as a person who has had the unfortunate experience of suffering from excruciating pain resulting from a botched surgery over the past year, I cannot adequately express in words how the government and medical systems approaches to the so called “opioid crisis” has impacted my recovery in the most dismal way imaginable. Having worked professionally in the field of Substance Use Disorders for almost 30 years, I know only too well about the consequences of opioid use disorders. But the concept that this is somehow new and suddenly a crisis at epidemic levels, certinaly does not sync with my 30 years of experience. But since I am limited in the amounts of letters I can use in this comment, I will use this to express my alarm over how people needing opioid medication for pain management are being treated (with suspect and shame). Doctors are being threatened an punished for prescribing to help patients. Pharmacies and hospitals have limited supplies that result in withholding necessary help for people in pain. Is it any wonder that people get desperate for relief and perhaps resort to desperate measures? This IS the “opioid crisis” in my opinion. Sure, it’s easy for those not suffering to prescribe mindfulness, ice packs and other non-opioid treatments for those who are screaming in intolerable pain. With so much more to say, I only have 13 words.
6
Sure, these meds can be helpful. But this editorial makes them sound far more effective than studies show. They work in terms of statistical significance, but are not incredibly effective.
1
Once, when refilling a low-dose hydrocodone that I only take occasionally, my doctor had (without asking/discussing with me) also prescribed an "epi-pen" type of buprenorphine... at first I thought, that was OK, wouldn't hurt to have on hand, if not for me, perhaps someone else. The problem was the pharmacy (which charges me less that $2 for 30 day supply) was going to charge me $5,000 because insurance wouldn't cover it. I didn't buy that... I couldn't afford it.
2
I had major back surgery in December. A 5 level posterior cervical fusion. They only provided me with Tylenol, Celebrex, Valium and Lyrica. I wouldn’ take anything but the Tylenol because the drugs they wanted me to take are not effective for me plus much more that I woun’t go into. Usually you get a pca machine until the next day or the morning after. I have had too many surgeries but nothing as painful as this was. They finally brought a pca after I screamed and cried in pain. When you have had major surgery and are denied medications that will relieve your pain I wonder how that’s supposed to reduce the “opiate” crisis. It is an absolute disgrace to deny and withhold medications because fentanyl has moved in and replaced the crack epidemic. How about stopping the illegal Fentanyl that makes its way across our borders?? No, let’s punish those who actually need the medications ‘cause it’s much easier. We can also blame the physicians and the legal company that manufactured them. They are easy targets whereas the Fentanyl creator sits back and counts his money.
8
Just stop the production of opioids for starters, but Big Pharma would probably howl and scream.
2
People with intractable pain are already "howling and screaming." "Solutions" like yours would only make the unbearable even worse.
7
Not everyone who gets high on opioids needs them anymore than everyone who got high on narcotics in the 1970s, 1980s, 1990s and 2000s needed them. Back in the good ol' peace, love, dope druggie days, it was common for youth to raid the medicine cabinet of parents and especially grandparents, etc...
One of my college friends stayed high for a solid 4 years off the grandfolks' who never seemed the wiser or didn't care.
THIS! So much THIS! It’s like we’re going backwards, not forwards, in our thinking, our rules, our regulations. We know what doesn’t work, so why do we keep making the same mistakes over and over? As long as there is misery, there will be a demand for escape from said misery. Address the real issues and stop chasing the illusion that we can control the problem by punishing the miserable. Get people the help they need and stop dicking around. How long does it take people to realize what they are doing is not and does not work? The war on drugs should have been abandoned years ago. One drug might be eradicated, but another will pop up to replace it. It’s; the way it is and always has been. Solve the problem by addressing the base issues. Heal the wound, don’t just slap a salty band aide on it. It doesn’t work and only hurts everyone.
3
The Cleveland Municpal Drug Court, where I am the public defender allows all medically assisted treatment, as does the Cleveland VA. One sad problem is that the Feds limit methadone treatment locales and some people travel over an hour each way.
2
Even though this medication saves lives, to visit a doctor to get Suboxone a patient must pay, out of pocket, upwards of $400-$500 to the doctor for the first "induction" visit. Patients who go through induction cannot get a refill for the prescription. They must visit the doctor again the next week, or two weeks, or month. That's not so bad as patients should be monitored by medical professionals to adjust doses, address issues and make sure it is working.
But none of these doctors, not one, take any kind of insurance payment. Yet they require the patient to return, month after month, with a cash-only payment.
So, for example, a patient sees the doctor the first month for $500. Then they must see the doctor every month at a "reduced" cost of $250-$400. Every month, no matter how long the patient is being treated; a year, two years, or ten years.
Also, a typical suboxone prescription itself costs in the range of $900-$1500 for a 30 day supply of the medication.
How many people who need opiate addiction treatment can afford that?
Not many.
And we wonder why they turn to black market dealers for help and wind up dying because some moron decided to cut the suboxone pills with fentanyl. The same goes for those who turn to heroin because it's all they can afford. 9 out of 10 times these days those people who only want help with their addiction are getting some potential fatal amount of fentanyl with the heroin.
The "War on Drugs' is a total failure.
4
@bartNJ I know from personal experience that some doctors who prescribe buprenorphine are much more humane than you describe.
2
Methadone 10 mg #90 is 12.24$
My perception of the crisis is that it is largely confined to uneducated, depressed white people.
As a Buprenorphine provider, I see no reason for the special licensing. There are so many other more dangerous, complex medications prescribed without restrictions. As for misuse a Buprenorphine crisis would still be better than our current Opioid crisis. If a provide has the authority to prescribe Opioids then they should have the authority to prescribe Buprenorphine.
5
Why have we not at at the very least, glanced in the direction of physicians, who also deserve a portion of the responsibility for the current opioid crisis? These are the professionals-- some of whom accept lucrative kick-back deals with the pharma co. sales forces--and who distribute the offending drugs to their unwitting patients. A conscientious physician should maintain a follow-up with each patient to determine if usage could safely be continued, or if there are signs of abuse, BEFORE it gets to the stage where a treatment like buprenorphine is needed.
1
Here's a surprise - the gigantic baby boomer generation is being kept alive by modern medicine into their 80s and 90s. They are not the cause of the opioid epidemic. As far as those doctors who prescribe oxycontin for a broken finger - I've never met one. Every doctor I know, including mine, is closely watched to see that he does not prescribe "too much" medicine for his suffering senior patients. It is ridiculous. The problem is with the young addicts, and those who take fentanyl, etc. We (millions of older people with arthritis, cancer and worse) are NOT the problem. Now we have two problems - the epidemic and the overly-suspicious supervision of normal, caring doctors. Those who cannot see any justification for opium prescriptions - well, if they are lucky they will get old enough to see how and why it's correctly used to treat chronic pain.
5
@Charlie Messing This is a newer phenomenon. Up until about 5 years ago doctors continued to prescribe opiates willy nilly. But I agree that patients with valid chronic uncontrolled pain should be prescribe what they need to function.
3
Stop the clampdown on prescription opioids and the deaths from overdose will drop. Many people who have had access to prescription opioids in the past have been forced into the black market to satisfy their needs. Instead of a pill produced in a controlled environment they are forced to roll the dice every time they buy something on the street. Chronic pain exists and opioids work. Forget the moral philosophizing and keep people alive with cheap prescription hydrocodone and acetaminophen tablets.
8
Having some personal experience with buprenorphine, I agree with everything this editorial says, but...I'd love the opportunity to write another column entitled "Stop Giving People the Medications They DON'T Need."
All medications have adverse effects, and the US has no sensible system for reporting them. Your doctors aren't required to report adverse effects and they don't.
Generic drugs (the ones we all take, in order to get insurance payment) are not required to stay current on their warning labels and can't be sued for faulty drug design (thanks to Supreme Court decisions of 2011 and 2013).
Over and over we've seen "blockbuster" drugs turn out to be deadly. Sometimes the dangers are known even before the drug hits the market, as with Vioxx and Celebrex causing thrombosis. Estimates of over 150,000 premature deaths.
Many of us remember Celebrex' advertisements, folks doing tai chi and "celebrating": another point--such direct advertisements are outlawed in all but one other developed country. Even the top medical journals are packed with advertisements for drugs--and of course they influence what's prescribed.
My own drug, and that of a number of my damaged friends (several are physicians, one forced to retire early) was a statin. There was no proof of benefit in my case, but yes, a permanent disabling, painful disease. Then buprenorphine for pain. Others are on stronger opioids--which they need. Your story? Send to [email protected].
2
>>> "My own drug, and that of a number of my damaged friends (several are physicians, one forced to retire early) was a statin."
Ah, yes. Nearly a third of people taking statins report muscle pain -- just the same percentage as those taking placebos in controlled, randomized studies. The incidence of serious muscle damage (rhabdomyolysis) associated with statin therapy is a few per million patients.
Soliciting "stories" is exactly the wrong way to gain meaningful knowledge about undesirable side effects of medication, but it can certainly feed poor judgment and misinformed activism. See the anti-vaccine madness.
The unfortunate way how our media has treated addiction in the country will take years and years to correct. The absolute domination of "clean and sober" as the only pathway to cure addiction, especially opioids, has been a public health disaster that will take nothing short of a culture change to resolve. I am definitely not knocking sobriety as a strategy--I'm knocking its supreme predominance as the gold standard of addiction treatment. The clean and sober narrative has been respouted for decades from excellent shows like The Wire to mediocre afterschool specials and it is a prime ingredient preventing the relaxing of all the many local and federal laws that stymie the greater availability of MAT.
5
@A
There are two (2) groups here: those that are suffering from pain due to a medical condition and are under the care of a physician, and those who buy illicit drugs to get high. The system needs to channel meds to the first group, and deny them to the second. The problem of over prescription needs to stay in the hands of doctors, nurses and pharmacists. The problem of diverting drugs to an illicit market needs to stay in the hands of the regulators and law enforcement. Denying pain killers to those who need them is not an option.
The current drug regulations just need to be enforced.
1
>>> "Denying pain killers to those who need them is not an option."
Denying pain meds to sufferers is *exactly* the option our system is currently promoting -- and enforcing.
3
The only way to stop the opioid epidemic is to get the docs
to stop prescribing the "killer pills". Especially Fentanyl.
Nobody knows how few doses it takes to create an
uncontrollable craving for the product.
Once addicted, successful rehab is a almost impossible,
no matter what the treatment because of the strong
influence of the drug.
The docs won't stop prescribing because of the demand
and they don't want to lose patients. Supply can't be
controlled because of the numerous illegal source.
Fentanyl can't be made illegal because half the lawmakers are probably on it and because of the lobbying from the
manufacturer and other big Pharma.
The only solution I see is to convince the general pop-
ulation that Fentanyl can kill and should be avoided.
The American Medical Association should urge docs
not to prescribe it and then FDA should demand it.
I am a recovering opiate addict, and, I have been saying they should be legalized for the past 35 years.
Alcohol does more damage to your liver than almost any other drug (except methamphetamine), and it is legal. Why? Because people have been drinking it for centuries.
One of the oldest cultures with exposure to alcohol are the Chinese, a 5000 year one. You don't see as near as many alcoholics who are Chinese, but they smoke cigarettes way more than most people in the US do. This is because they were not exposed to tobacco until relatively recently. The same goes for many Asian cultures. After the Vietnam War, most citizens (who survived the war) had begun smoking cigarettes. You get the point.
4
Everything in life has become so across-the-board reactionary. Right off the bat this issue began to affect all those people taking pain medication for valid reasons without any other recourse; alleviating debilitating pain that without proper treatment often leads to suicide. I keep two very basic, non-addictive, T-3s with me all the time to offset the deep abdominal pain caused by surgeries related to peritonitis; itself caused by doctors who would not believe me when I told them I had ruptured my appendix. (They work for me. I don't need anything stronger. I don't need anything weaker.) Hours of dealing with such head-banging pain is enough to hurl your body off a cliff - if you didn't have something to mask it. Now, however, I could be arrested by a newbie career-hungry cop for carrying these two little pills. I was once interrogated about them by TSA! I'm not about to carry the whole doctor's prescribed bottle around with me because a 3-month supply lasts me a year or more. I also now have to take drug tests for the few that I do use, and before renewing the infrequent, 18-month to 2-year, prescription. Going to the doctor now is like an inquisition. I've once had a doctor refuse to renew the prescription, even though medical records clearly show the infrequency for which I need them! It surely cannot be that hard to determine those who need such pain medication and don't abuse it, to those who, for whatever reason do. This reactionary approach accuses everyone.
6
@James Devlin you are correct. And at the same time, I am reading more articles advocating that pain riddled seniors just use cannabis (because, well 30 states have legalized it and maybe that is to assuage a conscious of doctors who will abandon pain riddled patients!), without acknowledging that the Federal Government healthcare entities will not prescribe it - that is Medicare, Medicaid and the VA!
1
The fact that the concept of "character" is thrown into the debate whatsoever is short-sighted and non-germane, and the anti-scientific misconceptions about methadone, buprenorphine, and extended-release naltrexone are mind-boggling, especially when coming from those in the medical community.
Mistakes can and will be made; the lifelong battle of recovery is reminder enough. One unfortunate lapse of judgment should not be a death sentence. Opioid use disorder is a real, manageable disease. Hiccups may happen along the way, but these hiccups are present when treating any disease.
These medications save lives, end of discussion. How we make them available, affordable, and safe is another question, but the evidence is clear that we need them and I find it alarming that there is still so much resistance to scientific fact.
3
One thing is for sure, if you're in severe pain, and you're denied pain killing medications, you begin to loathe whoever denied them to you. This anger grows along with the severity and duration of the pain.
In 2014 I had my left leg amputated below the knee. I was broke, so the County offered me a bed at a charity homeless shelter in Minneapolis. I accepted their offer, but the shelter required that they control all of my prescription medications. The staff at the front desk who stored and doled them out were not pharmacists, nurses or doctors. They had no medical license or training. After it became obvious to me that access to my medications was viewed as a negotiation by the Staff, based on whatever criteria they wanted to use, I refused all new prescriptions from my doctor.
In depth psychology they have a term called compensation. My anger toward the staff was a compensation for every bit of pain I experienced.
4
I have been a probation officer, a social worker, and now a facilitator for a group of people in recovery. Addiction is a complex issue and EVERY effective tool should be utilized to help. Medically assisted treatment is enormously beneficial and combined with individual therapy or mutual aid group (think AA or Smart Recovery), the chances of living an addiction free life increases. This is an excellent article that every politician should read. The strict requirements on doctors, clinics, prisons, etc need to be re-evaluated and soon.....lives are at stake.
3
Treating addiction is not the same as treating the flu; it is absurd to think that a doctor's office is prepared to offer the myriad of things that addiction treatment requires - psychological counseling, drug testing to ensure the patient has not reverted to illegal drugs, perhaps job counseling, help with housing, help with legal problems. Treating addiction requires a broad spectrum of remediations, not just a script for a substitute drug.
The editorial is spot-on that methadone and related drugs need to be more widely used but to thrust this problem into the laps of doctors who apparently want nothing to do with addiction treatment, given the 7% figure cited in the opinion, is asking for trouble. What is needed is more funding for addiction clinics that provide these drugs but also all the other things that go along with meaningful treatment.
4
I wish the press would report on the obstacles that people suffering from chronic pain have to overcome because of restrictions and reporting requirements imposed in an attempt to deal with this crisis.
I have been suffering severe pain for seven years, as a result of medical malpractice. Without these drugs, I would be curled up into a ball in a nursing home.
All because a group of people have made the choice to escape from the reality of their lives. I read these comments and there seems to be a universal belief that an addict has no free will to say “no” to doubling doses of pain pills prescribed by a doctor for an injury. Similarly, no one has free will when they are offered heroin. These addicts are all innocent victims of the drug industry, over prescribing doctors and everything but themselves. Do you know how disempowering it is for people to be told they have no free will?
And because these people have decided to take those extra pills, people like me have to pay the price. Chronic pain sufferers should be exempted from state and federal rules which limit the amount opioids doctors can prescribe, require originals of prescriptions, etc. Living in constant pain is bad enough without these additional restrictions.
5
@Bathsheba Robie
The choice most illicit users make is not to escape their lives as you put it but to get relief from pain that is otherwise refused to them by doctors.
1
Addiction is not about the substance but your relationship to it. This is what my doctor said when I was given my first dose of Suboxone (a buprenorphine/naloxone sublingual prescription)and that advice and prescription saved my life. He also said that I had to participate in a Twelve Step program. The Suboxone gave me the reprieve from the physical addiction long enough to change my relationship with the substance through the twelve step program and I have been drug free for ten plus years now.
4
As a recovering addict using Suboxon the problem is even worse than described here. If you are a Suboxon user and go to an emergency room, fully insured, when the doctors find you take this medication, that is the attributed cause of the your problem. I’ve seen and heard from people who experienced this time after time.
3
I agree with the NYT editorial on how to reduce opioid deaths. The unfortunate issue is a restrictive policy in most 12-step programs which expect total abstinence from its participants. They see use of medications like Methadone or Suboxone as substituting one addiction for another.
I believe 12-step recovery programs (AA, NA, etc.) for addicts and family members (Al-Anon) are a demonstrated successful approach to recovery. However, we need to remove barriers and broaden our approach by accepting variations to the 12-step model to include evidence-based methods supporting alternative medications. Recovery is not a one size fits all outcome. Certainly the recovery community has the heart to be secure and caring enough to welcome all who are serious about achieving recovery and serenity.
6
I am almost afraid to read the comments posted to this article. People are usually ignorant and judgmental about addiction, but when medication assisted treatment is the topic, people really show their behinds.
I was a pill addict for 15 years and graduated to heroine briefly. I am a good person. I have a very strong work ethic. I am a taxpaying citizen.I go to meetings twice a week at a 12 step program because its not just about being clean - living a life of recovery demands it. I am a good mother to my 5 children who are all very successful in their own lives. I am chubby, but healthy, and all thanks to 4 years in a Suboxone program.
My physician is retiring. I am petrified.
4
Evidence referenced here suggests these drugs could be a powerful help for people struggling with addictions, and not an expert in addiction, I'm all for it.
But let's not forget about the power of hope to reduce the allure of addiction. When our government, for myriad reasons (rabid politcal dysfuntion, devotion to donor class, etc) no longer represents the needs of people, and the "system is rigged," hope is lost.
I know addiction is complicated, many causes and complex remedies, but it is all "hopeless" when folks have no hope in their lives.
5
How about the demonizing of people who take opioids as they're prescribed and meant to be taken? On an occasional basis, to ease pain and allow them to function.
And also the demonizing of doctors who legitimately treat pain and prescribe opioids on a responsible, closely-monitored basis so their patients can function without pain and misery?
Recent PR frenzy and changes in laws, regulations, and coverage by prescription plans all place a larger onus on responsible doctors and make responsible pain-sufferers feel like criminals!
As a direct result, doctors often don't prescribe adequate pain medication (or ANY! "Take a couple of Naproxen and call me if you're still in pain tomorrow"!), even after "minor" surgery, dental surgery, and seeing patients in terrible pain from flare-ups of chronic pain conditions.
Abuse of opioids by some is a serous issue, to be sure. But making responsible pain-sufferers suffer more is not the answer!
6
So many comments about how addicts should act and how addicts should use the few resources available to less then 20% of them. I even read that their addict friend talked too much when they were on buprenorphine and it was not them talking it was the drug. How hypocritical. So many opinions from so many with no experience. There is no point where you are finished when you are in recovery. There is no clear point where you can say, its over or that you won. Relapse and death can come from meeting the wrong person at the wrong time in your life and then its over. Allow these people suffering from addiction to use the very few resources available to them judgement free. Let them substitute one addiction for another or talk too much or whatever keeps them alive longer. For too many people with this disease its a death sentence. They are someones friend, parent, child. I hope we can all remember that when we say, addict.
4
@Mark
Amen, brother. Speak on it.
Perhaps people can substitute splenda for sugar without comments from the people who don't use sweeteners at all.
Perhaps people are their own best informed care-givers. The problem is these groups of people who want the government to stay out of their lives, but only when it comes to letting them make money. Otherwise its a sermon everyday from them about what you can and cannot do with your own body and mind.
1
The April 2019 issue of The Atlantic contains a book review of: "Mind Fixers: Psychiatry's Troubled Search for the Biology of Mental Illness" by Anne Harrington. The review was written by Gary Greenberg. In the review, Greenberg cites Harrington's acknowledgement of how little the underlying biological causes of mental illnesses have been parsed, and that most are no better understood today compared to a century ago.
The book acts as a type of caveat emptor. It warns those engaging at the [psychiatry/specialist/patient] interfaces of the uncertain state of the current science of psychiatry. Greenberg writes that: "... This is not a story of steady progress. Rather, it's a tale of promising roads that turned out to be dead ends, of treatments that seemed miraculous in their day but barbaric in retrospect, of public-health policies that were born in hope but destined for disaster."
Overall, the review provides some historical context with which to better grasp the current issues surrounding opioid treatments; and, how empirically sound treatments today could lack in universal acceptance by practitioners.
[03/27/2019 W 9:44am Greenville NC]
2
Want to Reduce Opioid Deaths?
Inform people about the endless, excruciating, hellish pain they'll suffer if they use opioids. Provide ample sickening graphics in support.
(Of course, just like remedial medications, in the long run this strategy probably wouldn't do a lick of good for users.)
1
How's this for another idea? Stop prescribing opioids for pain.
Take a look at this: https://www.livescience.com/64329-opioids-chronic-pain.html.
Opioids don't really work, though I imagine that make you not care particularly much about the pain you are feeling.
In this, the opioid manufacturers - and we know the primary Big Pharma company we are talking about here - were and are no better than illegal drug manufacturers and cartels, who used their established network of dealers, i.e., doctors, to make them billions.
Even penalties in the tens or even hundreds of millions will do nothing to charge their practices or get these drugs off the market.
1
Well, once again this country ignores the answers to questions!
At this time I'm paying $11 a day for my grandson's addiction treatment at the local methadone clinic. They don't take insurance or checks. Cash is preferred. Credit cards allowed as I've just found out.
How many of you out there are able to do this for a loved one?
I think of the man in NY State who went to a Trump Rally, managed to get into the front row and ask Trump what he intended to do to help his son who was in need of treatment for drug usage. Trump promised to have many, many, many clinics for all who needed them. Today that man grieves for his dead son who never made it to a Trump clinic because they don't exist. Another broken promise from a man who so easily promises and so easily reneges.
Now he wants to dismantle the ACA. What a great guy.
2
Vancouver, BC already does most, if not all, of this yet still has extremely high death rates among addicts. Reducing heroin supply is a necessary part of the solution.
2
A question scientists should be asking is: can products based on the coca leaf be helpful in the opioid epidemic? Emphatically, this is not about cocaine, which contains about one half of one per cent (0.5%) of what the coca leaf contains (over sixty active ingredients) and is the 'big-kick' part of the coca leaf. Indeed, for most people, cocaine is a nasty drug. However exciting it may appear to be initially, in time it proves destructive.
But the coca leaf has been used traditionally by Native American cultures in South America. The Incas, for example, built a civilization around it, adapted to high-mountain living, as W.Golden Mortimer showed in his masterpiece, History of Coca, 1901. So evidence shows that there is nothing intrinsically harmful about coca. Except making it into cocaine.
Now two properties of coca are interesting for the opioid epidemic. First, it has analgesic properties. Second, after reacting with lime, it supports mental clarity and sobriety. So possibly some correct formulation of coca leaf could help an opioid addict with pain and also help some percentage of addicts to become free of opium-based products, when the person is part of a program designed to combat addiction. A fortunate synergy, if true.
Undoubtedly, increased scientific interest in and knowledge of the coca leaf is warranted.
"This denial of care is so pervasive and egregious, the report’s authors found, that it amounts to a serious ethical breach on the part of both health care providers and the criminal justice system."
There has been an ongoing ethical breech on the part of the medical community in their approach to treating addicts and addiction for as long as anyone can remember.
When the best most of the medical community can do is abdicate their responsibilities to their patients by sending them to groups who practice pseudoscience to treat their medical problems, you know the entire field has serious issues.
1
I have severe chronic pain related to cancer treatments. I take a small doses of oxycodone every day. I do not like the drug and it gives me absolutely no sense of pleasure, but it reduces my pain by about 50%. Don't deprive me of my needed medication, in an effort to solve a different problem.
4
The hurdles to medical providers needs to be highlighted. I am a retired NP. When any provider hears that they need additional hours of training, plus a special license- it is a put-off. The FDA restrictions do not encourage providers to use buprenorphine in their practice. And the lack of funding to foster this transition in care does not help. Without a doubt, this is an important adjunct in fighting the opioid crisis. The FDA needs to append their regulations, and work more pro-actively with providers. They needs to do more than send memorandums to providers.
68
@Betty exactly. Let doctors prescribe treatment based on science not ideology. We are letting shame and stigma fuel this crisis.
3
Might these problems owe something to a reluctance by Republican legislators to risk offending evangelical voters and donors who may view opioid dependence as purely a moral failing?
3
My son gets a Vivatrol shot once a month (naltrexone extended-release covered by his ACA insurance policy). Here are reasons it has been more effective for him than Buprenorphine:
1) Very few doctors prescribe it. Many doctors that do prescribe it don't accept insurance. Some prescribe it for cash after their regular office hours are done for the day. Those offices feel like the pill mills that got people addicted in the first place.
2) Buprenophine has street value among addicts who can't afford to see a prescribing doctor or who don't have insurance for a prescription. Disciplined people in long-term recovery will not buy, sell, or trade. However, many in early recovery see it as a commodity. That mindset endangers success.
3) It has to be taken daily - sometimes twice a day depending on the dosage. If the addict doesn't have the second dose in their pocket and they start getting uncomfortable, they'll reach for the most convenient solution. As my son has told me a million times, he can find a dealer anywhere, anytime. When he couldn't find a dose of Buprenorphine to calm the cravings, one of those convenient dealers inevitably popped up out of nowhere to solve the problem.
After trying Buprenorphine several times and experiencing all of the above, a rehab counselor suggested Vivatrol as a longer-term solution. So far it has blocked his cravings for over a year. Pot helps too because it calms the anxiety. Both need to be part of the conversation about solutions.
65
@Kaye
Unfortunately Vivitrol is not as effective as buprenorphone and is associated with more deaths. https://www.nejm.org/doi/full/10.1056/NEJMoa1505409 https://www.ncbi.nlm.nih.gov/pubmed/29560596
I would urge you to see an MD rather than a rehab counselor.
According to the Times:
... some of its marketing tactics, and Mr. Price’s comments, ignore widely accepted science, as nearly 700 experts in the field wrote the health secretary in a letter.
Not a single study has been completed comparing Vivitrol with its less expensive competitors. Some studies have shown high dropout rates, or found that many participants returned to opioid use while taking Vivitrol or after going off it. In one study that the company used to secure the Food and Drug Administration’s approval of Vivitrol for opioid addiction treatment, conducted with 250 patients in Russia, nearly half of those who got Vivitrol failed to stay abstinent over a six-month period, although they stayed abstinent and in treatment longer than those who got a placebo.
https://www.nytimes.com/2017/06/11/health/vivitrol-drug-opioid-addiction.html
4
@Kaye You highlight a great point: bupe, just like methadone and vivatrol, are not silver bullets. The medical community needs all available options on the table to help people with medication assisted treatment on an individual basis.
3
@Norman
Vivatrol is administered by a doctor, not a rehab counselor. The counselor recommended it as an option because nothing else had worked. Although the study you cited may have some validity, the buying and selling I witnessed with Buprenorphine made it problematic and to my mind, exacerbated the problem. Many hardcore addicts are skilled scammers and street chemists who know how to manipulate the use of Buprenorphine for purposes other than recovery. The reason Vivatrol has been effective for my son is because it keeps something he can sell out of his hands. Addicts will use anything to negotiate their next high. One way to stop that from happening is to limit their access to a negotiable commodity. Studies aside, that's the harsh reality of how things go with long-term addiction.
2
I have a waver and have been interested in Buprenorphine for injured workers who secure opiates from physicians who are not handling their injury claim. They pay out of pocket and use the opiates, often liberally. This makes advancement of their claim to return to work or retraining more difficult. They all have some type of pain, often chronic ,for which opiates are not indicated. The difficulty with Buprenorphine, at the present time, is that it is indicated only for Opiate Use Disorder and not FDA approved for treating pain, chronic or otherwise. I believe use of Buprenorphine should be approved as an opiate alternative for any chronic pain patient already on opiates over 3 months.
63
@Robert Lang MD
I suggest you go back and read some more about buprenorphine.
Long before it was approved for the treatment of opioid addiction, it was approved for the treatment of pain and continues to be marketed for this. Furthermore, prescribing it for pain does not require a waiver.
8
@Robert Lang MD
Three years ago, one of my cats received it for cancer, when I insisted she should get an opiate before being euthanized. The first dose was supposed to be the last, but it worked so well that we took her home, got her prescription extended, and did hospice for three good weeks. She was like a new cat the minute she received it, and remained lucid, comfortable, active and affectionate even as the cancer advanced.
From that day to this, I have wondered why it isn't used for chronic pain, because it has so many fewer side effects than standard opiates and is less addictive.
13
@Robert Lang MD I think that buprenorphine can be prescribed for 'moderate to severe pain'. See https://www.drugs.com/monograph/buprenorphine-buprenorphine-hydrochloride.html. In any case, many licensed physicians use it for pain off-label. And these physicians are the ones whose records are checked so carefully. So it must be legal.
1
My life partner, Cayman Mooney, began abusing opiates when he was 13 and transitioned to heroin when he was in law school in his late 20s (where he maintained his scholarship and graduated with honors and his choice among jobs). Although nearly all of Cayman's friends in school were dependent upon Adderall and anxiety medication (and alcohol) to keep up with the pace of their studies, Cayman was given a ultimatum by his judge of "character and fitness": give up his professionally prescribed, non-euphoric buprenorphine which kept him clean, or be denied license to practice law. As a result, I was widowed at the age of 30 and will spend the rest of my life aching for my best friend.
137
I read Cayman’s obituary. As a father it breaks my heart knowing that such an accomplished young man died so young.
My condolences.
21
@Rhiannon. My heart aches for your loss. I have two addicted daughters and I live with the specter of their deaths and the knowledge of the dangerous and degraded way they are forced to live their lives daily. Only those of us with addicted loved ones can truly understand the cruelty and twisted logic of the current laws and medical responses to this absolute crisis. "How many deaths will it take 'til they know that too many people have died? The answer, my friend, is blowing in the wind; the answer is blowing in the wind."
24
@Rhiannon I am a lawyer. I don’t believe any state bar has the power to deny someone a law license because they are taking a drug. I think the real reason for the rejection is that they did not want some addicted to drugs practicing law.
2
I’m on buprenorphine myself and have been since last June. I tried wearing myself off opioids for three years with no result other than a worsening addiction. I would have been ecstatic to have been given this at the beginning; it would have saved me a small fortune, not to mention preserved my general health. Trust me when I say the withdrawal symptoms are worse than any cold or flu you’ve ever had. It’s worse than the worse hangover you might have had — but unlike hangovers, it gets worse with time, not better.
This medicine is the key to our national opioid crisis. Period.
121
As an addiction physician, I really appreciate how well-informed this article is, as well as the editorial board's use of destigmatized and medically accurate language. It really has been a struggle to get my patients the medications they need but fortunately Massachusetts, where I practice, has made great strides. I am hopeful to see the tide turning when it comes to awareness but we still have a long way to go.
136
@Payel Thank you for a reality check. I had a great deal of problems in obtaining pain relief for my dying wife, stage 4 esophageal cancer. The local docs were concerned that this 68 year old woman dying of cancer would become an addict, yes, really! We had to go over 250 miles away to a research university to get responsible palliative care (on a weekly basis).
85
@njn_Eagle_Scout
I've wondering why buprenorphine isn't used for pain relief in place of true opiates. My cat received it for terminal cancer -- I insisted to the vet I was not going to euthanize her unless she went out purring. We gave the first dose, and she started purring and playing again, lucid and free of pain. It gave her three happy weeks more.
But we had to fight for every dose after that first one, based on both disapproval of our hospice decision and the bureaucracy of dispensing it.
I can't imagine how much harder it must be to obtain it for human beings.
44
@Scott
Methadone is underrated as a chronic pain medication. A family member has used methadone for over a decade - no psychotropic effects, no dose escalation, and effective pain relief, allowing an active, productive life.
Methadone has a bad reputation in large part because of its role in detox, which is often complicated by multi drug use/abuse, poverty, and other stressors. It has a relatively slow time to peak blood concentration, which means it should be carefully monitored in the initial phase of use. This slow change in concentration also makes it more effective than drugs that build up and metabolize away rapidly. Lack of dose escalation seems to correlate with the fact that methadone does not affect the NMDA receptor, unlike other opiates. This receptor potentiates pain perception -, while an opiate like morphine affects the mu-opioid receptors (inhibiting pain), it also affects the NMDA receptor (increasing pain perception) - hence, the dose escalation commonly seen with many opiates.
13
I was one of those French doctors (now retired) who started prescribing buprenorphine when it first came out in France over twenty years ago. The results were spectacular: even long time addicts (mostly heroin then) were able to start leading normal lives.
At the beginning, doctors were stigmatized for "daring" to help the opioid addicted. Now they're just a part of any general practice.
156
Yeah too many obstacles and another example that patient care is not the goal. Social control and profits are the primary goals.
Treatment should never keep people prisoners. It should free them to be living a healthy life.
1
Isn't the way to prevent opioid abuse to simply cut the supply of the pills. In all the discussion of this crisis, I have never seen any attempt to find the doctors that over prescribe these medicines, which would seemingly be easy given the paper trail. I realize opioids are available from smugglers and all that, but The Sackers didn't get rich from smugglers purchases. This seems more like the financial crisis of 09, when a major crime was committed but surprisingly no one was responsible or was punished for the crime.
1
I'd just like to add that I suspect dental pain is one of the major reasons people turn to opiates. Dentistry is so expensive, that only the very well-off can afford it, and dental pain is extreme, as we all know.
1
Nah, we pain patients have a much better solution now than having to suffer indignities at the hands of the medical community and politicians. Thank god for the friendly neighborhood heroin pill (which are now a reality, thanks to the CDC and Andrew Kolodny) dealer.
1
I'm an emergency physician and recently went through the training to prescribe buprenorphine. Our emergency department is setting up a program where we will give a short supply of suboxone to get started and directions to follow up with an open access clinic to set up long term treatment. The potential problem is we are being funded through a grant, to train the docs, set up the clinic etc. What happens when that grant money disappears? More funding is necessary, as opposed to the lip service that most politicians give it. I can't go a single shift without seeing at least one person with an opiate related problem, whether an overdose, someone looking for detox, complications from use etc. I don't think most people and certainly most politicians really have any idea how bad this problem is unless they have some exposure to it.
11
This is a great article- just a few additional thoughts:
- Thank you for not using the words "addicts" "substance-abusers", etc. We need to remind ourselves that these are people and not their behaviors.
-As someone working in infectious disease, being able to take someone from injecting, smoking, etc has such profound public health effects. These medications should be also seen as ways we can reduce someone's risk in acquiring lifelong conditions.
-Going after the Sacklers/Pharma/etc is part of the plan but the other part is we need to completely shift our preconceived ideas of who uses drugs in America 2019. It is not helpful to hold onto these outdated/unproductive views of a person who uses. We have to get better and do better in helping people get supportive, evidence-based treatments.
7
There is no "opioid crisis". There is an illicit fentanyl crisis. People under managed pain care do not abuse. Taking opioids or opiates as prescribed does not lead to addiction. Abuse leads to addiction. Don't punish pain.
12
@Rescue2: Hear, hear! Nailed it.
1
@Rescue2 you are incorrect...iatrogenic addiction after using pain medicine as prescribed most definitely is a known risk of using opiate analgesics.
What is the problem with congress to pass the laws of using Buprenorphine to help drug addictions? If the effect is so obvious, passing the law should be straight forward. I wonder why the leadership of congress and senate cannot see the solution?
4
@Usok We are the most puritanical country in the west. Pull yourselves up by your bootstraps!!! But alcohol is just fine.
1
People who misuse opioids do so with their eyes wide open. They do it by grinding up the tablets and snorting them.
They aren't victims. The way to reduce opioid deaths is for people to decide whether or not they want to be addicts, and if they don't, to then not misuse a very good medicine that is essential for millions and not misused by millions.
There have always been addicts--they shift their drug preference over the past dozens of years, but that's all. The rest of us seem to be constantly chasing after them to try to find ways for them to stop. But why?
Maybe we need to just let them live their lives as they have chosen.
4
I am a member of that 7% of physicians licensed to prescribe buprenorphine. I agree with the NYT that medication-assisted treatment for opioid addiction is the most effective treatment available. 12-step programs have proven incredibly ineffective for all types of addiction. To place an opiate addict in such a program without offering medication is often a death sentence, as illustrated by rising opiate-related deaths.
16
@CA Twelve step programs are incredibly ineffective? I'm not sure under what rock you're living, but it works for people who want to get sober more than anything else. However, they also have to go to ANY LENGTH to get it. That second part is where people fail, not the first. Almost any residential or intensive treatment facility will tell people they will relapse if they don't attend twelve step meetings. For those of us who actually want to do the work to get sober, it works.
@EJT: Sounds like you're OK with people failing, or dying, if they "don't want sobriety more than anything else."
Heads up: What works for you may not work for everyone else. And those for whom it may not work deserve options that could work every bit as much as you deserve yours.
And CA is absolutely correct: 12 step programs have statistically *terrible* results for people with opioid dependency/addiction..
7
@EJT Efficacy of an intervention is not based on personal report of success but on analysis of failure/relapse.
5
The US lags behind the rest of the industrialized world in treatment of addiction because we continue to call addiction a crime and not an illness.
For patients, there is a tremendous stigma associated with the diagnosis of "addiction." Even though diseases of the central nervous system aka the mind are just as real as diseases of the rest of the body, many people still think that an addict is a fatally flawed human being. And so they deny that they are addicted--until they get arrested for possession or some other addiction related offense. And then their lawyer tells them "Admit you are an addict. The court will go easier on you."
The double standard about so called diseases of the mind versus diseases of the body (body and mind are actually one) will need to be addressed if we are ever to overcome our mental health crisis. No civilized country should tell the friends and family of someone suffering from addiction--or someone in the midst of a schizophrenic breakdown---"Call the cops. He will get the treatment he needs in jail."
And law enforcement, prosecutors and prison owners will have to learn to do without the easy arrests, convictions and incarcerations that addicts provide them to pad their records as "keepers of the peace."
7
"Buprenorphine is available by prescription, but health care professionals must obtain a special license to write those prescriptions, a process that requires them to complete hours of additional training, grant the Drug Enforcement Administration access to all of their patient records and agree to strict limits on the number of patients they can treat with the medication." Meanwhile, it is easy for any family practice physician to prescribe oxycodone--the culprit to begin with-- without any special licence or training. Why does this seem backwards to me?
9
@Leo A good point. The one, oxycodone is one of several potent opioids only requiring a medical or advanced practitioner nursing license and DEA registration. The assumption in med/nursing school appropriate use was learned for the treatment of acute pain.
Buprenorphine-when used to treat substance use disorder (SUD) is to be used in a comprehensive approach to substance abuse. So, the theory goes, a doc treating SUD needs to be trained and demonstrate competence in the use of buprenorphine in that special population.
The FDA has recommended 4-8 hours of Risk evaluation and mitigation strategies for extended release opioids (REMS). I am uncertain of the total but I am relatively certain less than 30% of clinicians licensed to prescribe opioids have done so.
What is not discussed: at least 2 buprenorphine products are available for pain and not SUD. These are in my mind underutilized as analgesics. Given the pharmacologic actions of Buperenorphine, it may be somewhat safer -to degree-than so-called pure opioid agonists.
2
How about a real settlement. Purdue should be forced to pay for all opioid dependence medication assisted treatment!
5
Isn’t it interesting that OxyContin was rushed to market but suboxone is held back? This is a crime, and it’s a manufactured crisis.
15
You want to diminish the opioid crisis?? Get us old folks the medication we need. I can't get a prescription for drugs like Tramadol (Ultram) or Vicodin. ( And no, I do not abuse these drugs). Heroin and Fentanyl is now easier and cheaper to get. I don't use these, but if someone offered to sell me some Fentanyl, I would seriously consider using it. Properly monitored prescribing of opioids for pain does not an addict make.
8
This is a reasoned, fact-based editorial that makes perfect sense, but it leaves out two things: a path to an alternative delivery method and delivery frequency for methadone other than daily doses at clinics that, by necessity, have drugged people frequenting them. And, while Kellyanne Conway is the unqualified face of the Trump administration for opioid abuse prevention, liaising with the DEA - do you really want the DEA checking every single methadone-prescribing doctor's prescription?
1
This country is so ignorant about drugs, choosing to trust pharmaceutical companies who are all about the money. Oxycontin should have never been prescribed so readily by so many doctors who should have known what the long term effects were. However, the drug companies have been lying or misinforming doctors and consumers, leading to this crisis. A much safer option, but one hated by big pharma, is cannabis,medical marijuana, a non addictive plant, with many strains that alleive pain.
1
@SLD
Pharmaceutical companies are favorite targets for politicians, doctors, and those who wish to project blame for their own misjudgments about how they lead their lives. They castigate and sue the companies, depleting their research capabilities, looking for huge cash payouts to compensate for their "unjust" suffering. These companies (most of them are NOT interested in cheating mankind for private benefit- there are far easier ways to make a lot of money- build a glitzy hotel and cheat on your taxes!) that work overtime to provide tools to alleviate human suffering. Where would we be as a society if no one wanted to spend the money and do the tough science to create a therapy for HIV, infections such as measles, ebola, alleviation of chronic pain, etc? How many lives are better off due to these efforts?
It is the doctor's responsibility to learn of the the possible side effects of a drug and wisely prescribe and monitor the use of that drug. Doctors should also counsel their patients on how to HEAL their bodies through diet, exercise, and mindfulness. Too often they become prescribing machines, looking to hand the "magic bullet" pharmaceutical to patients. It ups the though put of patients by getting them out of the office within 30 minutes, and they can always prescribe some more if (when) the problem doesn't go away. So THEY are part of the problem too.
4
Look at Rhode Island, Their MAT program is working. Look to other nations that have the programs, They work. Stop being backwards America, We are better than this, we could be solving our problems faster than we are if we stop being so darn stubborn. What are we waiting for?
The poor sots to just die off and get out of the way of the Non-addicted classes? It seems like we know the answers but just love watching other humans suffer cause that's the american way. Why are the hardliners not voted out of office and the people that see the help that can be had voted into office so we as a nation can get on with being better than we seem to want to be.
One voice crying in the wilderness.
4
What a surreal situation: a call for another Pharma company to supply “medicine” and benefit from a deliberate addiction created by another Pharma company. How about holding the entire guilty Sackler family responsible, jailing and confiscating the blood money they’ve looted.
It would appear that it's easier for doctors to prescribe oxycontin than to prescribe buprenorphine or methadone
Too bad the sacklers (aka murderers) don't put some of their billions into solving that issue
2
So the answer to opioid addiction is another drug that you take for life? Balderdash!
These people need to get into a government program m that puts it under control and then eliminates the addiction. The drug companies that make the opioids and caused the problem must pay for it.
2
Trying to cure addiction is like trying to stop death. All you're doing is postponing the inevitable.
Want to reduce Opioid deaths?
Jobs,Jobs,Jobs!
2
My buddy has been on suboxone for 12 years he’s regular family guy leading a successful conventional life...that suboxone works! He says he doesn’t remember his heroin days...Apparently suboxone is a kind of “silver bullet”!
2
These junkies are costing the taxpayers hundreds of millions of dosllrs. How about we focus on not letting these people of weak character start with these drugs in the first place?
Addiction is s word thrown around much too loosely.
Take the drug when you need it.
When the pain subsides, stop taking it and get on with your life.
It really IS that simple.
I’ve done it as have many others.
2
@There
First of all the word Junkie is the first problem in this response to the article. Unless you have witnessed first hand the devastation of addiction on the the person addicted and their family you have no idea what a miracle Suboxone is.
Weak character is another description that I find highly destructive and offensive. For whatever reason a person becomes addicted a “weak character” is not even part of the equation.
Unless you have researched the many ways people become addicted and how these drugs affect normal functioning of the brain and it’s pleasure receptors you will never really understand the power these drugs have over the people that use them.
Suboxone was a life changer for my son and enabled him to become part of the real world again.
Suboxone is not a cure but with other support systems in place like personal and group therapy, AA and other narcotic support groups, addicts can survive and thrive.
6
From you mouths to Trump's ears, or, at least, to the ears of the Democrat presidential candidates. And may AOC focus her media magic on this relatively easy help to combat the opiate apocalypse.
1
After my major operation I needed pain killing opioids big time and got them. I had no problem stopping after I healed. People NEED these drugs when they have major surgery. This politically correct witch hunt has to cease.
5
@skanda "Politically correct witch hunt?" There's two dog whistle conservative phrases in one sentence.
Do you really think the opioid crisis is manufactured? Sure people need these drugs after surgery, but they also need to ween themselves quickly and doctors need to make sure they don't take them one day more than they need them. Good for you for getting off of them quickly and easily, but for those who have not, "just say no" is not the answer.
The overprescription of opioids was about money, pure and simple. This "witch hunt" was actually going after a real witch.
1
None of these medications “blocks” the cravings for opioids. Methadone, being a 100% opioid agonist, satisfies the cravings. Buprenorphine (Subutex) is also a 100% agonist. Buprenorphine/naloxone (Suboxone) is a 50/50 opioid agonist/antagonist; that is to say if it is administered when the addict is in withdrawal, it will satisfy the cravings, but if administered before withdrawal begins, when there are still opioids in the system, it will engender an immediate, very nasty and dangerous precipitated withdrawal. Naltrexone is a 100% opioid antagonist - it binds to the body’s opioid receptors immediately and more effectively than any opioid, including heroin, thereby blocking the narcotic effect of these opioids completely. If the addict takes any opioid whilst Naltrexone is in the system, he/she will not feel it. As with Suboxone, if Naltrexone is taken whilst opioids are in the addict’s system, agonising withdrawal is immediate and can be fatal in extreme cases.
The fact that addicts in the USA find it difficult to access these effective, lifesaving medications is not surprising. The USA, for over a century, has been hoodwinked into regarding chemical dependency as a moral failing only experienced by degenerate human beings who deserve neither empathy or compassion. Addiction is still treated as a moral failing in your country. The US would do well to abandon its failed “war on drugs” and look to Europe and other places where a medical approach to the problem is working.
6
@Tony Lewis Buprenorphine itself is a partial agonist. Naloxone is essentially an inert ingredient due to Buprenorphine's high affinity. Please do some further research and education on pharmacology. Buprenorphine definitely does "block" both cravings subjectively and the opiate receptor objectively.
1
Our medical system is infected with politics and religion. Get both out of the doctor's office and our bodies.
4
If all those people addicted to opioids started working would their be jobs for them?
1
@Nycoolbreez: Not good, secure jobs that pay living wages and provide needed benefits. We don't have nearly enough jobs like that, and *that* reality is one of the drivers of the opioid crisis
In my view, the Republican answer to the opioid problem is to stick their heads in the sand. I am sure they are stuck on the problem as being one predominantly facing the poor and minorities. And since treating it is, more or less, controlling it like taking insulin for diabetes, their inaction comes down to letting the addicts die. That is their answer. Next step...cut Medicaid that will pay for treatment. The real answer.... Democratic leadership...They may not have all the answers, but lip service won't be one of them.
26
@Walking Man
As a card-carrying Democrat, I wish this was true. Unfortunately, most politicians, from either side of the aisle, prefer to pay lip service to this deadly plague rather than give effective, evidence-based treatment the funding it desperately needs. Here in CT, our recently elected Democrat governor has proposed a budget that would gut DMHAS funding in a way that threatens access to medication-assisted treatment for thousands of people. Methadone and suboxone treatment work, offering people the chance to regain their footing and rebuild their broken lives while hugely reducing the chance of overdose, but they do not yet fit into the general public's notion of what recovery "should" look like. Until we as Americans understand and accept the proven science behind effective addiction treatment, the opioid crisis will continue unfettered.
3
@Walking Man
What would also help is if politicians and others called this what it really is. Not an "opioid" crisis but a "fentanyl" crisis.
The uptick in deaths from opiate overdose are DIRECTLY related to two factors:
1. The scapegoating of painkillers and subsequent denial of needed treatment from doctors because the FDA, DEA and most on the right want someone to blame when white people start dying because they had no choice but to turn to the streets for relief.
2. The insidious use of fentanyl (produced mostly in China) in heroin and fake pain pills flooding the "market".
2
@Walking Man. The one thing that politicians have done about the opioid crisis is to deny pain sufferers the medications they need. Very few people who are in genuine pain get addicted to their pain medications. The highest number I seen quoted is 7%. Many aspects of healthcare in this country are cruel and just plain stupid.
3
I agree with you that better availability of these medications would help the current crisis of opioid deaths, however, I believe the medicine alone cannot solve it. Unfortunately, those willing and able to stand in lines at clinics don't have the resources & support to make the changes to lifestyle necessary to replace the drug addiction. Patients need complete overhaul of surroundings to eliminate triggers & reminders of the illegal drugs. Someone somehow has to come up with a public plan for rehab which includes job training, medical assistance, housing, and depression/anxiety counseling. There are SO many health issues as a result of opioid use - it affects teeth, heart, digestion, etc. for the rest of one's life! I know clinics offer help, but they're just a piece to a larger puzzle that must be solved - and will cost a lot of money. I hope the situation with the Sackler family opens this as a possibility.
Coming from a physician who treats addiction. Bravo for trying to get the word out nyt. So much misinformation out there
9
I have been writing this for the better part of 2 years..
Here I go again...
If there was an additive in pet food that was killing the family dog at the same, alarming rate as opioids killing humans..
The CEO of Purina would be publicly tarred and feathered by now..
Still we dance around the issue ... There goes another cousin, there goes another uncle, there goes another aunt ..
... let's imagine if Queeny, Prince and Duke start falling... Then and only then will America take notice.
We are selfish and stupid and we get the government we pay for .. and we get the government we deserve.
4
And who makes this miracle drug buprenorphine? The Sacklers of course! Watch Purdue Pharma joyously filling their pockets by selling us a drug to save us from their last one. At the very least, odious Team Sackler and the criminals at Purdue should be mandated to provide this remedy for free as recompense for the death and misery they’ve created and profited from.
4
@Anna B
Burprenorphine products are produced by Indivior and Reckitt Benckiser, not Purdue.
1
Congress should deregulate buprenorphine prescription now, As experts in opioid use disorder and its regulation, my colleagues and I have published on how to deregulate buprenorphine see https://www.ncbi.nlm.nih.gov/pubmed/30586140 and https://www.statnews.com/2019/03/12/deregulate-buprenophine-prescribing/.
This action particularly if done in conjunction with policies that promote clinician training in buprenorphine prescription for opioid use disorder and that reduce financial barriers to access could have an immediate impact on opioid deaths, Congress must act now.
Kevin Fiscella MD, MPH
3
It's all about the money.
1
My childhood and adolescence were a living hell because my parents were prescription drug addicts. This was in the 1960s. There was absolutely no recognition of the problem, no treatment, and no escape. I became almost hysterically fearful of pain medication, which has been lifelong. My beloved sister, however, fell into drug and alcohol abuse. She was born addicted, but this was unrecognized in the early 1960s. My mother received prescriptions throughout her pregnancy.
Fast forward 50 years. We knew so much more about addiction. We have medications, therapy and support. We understand how addiction begins. Yet, we hoard these miracles, allowing the damage to continue unabated. Shame on us.
2
The opioid crisis is a black hole that sucks in the addictive personalities and slowly kills them. The notion of treatment really hasn't worked. Abstention due to a lack of supply would. Congress simply doesn't possess the requisite political courage to act without intense pressure from the voters.
As Purdue Pharma comes under a legal barrage for pushing Oxy, it will be interesting to see how the opiate deluge and the resulting deaths trend up or down.
Oversight of these programs has always been stringent due to the worry of abuse or shoddy care. Given the sorry state of our medical care system which favors profiteering over true care (we sure have lots of docs who can inject botox), I don't have a lot of confidence in the medical community to step up to the plate without a lot of incentive from government. And that would, in part, rely on action by Congress and our president (lower case intended). I have even less faith in them, particularly the GOP. They are a reflection of the US electorate - ignorant, spiteful and backward.
3
",,,more than half of all counties have no licensed buprenorphine prescriber at all. That’s too bad."
That's too bad? That's gross negligence.
2
While few would openly say that they would prefer that drug addicts die, the present policy can be seen as an implementation of that preference. One sees evidence of this
hidden preference in comments that suggests addicts are criminals and should be penalized rather than treated.
3
From the outside looking in, it would appear that we loathe the poor and distrust science. Pair this with the piece about cutting foreign language instruction, and it feels we are backwards in so many ways.
3
i would be interested to know why the regulations governing the prescription of buprenorphine, a drug with a proven record of effectiveness in fighting opioid addiction, are so ridiculously strict and yet, until quite recently, the regulations governing the prescription of pharmaceutical opioids like OxyContin were ridiculous lax!
Could this have something to do with the power of pharmaceutical multinationals to influence Congress?
3
Cannabis has proven to successfully help some people wean themselves off of opioids. I work with many patients that claim that cannabis saved their lives.
23
@Tom Schneider
I agree but big pharma can't make billions off of MJ so we'll never see it prescribed as an addiction treatment.Same with pain issues,if drs. could maybe they'd suggest a person in pain try marijuana first before prescribing opioids.
1
As a member of a community that has ravaged by opioids for half a century, I can tell you it is hard to put the genie back in the bottle. Treating it with drugs like Methadone is like changing seats on the Titanic. If anyone thinks Methadone is the answer I suggest they park outside of a Methadone Clinic on a Friday morning and just observe. Addicts call Methadone legalized slavery and to be truthful it is just a maintenance program. To me, the answer is treatment not substitution with another addicting drug. The same drug industry that helped addict millions will reap the rewards of making drugs require daily doses to curb the opiate desire.
3
I wish the Times would stop touting buprenorphine as the magical answer to opiate addiction. Having known more than one person who was aggressively pushed to switch to buprenorphrine by doctors who then refused all requests to help the addict taper down and become drug-free, I can assure you it does not offer freedom from active addiction. And the effect of the drug is often mood and mind altering - many people who are treated with it are "speedy," jittery, and go on long talking jags without realizing it's the drug talking, not them. They are often impulsive and make poor decisions. Those few who eventually manage to take their medical decisions into their own hands and go off buprenorphine or methadone - frequently against medical advice - become observably calmer, more rational, and frequently get back the ability to uneventfully resume working and living in society in relatively short order. Yes - inarguably, using methdone or buprenorphine is better than overdosing and dying. But they should be used, when necessary, as a short-term detox subtance with an agreed-upon plan in place between the doctor and the client as to a tapering-off schedule and the period over which that will occur.
4
The inadequacy of the response to the opioid crisis never ceases to shock me--akin the the country's response to the AIDS crisis in the 80s. In 2014, eleven cases of the Ebola virus were reported in the US (two died), and the country went haywire. Something in the neighborhood of 60,000 people per year are dying of opioid-related causes in the US and response is still absurdly low-key.
Some random observations:
Every addict can be forced to stop...often for short periods, even weathering the pain of withdrawal. But many can't stop themselves from not starting again.
The Methadone clinic at 25 12th Street in Brooklyn is located in a Pathmark parking lot, beneath the Gowanus Expressway, is difficult to find, and isn't open on Sundays. They give the addicts two doses on Saturday and somehow the addict is supposed to wait until Monday for the next dose?
Paying for Vivitrol (the monthly injection of Naltrexone) with medicaid (many addicts have no money) is extremely difficult. For many addicts, Vivitrol is a life-safer. Given the choice between getting high on heroin and taking a daily Naltrexone pill, why would anyone choose the latter?
We should have serious discussions about licensing addicts and distributing heroin to them in supervised, clean injections sites.
I have found the various national hotlines nearly useless.
Prisons and rehab centers are often deadly places for addicts--when they get out, their tolerance for the drug is low, they shoot too much and die.
6
Although much of what the article says is true, the sad fact remains that by using the drugs mentioned such as methadone, we are just substituting one addiction for another. The addict remains stuck in addiction, just a somewhat different kind of addiction.
I am a physician who prescribes medical marijuana.
I have a subgroup of patients who use medical marijuana when opioid cravings kick in.
Half of my patients use med mar for chronic pain.
This is still a drug, however patients can not overdose. There are simple measures for "too much"
I see this as a much safer choice for patients to be comfortable.
4
Here in Medicaid unexpanded North Carolina the challenges are many including a very spread out rural population with many underserved areas. But the biggest problem for my patients is medicine cost. With all of the grants being dumped into this problem almost none of it is going to help defray the costs of the drugs which the uninsured otherwise can’t afford out of pocket.
4
A special license, training and DEA scrutiny should be required to write opiate prescriptions not opiate replacement therapy. If fewer than 10% of US prescribers were permitted to write for opiate pain medications we wouldn’t be in our current addiction crisis.
2
Another benefit of these drugs is that they are often effective at treating chronic pain, without the threat of serious addiction. My late father took methadone for over 20 years along with a low dose opioid to help treat his severe chronic pain. These drugs allowed him to tolerate his pain and live until the age of 87.
Along with treating addiction, we must find effective ways of treating chronic pain and stop treating those who suffer with such pain as if they are all potential addicts. Better to be dependent on a medication that to suffer each day in relentless pain.
13
@Fred. Your father was fortunate to be treated properly for his pain. I have been in terrible pain for some years from several conditions and methadone was the only drug that helped. I was given a prescription for one week's worth of methadone by an emergency room doctor several years ago and I was almost completely pain free for that short time. Oxycontin and its cousins never even took the edge off my pain, but that is all doctors will prescribe. When I have asked for methadone they all cringe. I don't take anything for my pain and I deeply resent being treated like I don't count. Some days I just barely hang on and sometimes I wonder why I bother.
2
Extremely important that doctors never prescribe any morphine derivatives, i.e. codone, hydrocodone, etc. instead of acetominophen and non-steroidal anti inflammatory drugs for pain, unless there is a definite contraindication to these other drugs. Most of the patients who get hooked on opoids have done that after their doctors have prescribed opoids in the form of codone, hydrocodone etc.
@Ralph Sorbris
Your logic implies that most of the people who have been prescribed codone, hydrocodone, etc., have gone on to become addicted to those drugs. This is not true.
The vast majority of people who have been prescribed opioids after surgery, for instance, or for acutely painful episodes of a chronic condition do not continue using those drugs. Look at the numbers.
8
The laws that govern methadone make it an even worse option than it already is. They worsen stigma, do nothing to treat the underlying condition of an addictive disorder and foster the benzodiazepine and other drug scourge. In order for methadone and buperenorphine to have an impact we need to treat them like any other drug and allow those with skills in treating addictive disorders to prescribe them at discretion. Like an oncologist can prescribe any chemotherapeutic agent and an orthopedic surgeon perform the indicated optimal surgery , the hands of addictions specialists must be unfettered.
8
@Prameet And we need to get them into the hands of those who can prescribe them effectively.
1
Preventing people from harming themselves with drugs is a shared duty with all of us taking primary responsibility for protecting ourselves, followed by the government in the person of the Food and Drug Administration, prescribing physicians and the manufacturers. As a practical matter, it is difficult to constrain businesses from boosting products they have an intense interest in profiting from. Buyers must always be aware.
2
Methadone clinics popped up everywhere when the DEA classified narcotics and criminalized their use in 1970/71.
Then addicts would sell their treatment drugs on the street.
It was a big issue through the early 90’s
I don’t know what happened to that federally funded program.
At that time every hospital had a drug clinic dispensing methadone.
Politics always destroys the lifelines we give to the desperate and poor.
Their voices are drowned out by trumpian types
Their needs are ignored out of pure meanest and evil intent at the Essence of our dark souls these days.
Vote 2020.
4
I've seen first hand how doctors will give a person these drugs then abandon the patient when they ask for help once addicted.
The cost for rehab is too much and often not covered by insurance. So the option is to let them stay addicts and pass out anti overdose meds?
Future generations will look back at this time as a sad period of greed and apathy for the addicted and ill.
7
Before people can get the meds they need, doctors and hospitals need to change their metrics for success. It's not about whether the patient "feels no pain" it's about whether the patient is being properly taken care of for their current state of health.
Hospitals and treatments are too often judged by how much pain the patient is in when they leave. Hence hospitals work very hard to erase all sensations of pain. Hence too many opioids are prescribed - just to keep their scores high.
Sometimes a little pain is just fine - you'll live through it. Being happy doesn't mean you're getting what you need.
3
Compared to the strict regulations for these treatment drugs, the regulations for prescribing opioids are minimal. The entire system, from prescription pads to treatment centers needs an overhaul, but our politicians are all talk and no action, and professional organizations are not contributing to a solution as much as they could.
3
@William what are your suggestions for all of our professional organizations contributing to a solution ? Anything ?
@William
You totally nailed it. I have had opioid prescriptions for a root canal, written by a dentist, and for a sprained ankle, written by an ER doctor. As the daughter of parents who were addicted to prescription drugs, I knew better than to take the prescribed drugs. If I didn't know these things, there, but for the Grace of God.......
1
American television programs have too many advertisements for different types of medicine for all sorts of problems. It is obvious that the effect of these advertisements is that people begin to imagine that they have the symptoms and illnesses being described when they actually do not. Off they go to the pharmacy to be exploited once again. The pharmaceutical industry has no conscience. Nor does capitalism. These medical advertisements do not occur so much in other countries where healthcare is not a business but rather a service.
13
Let's see, since I didn't do well in organic chemistry, I would only be speculating if i were to voice an opinion, but everyone has one.
I believe that since most opioid addictions are the result of illegal use of controlled substances, the users are essentially criminals and so should be penalized rathewr than treated for an illness. Especially harmful to the notion of treatment is that penal institutions are not known for providing good medical care.
believe there is also some religious component involved here. If preachers riding a circuit would agree to carry these life-saving medications with them instead a Bible…say trade a good black book for a good black bag…they might have long lines at the confessional, as if I knew whether they even have confessionals in the evangelical trade.
1
There's more information about buprenorphine that most people, even physicians, don't have. It's a highly effective anti-depressant. There's some research on this but not enough, since the government isn't very interested in studies that promote the use of an opioid. Most of the evidence is anecdotal, but one can take a low dose of buprenorphine for years without needing to increase the dose, and depression disappears completely.
2
@Luciana
Similarly, another opioid, Klonopin, is extremely effective for some people with panic disorder (with or without agoraphobia), who do not respond favorably to SSRIs. The drug has been approved--even in the US!--for a few decades now. People have maintained low daily doses for all those years. Current mass hysteria about "the opioid crisis" threatens their access to the only relief they've experienced. Yes, even small doses. over two decades, certainly qualifies as physical addiction to a substance. So does the need for air, water, and food.
2
Reading so many of these comments makes it clear that addiction is still the most misunderstood disease, even though it is an ancient disease.
Writings about addiction as a disease go back to the Roman times. Scientific American wrote in 1877: “Science draws a broad distinction between drunkenness as a vice and drunkenness as a disease."
Part of why we can't conquer it is that society - even medical professionals - largely don't understand it. And buprenorphine is a band aid.
1
@Lilla Victoria. I'd rather have a band aid than bleed to death.
1
In general, have a high tolerance for pain or so I thought, until I got a kidney stone while abroad. I never experienced pain that severe. When I got to the hospital, I was given 10mg of morphine. After a few minutes the pain simply disappeared and I was very, extremely, relaxed. Not high, just relaxed. I was perfectly able to converse, etc., but wonderfully relaxed.
When the morphine wore off, I asked for more. The answer was a firm "No". I was given acetaminophen and dipyrone. No morphine whatsoever and no expectations of more morphine. There was still pain but it was certainly bearable.
Had I been in the US, I would have been given morphine or Oxy or similar non stop.
Abroad, where the MDs and hospitals are NOT rewarded by Pharma, treatment includes an "ounce of prevention" (i.e., no unnecessary, very profitable, opioids). In the US where the MDs and hospitals ARE rewarded by Pharma, treatment is different. Eventually, after prescribing lots of expensive opioids and addicting patients, subsequent - additional treatment - involves a pound of very profitable "cure".
Till now, several years later, I realize that I could easily have become addicted. Luckily for me - I was not treated in the US.
13
@Ed Watt You are wrong. You would not have become addicted to morphine while being treated for a kidney stone.
4
@Ed Watt do you have a history of addictive behaviors? Because only a very small percentage of people who use these drugs become addicted.
2
Most everything out on the streets is laced with fentanyl, a deadly drug, whether cocaine, meth, even marijuana. The jump in the amount of fentanyl sized in a period of just 4 years went up 74,000%. The epidemic of fentanyl is so deadly, that even those who are on the front lines, police, border control agents, and are exposed to it, are at risk. Once, you cross the desire for fentanyl, the addiction is so strong, that the chances of you being alive in a few years, is very small. Much of the overdose deaths in the states, are in ones where there is more disposable income. Most people are not seeking recovery, but are seeking highs, and that is why the problem is so severe. If you live in a small town, and are aware of the number of people addicted to alcohol, and how so few are even interested in quitting, because they love alcohol, as it is now an epidemic in the senior population in the ages of about 55-80, and they don't want to quit. Usually what happens, is one of the partners, either is a non drinker, or drinks less, so they can keep the heavier drinking spouse from driving, etc. However, what they can't do, is keep the alcohol from having a very serious effect on one's health. We know many alcoholics who don't consider themselves alcoholics, and never will, until their life is over. It is to the point, that about 70% of the population is either an alcoholic, other drug addict, or overweight, and the money that will be spent on all of it, is astronomical.
7
@MaryKayKlassen "...about 70% of the population is either an alcoholic, other drug addict, or overweight,...." Do you have a source for this figure?
@Luciana since 60% of all Americans. including children. are overweight or obese, the fact that there are easily another 10% who are alcoholics, and other drug addicts is easily googled. When you had almost 60,000 alone who overdosed last year, it is all a serious problem. My family has had 13 doctors over three generations, so all issues related to the poor health of the average American have been both observed over the decades, living in a small town, and having conversations with not only my primary doctor, but those in the family, as well.
1
Get people jobs with a livable wage. The crisis won't go away until people feel secure in their lives.
9
Citizens choosing not to use non-prescribed drugs whose dangers are abundantly clear could also help reduce opioid deaths.
3
@Roger Easy to say, but addiction is not a choice. Most who become addicted do so after being prescribed the medication for a real condition. Addiction is not different than any other disease. No one chooses cancer or diabetes either.
14
@Micaela Having lived with drug-using spouses and step-children, I don't know about 'most'; are there statistics on this? But I referred specifically to non-prescribed. And addiction is not just like other diseases, like cancer: It requires the specific behavior of choosing to take the drug, in spite of knowledge of the risks: a conscious action.
5
@Roger We're a drinking and drugging society. There is a huge expectation that people drink socially. One out of eight people who drink eventually become alcoholic. This is a genetically based disease, caused by multiple gene variants. Doctors have replaced the drug dealer - mood-altering prescription drugs have become the norm. What's called the dry moral model is when we see the solution as abstinence. We're not a society that supports a dry moral model. We're legalizing marijuana making it easily available, which will lead to bigger problems over time. There are many diseases that are triggered by things taken into by the body. Diabetes, heart disease, cancer. Look on your diet soda can or sugar-free gum and you'll see a warning: "Phenylketonuric: Contains phenylalanine." PKU is a genetic metabolic disorder and consuming this particular protein causes brain damage, intellectual disabilities and serious physical problems. Another example of having to add something to the body to trigger the genetic coding.
11
The Board places much of the blame on law enforcement. In particular, they blame prisons for not prescribing remedial medications. But prisons are not rehab centers and prison employees lack the expertise to prescribe and monitor the use of dangerous drugs. Addicts get treatment in rehab centers, not prisons. If the Board calls for rehab, it will have to send drug addicts, including many gang members and violent criminals, to rehab centers. Blaming prisons for not doing what they are not equipped to do is irrational.
3
@michjas. the majority of the prison population suffers from addiction. Addiction is a disease. However you "caught" the disease doesn't really matter, does it? Would you deny treatment to someone in prison with AIDS? With Ebola? With cancer? With diabetes?
Prisons in the US are supposed to keep communities safe from people who break the law (according to their websites - have you ever read them? I have). They are also supposed to prepare inmates to re-entrance into society so that they do not commit more crimes - that's why recidivism rates are studied. If you don't treat a disease, you are placing a lot of sick people back into society where they will continue to use and do whatever they did to obtain their drug which caused them be sent to prison in the first place. Many, many people in prison right now were drug USERS, not drug dealers (crime? drug possession). So please explain to us, again, why treating the disease of addiction in prison is so irrational.
1
@michjas
Or qualified rehab professionals could be allowed to prescribe and monitor prisoners in situ.
Don't forget that 'An addict, any addict, can stop using drugs, lose the desire to use, and find a new way to live. The message is hope and the promise of freedom.'
Good luck on your journey!
4
If you see the opioid epidemic as a phenomenon that causes overdose deaths, then buprenorphine is objectively a way to prevent the deaths. If your goal is to stop people from using illegal drugs, then buprenorphine won't help. So yes, you can "give people their lives back", and you can prevent people from overdosing. But they'll still be chemically dependent on opioids, and most will still be using more than just the buprenorphine. It's true that there is a stigma against medication assisted treatment. Because people are stubborn, and want to try for the more idealistic solution of actually getting people clean.
3
This reporting is excellent, but it seems to me that perhaps this failure, like most caused by the greedy for profit healthcare system in this country, is that there is little money in it for the doctors or hospitals. Just mandate that every single physician in America undertake the requisite education to become a prescriber of these medicines and require every hospital to stock these drugs. And about the DEA having access to a doctor's prescribing of controlled substances - that already exists for every physician in America.
I am a recovering drug addict and alcoholic with 33 years of continuous sobriety and I am all for anything that saves lives and helps people suffer less, even though AA is what worked for me. I have never used any of these medications, but have known several people on methadone maintenance treatment in lieu of heroin addiction. I also know heroin addicts who have gotten clean and stayed clean without these drugs. The latter group has a far higher quality of life and the methadone patients, in my observation, have slipped as much as those taking no medication. The methadone patients I have known seem to always be, well, drugged and somewhat depressed, but that certainly is better than being dead. The training requirements for treatment is understandable, because at least with methadone, doubling or tripling dosages of the medicine will produce heroin like euphoria. And many say methadone withdrawal is far worse than heroin.
4
As a palliative care physician who trained at a big city hospital with plenty of heroin and alcohol addictive, no methadone withdrawal is much safe. The is no spiking high since it is long acting. The methadone can be used as a safe taper, just as the Valium is to taper an alcoholic. I’d agree the goal for all is to stop the crutch, here the methadone and treat any mental illness, give supportive housing and job training. If the economic causes of this crisis are not addressed, no medical interventions will “fix” this epidemic.
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@Elizabeth Landsverk MD
I can't understand how an MD can still advocate for a "taper" to abstinence.
This editorial is obviously based on the recent
published medical evidence ( for example https://www.nejm.org/medical-research/addiction https://www.ncbi.nlm.nih.gov/pubmed/30878228 ) which clearly concludes that buprenorphine in particular reduces deaths, and attempts at abstinence, even by addicts who are trying to "go clean," results in deaths.
Do you believe in evidence-based medicine or not? Do you want your patients to live or die? Do you believe that you're right and Nora Volkow, the head of NIDA, is wrong? How many opioid addicts have you encouraged to give up methadone and buprenorphine, and how many of them have died within 6 months?
As a long term member of AA, I hate these articles that sight a new drug that cures drug addiction. Another magic pill to wean addicts off their medicine. Where are all the methadone users who stop using methadone? - 70-90% relapse, suggesting that methadone is just a substitute. Buprenorphine is just another substitute as well. We need to look at addiction as a complex health issue. The physical addiction aspect is only a part of a complex emotional psychological disease that is extremely difficult to treat. Abstinence is the only treatment. The real problem is that most addicts don’t care, so it’s only a matter of time before they are back using. This disease is an plague and requires the same focus and resources that epidemics such as HIV or a Ebola require.
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@Peter Z
Read the medical literature. https://www.nejm.org/medical-research/addiction https://www.ncbi.nlm.nih.gov/pubmed/30878228 Opioid addicts are five times as likely to die on abstinence-based treatments as they are on buprenorphine. The lowest rates of relapse -- and death -- are on buprenorphine and methadone. Doctors say repeatedly that you might as well ask diabetics to give up their insulin.
4
@Peter Z. I'm very happy for your success...I know through my daughters how difficult getting clean is. But if buprenorphine or anything else can assist in that journey then isn't it worth it? Isn't it worth saving their lives in the process? There were over 70,000 addicts who died over overdoses last year, and hundreds of thousands more family members who suffered right along with them. If even a handful, even one of those thousands had their life made just a little better by using a drug that could be prescribed that would allow them to slowly reduce their dependence and stay alive and function in society, my God, wouldn't it be worth it?
3
Americans take too many medications. I am shocked when I watch CNN and almost every ad is for some medication. The father of a close friend just passed away as a result of poisoning from a medication he had been taking for a prolonged period of time. Patients should be made aware of such possible long range consequences and physicians should do more follow up on the effect of medications on their patients.
4
Medically assisted treatment (MAT) for addiction with drugs such as Suboxone is the only way to treat the brain’s craving for opioids.
Unfortunately, suboxone clinics around the country are under attack by the very government that authorized such treatment. Even physicians who have the DATA-waiver license to prescribe Bup walk on eggshells. America needs to wake up and realize MAT is what works in the long term.
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@Conservative Democrat. My son detoxed from heroin using Suboxone, and so far, so good. He couldn't get it from a doctor however, so he bought it on the black market for $25 a pill.
1
When discussing the opiate crisis it is important to realize that some of the bad drugs like heroin which
is an illegal drug from start to finish shouldn’t be lumped together with an incredibly valuable anesthetic drug like fentanyl which has been applied
to broader uses like transcutaneous patches with
huge doses that are intended for slow release to treat cancer pain. This portal, out of the closely regulated hospital setting, put fentanyl in people’s homes where it could be diverted by anyone who
might be tempted. In our community it was not unheard of for young teenagers to smoke a grandparent’s 10000 mcg fentanyl patch which was
intended to treat intractable breast cancer pain. Subsequently, fentanyl and presumably even more potent related medications like sufenta have found there way from off shore to the street. My fear is that the zeal to deal with the epidemic of overdoses will eventually lead to the removal of this essential medication from legitimate practice. Much can be done with regional anesthetics and non opioid pain medications but I would guess that we are a long way from giving up opioid medication for serious acute pain in a medical setting.
I do not disagree with the stated purpose of the article that access to medications like methadone
and buprephenone should be facilitated along
with comprehensive medical care to treat opioid
addiction. Superficial characterization of a few drugs as bad or dangerous doesn’t really help us
understand what we face.
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@howard williams
I failed to proof read.
I meant to say buprenorphine, but said buprephenone.
Superficially the editorial makes sense. However, sense frequently ignores reality. It would be sensible to engage in things that would prevent the large majority of the 40,000 vehicle deaths each year which are preventable. Preventable if culturally we accepted what it would take to make drinking or gadgeting and driving culturally unacceptable.
Laws do not change culture. If they did, Roe v. Wade would have settled the abortion issue decades ago. Unless we look in the mirror and examine why it is that distracted and impaired driving is acceptable, and unless we look in the mirror and examine why it is that people take knowingly dangerous drugs, we shall get nowhere.
"Just say no" didn't work. A "war on drugs" didn't work. Buprenorphine, naloxone, and needle exchanges will not work. Will they save some lives? Of course. However, if at the same time we consider them a "solution", we will take our eye off the ball and strike out, when it comes to substantially affecting the underlying problems: cultural and sub-cultural acceptance.
9
@Steve Fankuchen
To add another relevant thought: we are not very good at risk assessment. We spend untold billions and accept substantial inconvenience and privacy intrusions because a half dozen guys on 9/11 killed around 3,000 people. In the following four weeks, an equal number were killed on our roads. The average person is much, much more worried about a terrorist in an airplane than a drunk or TEXTer on the highway, yet the risk from the latter is orders of magnitude greater.
Am I proposing any solution possible in our current cultural climate? No. What I am proposing is that we look in the mirror and ask ourselves if we are part of the problem, if we accept all this by consoling ourselves with slogans such as "know when to say when."
20
@Steve Fankuchen
One can look for a solution to a problem AND simultaneously seek to mitigate its harm. Saving lives and relieving suffering is a moral priority in itself,
Also, substance use and abuse occurs in pretty much every culture, and has existed throughout human existence in various forms. It appears more and more likely to be a physical rather than cultural phenomenon.
8
@Naomi
Naomi, thanks for your addition to this discussion. While I agree in general with what you say, especially in your first paragraph, I think we do need do differentiate between substance (including gadget) abuse that harms the individual (and consequently his or her loved ones) and behavior that puts the general public at risk.
2
This article focuses on pharmaceutical opioids yes, but ignores other opioid sources. Rehabilitation in an environment where wide spread networks deal non pharmaceutical opioids is futile. Underground opioid profits rival the legal.
If this issue isn't addressed headon these well intentioned programs may have little benefit.
Illegal opioids cause the most harm..
3
The drug industry sponsors studies that indicate a benefit to the use of their drug. They omit that the drugs are effective in conjunction with talk therapy with skilled therapists. So the drugs get sold as standalone cures. We see this with all psychoactive drugs, even those that enhance suicidal tendencies.
There is a high probability that all of the scientific research is sponsored by drug companies and the government agencies approving the drugs are advised by academics with research funded by the government to advance an agenda.
If throwing money at the problems, as dictated by scientific experts, were the solution, why is it that wealthy celebrities are not cured and still die from drug overdoses?
There aren't simple solutions to complex problems.
5
@ebmem
No, there were studies reported in the New England Journal of Medicine that compared medical treatment (buprenorphine or methadone) plus talk therapy to medical treatment alone, usually with an endpoint of death over several years.
Patients who received medical treatment alone did just as well as the patients who also received talk therapy.
As the NYT has reported, talk therapy is also a profitable industry.
3
The editorial contains some misleading information.
Methadone and buprenorphine were both approved as analgesics long before they were approved for treatment of opioid addiction. When prescribed as analgesics, no special license is required of physicians other than DEA registration as required for prescribing the other opioids. They provide as much pain relief as any of the other opioid analgesics. In fact, methadone is better than the other opioids because in addition to binding to opioid receptors it also is an NMDA receptor blocker so acts like ketamine. The editorial's statement that it is weaker than OxyContin or fentanyl is false.
With regard to treating opioid addiction, as far as I'm aware there are no studies demonstrating it is beneficial for those patients who are prescribed opioids for legitimate pain complaints and end up abusing them. In fact, as a pain doctor myself, I have long argued that if they are actually beneficial for this then methadone and buprenorphine should be first line opioids as we be already providing the treatment if opioid misuse should develop.
14
Great society,
Flood the country with legal opioids to supplement the illegal opioids and create a rehabilitation industry.
They’re showing some vape tobacco device commercials on TV now, touting how wonderful the smoke is.
We’re either going round in circles or moving backwards.
7
NYT hits the nail on the head: medications save lives because they treat the underlying neurochemistry of addiction, allowing the brain to heal and lives to improve. This is a major cultural shift for many addiction treatment programs that were started before the era of medication treatment and sometimes distrust medical responses. Increasing access to treatment requires growing the addiction treatment workforce. All providers who prescribe oxycodone should be able to prescribe buprenorphine without special licensing. The emerging field of addiction medicine has added over 40 training fellowships programs for providers who wish to build additional expertise in addiction treatment that can be integrated into diverse medical settings. Yet, these fellowships are not federally funded as are cardiology and other specialty training programs. If we want more integrated medical treatment of addiction, we need federal support for these critical educational programs.
51
These poor souls could be helped if we were a more compassionate society.
If we could convert 10% of the countries prisons to rehabilation centers, that would be a start.
To operate a rehabilitation center vs a prison are probably close in cost.
40
@New World
Doubt it .. We are an informational age .. the fact that everyone knows the consequences to "bad behavior" should be deterrent enough. Still people feel empowered to act out and make bad decisions. I am tired of hugging the cactus for these people .. they know right from wrong.. they just push the system until they get caught.
America needs some kind of Kibbutz system. Not being Jewish, I do think I have a basic grasp of the idea. I think it would be a valuable idea, more valuable than even college (which could still refashion itself into something adjunct to it! Laudatory goal!)
Give people the option of going to a farm and working a solid day's work, with honest conditions and wages, I don't know, call it a new WPA or PWA. Maybe basic college work can attach itself to our American Kibbutzes; I am sure many local schools would love to join in anywhere these refuges would be located.
And that would be, what they are. Refuges. Retreats. A break. A productive break.
Sad to say that, it might be a good idea to let our young people work out in nature for a few years before going to college, or blending college with real work.
We are setting up a bad society. Some win, others lose. It is a sad society. We need to make more winners. Medication alone cannot help someone who feels no role or place or value. Those things can only be discovered by wholesome work with others, on the face of this beautiful earth.
A river runs though our souls. No medication can replace discovering that in the flesh, and medication only works to the degree to which one is discovering one's value with others in work in nature.
Very Emersonian, but that is our heritage, after all.
16
@pjc
Amen to that, pjc. While I do not necessarily agree with every one of your points or implications, you clearly understand that the underlying problem is cultural, not chemical.
2
@pjc
Amen to that, pjc. While I do not necessarily agree with every one of your points, you clearly understand that the underlying problem is cultural, not chemical.
1
@pjc
Astonishingly, I was thinking the same thing.
In the old country (Ottoman Turkey) they were taken away to farms to work with the farm animals.
Buprenorphine will not become widely available because there is still too much money to be made with oxy prescriptions. The laws that are in place that make it very hard for doctors to be able to prescribe Buprenorphine were put in place because the makers of the oky like drugs paid millions to the lawmakers in the form of campaign contributions to make sure that they passed the laws that made it very difficult for doctors to complete the supposed 'necessary training' and to comply with all the other restrictions set in place by these laws - but at the same time, no restrictions or training was ever required by doctors to prescribe oxy. If you do the research you will find that the Purdue actually wrote the laws that lawmakers passed to restrict the use of Buprenorphine.
There are emails that show that Purdue knew that Buprenorphine works fantastically in reducing dependence by those addicted to oxycodone but instead they were working hard to undermine the use of it because of the large profit margins being made off of all the millions addicted to oxy.
97
@Jimringg I've spoken with many family practice doctors who were interested in or did get the training and certification to use these drugs, but became overwhelmed and prevented them from seeing other patients they were trained to and enjoyed doing.
The comments were that the docs themselves were treated as enablers and the microscope that they were put under by the DEA seemed to them to indicate that the government did not have recovery or avoiding relapses in mind, but making it so difficult and once granted so hard to avoid being accused of a felony if these drugs were not used exactly as mandated, that they gave up using their license to do so.
We need folks handing out clean needles, so to speak rather than imprisoning those who are addicted. Is it a crime to be diabetic? Have hepatitis? Why should it be to have an addiction?
28
@Jimringg
Please believe that they are making a ton off of Suboxone as well... $30-$45 per day for a starting dose, taken daily. FYI.
So sad . No one even bothered to comment. I believe this is because while the stigma surrounding methadone and buprenorphine is great, the stigma surrounding addicts is even greater. People really believe they do not deserve help or even to live.No one ever became an opiate addict without a little help from their friends in the medical community. Time to get real about drug replacement therapies that save lives. This treatment should be readily available and affordable if the U S is serious about reducing the current opiate crisis. times a wasting.
20
This is a great article. We are in an emergency situation and it needs to be tackled in more than one way. Safe Injection sites are critical at this point. Most overdoses occur when people are using alone. Safe injection sites reduce deaths from overdoses. This has been successful in Toronto and Vancouver, but the US Justice Department won't allow it in the United States. We need to try everything and Safe Injection sites plain out save lives.
17
It's interesting that many people got addicted in the first place with prescription pain killers. Now they don't want to treat the addiction with what is shown to work the best.
I don't understand American aversion to using scientific evidence to inform policy.
80
@Sharon
Science gets in the way of making money off of peoples suffering.
8
@Sharon. Yes you do. It's all about the money and who writes the laws. Keeping the competition out by bribing the legislators with campaign funding. This is a brutal society.
Congressmen have no shame.
11
Here's a crazy idea, remove the idea that doctor's are here to remove pain. Pain is a part of healing. Accept it. Get pharma out of government and health.
5
@Pilot
Actually, uncontrolled pain prevents healing. Ask me how I know.
And sometimes pain is not a part of healing, but a symptom of chronic, incurable disease that someone has to live and function with. Have you ever been in severe, unrelieved, open-ended, pain?
I'm guessing not.
61
@Naomi
What never seems to be addressed when discussing the crisis of opioid abuse and addiction is the other "silent" opioid crisis. Millions of Americans who are suffering due to undertreated chronic pain. Not all pain is temporary. I am disabled due to chronic pain. In the past 3 years, I have had my opiate pain medication reduced by two-thirds. I used to be able to participate (in a limited fashion) in my own life. Now I spend every day on the couch. Many nights I am unable to sleep because of the unrelenting pain. A change in the barometric pressure can make even just laying down extremely difficult.
Don't tell me to just "grin and bear it". It doesn't work like that. Opiates are the only thing that have always worked. They are my last line of defense against ending it all.
I empathize with those who face addiction. I only wish that the DEA would end its' campaign of fear being waged against pain management doctors and their patients. We deserve some attention also.
25
@Pilot*** your right it's a crazy idea and totally ridiculous too.
6