The HUGE problem with these "truther" ads is they AREN'T THE TRUTH.
I was maintained on opioid medication for EIGHT YEARS for serious chronic pain. Due to a malfunction with my HMO, I was unable to get a prescription refilled and had to be withdrawn from the medication. Because of the social stigma of taking opioids, I decided NOT to go back on them. NOT because I didn't NEED them, but because the SOCIAL STIGMA of taking them was simply TOO MUCH. I was tired of being treated like a junkie for taking medication as prescribed by my doctor. Instead, I CHOSE to live in serious chronic pain every day. It's been years since then and I've done everything I can, including developing auto-immune disease from overuse of anti-inflammatories and stomach meds to avoid opioids--which WORKED and didn't cause disease.
I was NEVER addicted. I was, however, dependent, which is a physical condition. Addiction is psychological.
This is garbage. It does horrible things to people with chronic pain. It's bad science. It does nothing for addicts. It stigmatized dependence which IS NOT AND WILL NEVER BE addiction.
These non-truth ads are manipulative and they conflate dependence, which would indicate using a withdrawal cocktail to properly detox the body, with addiction which has a whole different treatment regimen. The reality is, we don't know WHY some people get addicted and why some people NEVER DO.
The solution is NOT to torture people by not giving them proper pain relief.
4
The huge difference between cigarettes and opioids is that no one needs cigarettes, but when someone is grievously injured, opioids can make the difference between living normally and living in 24/7 hell.
7
If the ads are indeed based on documented cases, they might be effective. If they are marketing hyperbole, they are going to backfire, because they are then as manipulative as the portrayals of the tobacco industry mentioned. Hyperbolic lies end in cynicism.
1
My ex-husband (raised in a nurturing and prominent 2-parent home) passed away from opioid abuse as his disease progressed from pills to heroine. The ads could help youth and worth a try. Any reinforcement and program would help. In my experience, my ex destroyed parts of my life back then as so many addicts do with their spouses and families. The financial, emotional and psychological damage he caused me was horrific. Any redeeming quality he once had was usurped by his disease. I ultimately left him when he secretly got another married addicted pregnant and I learned about it when she was 8 months along. Imagine financially paying for an addict to live under your roof and covering their bills only to have them betray you. The young child was ultimately given up to his family for rearing sadly. He was married. To me. Such a horrible betrayal after I helped him get better and would have done anything to assist in his recovery process. I attended mtgs, sat through his rehabs, detoxes, hospitalizations and cared for him financially as he concealed his use time and time again. He used on Amtrak home from Florida rehab! After 6 mos sobriety. I was used by him and his wealthy family never intervened to help me as I was left homeless bc of his negligence. It took a long while but I restarted my life, got several jobs, a new apt., studied and earned a Masters Degree. He was never injured or felt pain. Just loved his drugs and nothing was going to stop him from getting high. Nothing.
2
@Story
This is why low dosage opiates should be regulated, legal and controlled, so people don't go to unregulated, deadly, heroin. This is what Portugal has done with amazing results. It is the only realistic solution.
Alcohol causes far more death and social wreckage than opiates, and we promote it with billions of ad dollars.
Alcohol is the number one date rate drug.
Amazingly, we take all this as normal, and drinkers usually consider themselves non drug users. A fraudulent charade is being perpetrated on the American people. We celebrate the potentially addictive, potentially deadly drug alcohol, don't call it a drug, and shout from the rooftops - "just say no to drugs" or "partnership for a drug free America". What we have right now is actually kind of an affirmative action program for one drug, alcohol, which some claim is the worst drug.
We can get the opiate problem under control. Heavy drinkers will always be out of control. And we can live with that too.
1
In the old days, you usually only got opioids - we called them narcotics - after an operation or severe injury. You only got one Rx and could not refill it. Many of them were the same drugs that people are abusing today; some, like Darvocet, have been banned. The side effects are severe constipation (how do addicts stand it?) and dizziness. We couldn't wait to get off them, but saved a few for a bad day. I never met anyone who got addicted to them. The real drawback of this crisis is that people who really need these drugs can no longer get them. After I was run down by a van, I didn't get opioids, but high dose Rx Ibuprofin and scary muscle relaxants that numbed half my body. Thank goodness the Ibuprofin worked, but I had to take a lot of it.
4
@Stephanie Wood
In the "old days," what was prescribed were opiates, naturally derived from opium. They are about 1/10 are strong as opioids which are synthetic.
BIG, HUGE difference.
1
Glad I cut my cable and dispensed with commercials! They sound awful.
I use opioids for chronic pain, and I am no doubt physically dependent. However, I am not an addict. I take them exactly as prescribed. Most chronic pain patients are not addict, we just want a life. I am glad to see these ads as opioid addiction is a national health crisis but, from your description of the ads, they seem to focus on prescriptions. The problem is that 80% of addictions start with recreational use.
48
I've seen people with 1000 Oral Morphine Equivalents saying "I'm fine, I'm comfortable, the doctor prescribed me" and I do wonder how long they've been chronically constipated. The reality is chronic pain and opioids are not actually a suitable match (the longer you're on opioids the more pain sensitivity you have) - but for cancer, palliative and acute pain they're amazing.
But if someone is on fentanyl patches for their sore back then they're kidding themselves.
If someone takes >120 oral morphine equiv per day, even in the supposedly "lower risk" opioids like Codeine (its not low risk at all), then its appropriate to talk to your doctor about "descending the analgesic ladder" or utilizing other ways to reduce pain.
5
@ninp
With a 1000 mg morphine equivalent
dose, hope that your friend had access
to Naloxone. (Narcan) that type of dose
is like playing Russian Roulette for
respiratory depression and death!
Also, no responsible Doc. prescribes fentanyl
for a sore back. Ain’t happening.
4
@ninp , I agree with you that strong opioids are not for people with "a sore back", ie strained muscles, tendons, someone whose back hurts from sitting, etc. However I don't know if you are a chronic pain patient who used to utilize opioids, are a HC worker or just a concerned person but for some people, strong, long acting opioids are the only thing that keeps them getting out of bed and functional in the morning. I have several damaged discs in my back, a nerve impinged into my rt arm and hand (among other things). I have been dealing with this since a MVA in 2000. I was previously on both long and short acting opioids. I agree, it was like passing rocks. Apparently they have drugs to address that now? I got tired of the hoops I had to jump through to get my Rx's and the stigma that goes along with taking them. I am now on a low dose opioid and I take ~ 1200 mg of Tylenol and 1200-1800 mg of Ibuprofen daily. So now, instead of taking a nice, safe drug that I only have to worry about my evacuations, now I get to get my liver and kidneys checked every 6 months. I am only 53, so I will need my kidneys for quite awhile longer, God willing. I have tried it all, PT, OT, MedX, acupuncture, biofeedback, mindfulness/meditation, TENS, lidocaine patches, etc. Before I started on opioids, I lay on the sofa and planned ways to kill myself. These are the choices, for people like me.
9
Opioid promoters have organized people to write about how much they need their opioids. People who actually need their opioids also write about how much they need their opioids. So readers of these comments may find themselves parsing the comments and trying to spot the real ones. And some readers have run into "Reefer Madness" and other antidrug propaganda, some of which is still around.
There is an ocean of difference between cigarettes and opiods. Cigarettes have no medical purpose. Not one. Opiods are a crucial part of controlling pain. While it is laudable to prevent young people fron abusing opiods this campaign has gone way to far in keeping people from getting necessary medical care. Please consider how you would feel in a car truly accidentally fell on you, broke your back, and the ER offered you nothing but Tylenol for your pain. This IS happening. Wake up, its only a matter of time before this affects you!
6
Not all teens in America are created and treated color aka race, ethnic, national origin and faith equal in America.
When opioids were devastating the black African American community it was an ignorant moral degenerate crime wave worthy of mass incarceration.
Now that white European Judeo-Christian Americans are making, marketing and selling and using opioids it is a crisis and an epidemic worthy of compassion, empathy, sympathy and treatment.
While the Mexican Sinaloa Cartel of the Guzman family were treated like traditional organized family crime lords, the American Sackler family of the Purdue Pharma Cartel were long treated like honored corporate plutocrat philanthropists.
Opioids should be legalized and treated like a potential health abuse problem akin to alcohol and tobacco.
4
How much do I know about opioids? Enough to know you have to distinguish between the harms caused by the drugs themselves and the harms caused by their prohibition. I wish the NYT knew that.
3
Thank you for this article!
I do know nobody really cared when heroin was ravaging communities of color.Now that is has escaped the bounds of the poor and disenfranchised we are looking for solutions? Opioid addiction is insidious because a lot of times the pusher is your local drug store.
2
It's kind of a sad farce that that this so called Truth Initiative is using highly unrealistic ads to get their point across. Someone under a car kicking out the jack? It reminds of the early anti pot ads showing a fried egg cooking on the sidewalk, with the logo "this is your brain on drugs". Pot is now used for numerous medical issues. I use it for side effects of migraine medication I take and it is terrific. It is, in fact, life enhancing. We were lied to about pot for over a hundred years, and millions of people were(and continue to be) wrongly criminalized.
The fried egg on the sidewalk is, however, a pretty good description of your brain when drenched in the legal drug alcohol.
A better Truth Initiative would be realistic warnings about opiates along with the truth that many people need them, they work, and must be treated with the utmost care and hesitation.
Most importantly, a list of well known people who have kicked opiates and on gone to highly successful careers should be provided - Elton John, Robert Downey Jr., Rush Limbaugh, James Taylor, etc. etc. In other words, if you stumble, get help, we can bring you back and want you back. Everyone is important.
5
There are problems with making opioids the new tobacco. As someone who relies on highly regulated and monitored opioid use to manage chronic pain and someone who used to smoke, I can say from experience that while cigarettes have zero redeeming value, opioids are life-saving and life-changing for me.
In order to obtain my prescription, I have to see my pain management doctor every 30 days. I get exactly the number of pills I need to address my pain. I had to sign a form verifying that I would never take any opioids from other prescribers and never give them to anyone else. I have to get my prescription from the doctor a week before I need it because my pharmacy has to special order my medication, as opioids are so highly regulated now.
I remember as a child screaming at my mother for smoking because we were told it was so dangerous (as it is). It would be terrible for chronic pain sufferers to be shamed because of their need for medication.
8
There was a"protocol" that was changed to allow the scourge of opioids to be distributed here like Opium was distributed in China many years ago. That is what is so exacerbating is that the medical profession has know this is a scourge and did nothing when "protocol" was changed to allow them to hand out opium to anyone! Until we understand how this started, we will be subject to it happening again. The changing of a "protocol" changed everything for a lot of people.
4
How about:
- restriction to special perscriptions,
- prescription by qualified doctors only,
- mandatory detailed prescription rules particularly for doctors,
- long-term prescription only by well trained experts for pain therapy,
- compulsory provisions for evaluation in each individual case if it is a long term therapy (more than 30 days),
- strict monitoring of prescription practices by insurances and medical associations,
instead of more or less attempting public PR campaigns for complete medical laymen who barely know a opiod pill from aspirine?
2
What the article fails to mention is that the anti-smoking ads that have been effective at reducing cigarette use were only possible because states successfully sued the tobacco industry and won a very large settlement based on the public health costs the industry knowingly inflicted upon the public.
Unfortunately, Big Pharma learned from Big Tobacco, and they have adopted a strategy of avoiding a large, global settlement by paying off individuals and local governments, funding rehab clinics and the like. Without a large, global settlement, there will not be funding for the type of ad campaign that we've seen against tobacco.
Unless the federal government did something. But don't hold your breath on that one.
1
Just for the record, the education component of the anti-smoking campaign was based on shaming and shunning more than facts and fear of disease. Also, I wonder if the "success" of the anti-smoking crusade contributed to greater use of alcohol and other drugs. It certainly gave rise to vaping among young people. It is human nature to seek out substances that make us feel good quickly and relieve physical pain, emotional pain and stress. Alcohol remains the Number One socially acceptable drug and for many leads to addiction and untimely death.
3
Yes, opioids can be addictive, and yes, they can ruin lives. How about you cover how this opioid “epidemic” has impacted the millions of chronic pain patients who once benefited from proper use of opioids? How about you write about the terrified doctors who ‘fired’ their patients without tapering them off from opioids properly? Or, you can write about how legitimate chronic pain patients have been forced to resort to using street heroine to relieve their intense, life-altering pain. Also, you can report how illegal opioid use has increased. How about chronic pain patients taking their own lives because of the pain? More often than not, chronic pain patients do not abuse their opioid prescriptions. But, I suppose the trade off is acceptable... let’s save the people who abuse drugs, some 50k to 60k deaths, over the millions who absolutely need opioids to experience any semblance of life.
23
I have been on opioids twice in the hospital, and have stopped them successfully both times. Once for a bike accident where I broke both my arms, and recently, after open heart surgery. They helped me when I needed it. They are safe when used for a short time to treat pain that will heal. Problems happen when taking them for things like a lower back injury that will not heal, or not quickly. The first time I was scared to take them because of the fear of addiction. My surgeon then chewed me out for not taking them when the pain was so bad I couldn't do my rehab exercises. It is more important to do the exercises than to be stoic about the drugs. A fellow patient still refused to take them, and later he kept re-injuring himself because he had trained himself so well to ignore pain. After the heart surgery, it was necessary to take them because pain was preventing me from sleeping. At some point, not sleeping is worse for you than the drugs. The key is to stop after the immediate crisis passes, which I was able to do (but some have trouble with). I agree with anti-addiction efforts (as long as they don't scare people unrealistically). but these drugs do have a legitimate use. We need more research into pain.
11
As a pain management physician myself who knows a fair amount about opioids, I am well aware that the over prescription of opioids especially for chronic pain is a major public health problem.
However, I believe the author presents a distorted picture of what two of the studies show.
The first is that one showing that teenagers prescribed opioids have a 33 percent higher chance of misusing opioids later in life. The problem is that no one knows the circumstances of the initial prescriptions, i.e., if they were required to control the pain or if they were requested by the patients or their families. And whether or not they had already misused opioids appears to have been difficult to determine and certainly anyone trying to get opioids isn't going to tell doctors they had previously used them illicitly.
The second study regarding that increased probability of long term use after only five days of therapy. It is important to note that opioid dependence and opioid addiction are two different things. The former is a physiological response to taking opioids that can occur in anyone. The latter is a more complex issue combining physiological, psychological, environmental, and genetic factors.
As to those ads. I've seen many patients who've come up with all kinds of stories to obtain prescriptions for opioids. I've never had one who self injured themselves in order to do so. I fear that ads like that will end up being laughed at and ignored.
17
@Steve
Agree with you - totally - dealing with an old (75+0 person with Parkinson's and horrible debilitating chronic pain... for years -- managed with Librium ...(benign compared to opioids but a problem in terms of getting scripts.)
Eight years with knees pre surgery (a miracle) which unlike hip replacement is good supposedly for about 20 years and cannot successfully be repeated. (Waited til 70-- but what a difference!). All pain relievers were initially effective and then no more. I discontinued all except on rare occasions when they worked because the nerves were not "used to them" and blocked the pain signals. Apparently in another era, well off morphine addicts had decent lives. Is this possible with opioid addiction?
So far as teenagers -- they often need much more than ads -- as in everything from food and shelter (homes can be abusive) to education to jobs and HOPE.. The developing brain does not mature til age 26! The emotions run high... as does the potential for great things.
2
Here is what I know. I know that I a serious medical problem and I take a low dose 10mg x 3 plus tylenol that makes life much more comfortable for me and by extension my family. I know that once kids in the suburbs began to have opioid problems this became a "disease" and ordinary folks that need these drugs hard having a really difficult time because of all this. Blood tests, I have to pick up the prescription in person, not even my wife can pick up the script. My Doctor cannot call it in. People presume you are abusing these drugs,at least the one that are not familiar with you. In NJ you need to show your license to buy sudefed and only once a month. I joke with the sales person that it is easier to by a firearm in Virginia. That's what I know.
13
First let me say that most people fail to distinguish between legitimate use of opioids and misuse. Many people are helped with pain management by opioids when nothing much else can help them. I took them for two and half weeks when I had a broken arm several years ago, and when the pain became manageable with ibuprofen and tylenol, I quit them with no problem. Right now there is a lot of justified emotion about drug overdoses, etc. but we must not lose sight of the more balanced view about the use of drugs to help alleviate pain.
9
@Rebecca Hogan
Legal opioid use is 2000 times higher in the US than in India. Opioid use in US is 50% higher than Germany which comes in second in the world. 130 people die daily in US after overdosing on opioids. Opioids have justifiably have caused great "emotion" as it is a Killer. US citizens must either get used to more pain or more deaths.
From personal family experience, I’ve learned that opioids are so powerfully addictive, that the only way to prevent addiction is not to start. I have a hard time believing an ad campaign will have any effect.
Having counseled addicts, I’ve the same story a number of times; it goes something like this:
“You told us cigarettes were addictive, they weren’t; you told us alcohol was addictive, it wasn’t; you told us marijuana was addictive, it wasn’t; so when it came to Heroin, we didn’t believe.”
This, for many addicts, is the reality.
I’ve also known too many addicts who’ve joyfully proclaimed their recovery and new-found sobriety only to relapse and sometimes die shortly after.
My unrealistic advice to worried parents: if you can, send your teen to live abroad until he or she is 21–a country where it’s hard to find drugs. They’ll learn another language and grow old.
4
@William Profound and incredibly sound advice, across the board, but I particularly agree with your observation about opioid dependency relapse, overdose and death. In his 2010 book "Life", Keith Richards recounted multiple tales of people who were habituated, went on the "wagon", fell off and decided to try the same dosage they utilized before rehab... As it turns out, all too many "bought the farm". Nothing new under the sun.
3
@William
Addicts must be really stupid. Cigarettes and alcohol are super addictive and the facts are overwhelming. My brother was in social work and dealt with heroin addicts and many who he helped "kick" heroin couldn't quit smoking cigarettes. Because of availability they are tough to get away from. These addicts are fools if they say what you said they say.
1
I am in my 30th year of severe psoriatic arthritis. A low dose of hydrocodone allows me to stay active and relatively pain-free. The thing about opioids is: they work. Doctors are under a great deal of pressure these days not to prescribe them to anyone, which is a tremendous disservice to those of us who use opioids, but don't abuse them. Hydrocodone is not heroin.
14
Tina, how much do you know? By lumping ALL opioid types under the generic label, "opioids", a conflation of data and resulting conclusions is doing a huge disservice to the many millions who successfully manage severe and chronic pain conditions with the responsible use of oxycontin. The spike in deaths has arisen entirely from Fentanyl, Heroin, and others of that ilk, and I would refer you to this chart from the CDC https://www.cdc.gov/drugoverdose/images/data/OpioidDeathsByTypeUS.PNG The death rate from oxycontin, and other commonly prescribed opioids, has been essentially flat for a decade. Do your readers and the world at large a favour, and produce an essay on the contributions of those still working because of access to an important therapy, and bring a bit more precision to your research please. There is lot's of "spin" deployed in the world, even for well-intended causes.
16
@walter
Let's just ignore 130 deaths per day in the US from opioids. Yes opioids are great for pain but with 80% of world opioids being used in the US we have been loved too much. These are facts and our government allowed this to happen and it is a national disgrace. Opioids are bad news. Period.
I'd like to see the results of those programs in peer-reviewed publications. All the data I've seen shows that they're a waste of money.
In the 1970s, my prof got a grant to draft a report on the use of mass communications in family planning. I reviewed the family planning literature and, more broadly, mass communications in public health.
It was a hot topic. Government organizations were spending millions of dollars to promote family planning.
They said, "If we can use advertising to promote cigarettes, why can't we use it to promote public health?"
Unfortunately, the clear consensus was that these mass communications programs were ineffective. All that money was being wasted. The PR professionals were deluding themselves.
The best study was in auto safety. The Insurance Institute for Highway Safety designed a textbook, randomized controlled trial to see whether professionally-produced TV commercials could encourage people to wear seat belts. They had observers at traffic lights. The result was that the commercials had no effect. If anyone has gotten better results, I'd like to see it.
A controlled study of the effect of television messages on safety belt use.
Robertson LS, et al.
AJPH. 1974 Nov;64(11):1071-80.
DOI: 10.2105/ajph.64.11.1071
Free Text
4
PS. The article you link to support the success of the Truth Initiative in stopping smoking actually says that we don't know whether methods like Truth Initiative works.
https://www.washingtonpost.com/archive/politics/1997/11/02/officials-seek-a-path-to-cut-into-haze-of-youth-smoking/bdfdf1a0-4c3e-433c-844c-8eca9b746253/
Do you remember how marijuana was so dangerous? They used scare tactics on my generation. The only ones who believed that were our parents. Since most folks DO NOT get addicted quickly, they will have trouble believing. Different generation, same issue. I truly have no idea what can work, but I can tell you that opioids are necessary for me. This emphasis on how bad opioids are is overwhelming for legitimate pain patients. More reality, less propaganda.
10
I have one friend who gets over a hundred kidney stones a year and has spinal fractures. Another friend debilitating migraines and they are scorned by ER doctors, ER paramedicals, Nurse’s, pharmacists or their assistants when they either turn in their prescriptions or ask for maintenance levels of opioids. This anti opioid crusade has become worse than a cult. Of course there were tens of f thousands given opioids who should not have been on them, but millions who don’t get addicted and hundreds of thousands who are given ok quality of life so they are not in horrific pain and can function. Many of these medical professionals are scared of being carted to jail for giving an opioid on Day 6. Someday we will look back and see how the fanatics have taken over and reason based on individual cases was discounted.
26
@Mike that's really sick that they can't get the meds they need. Pure insanity laced with sadism.
1
The opioid issue is complex and there is much more work to be done, public education, destigmatization for people who have issues using them and more trust in medical professionals in prescribing. I am a chronic pain patient, I have been on various opioid meds for pain. I have been treated like an addict and a drug seeker for the crime of seeking relief from my pain. I have never fallen into the problems some have with my Rx's. The biggest problem I've had is being taken seriously as a patient. My dad died of bladder cancer this past Dec. The last few weeks before his death he was wailing in pain and I could not get the hospice nurses to raise his morphine. He died suffering and in pain because they would not help him. They knew he would die, yet he did not merit pain relief to them. THIS is one result of the opioid epidemic, that real patients are losing access to pain relief they should be able to get. Patients need more information and warnings about these drugs when prescribed. They need to be told about the physical addiction that goes with them. That they will likely have to taper off of them, that it should be okay to call and get help with this. People find they feel sick from withdrawal and they get treated like an addict when they call for help (or get shoved more pills). Truth ads should include that a non-opioid tolerant person can overdose with their first use. Also, show the number of people who end up on heroin after having been Rx'd opioid pills.
18
@Susie Sorry about your father. Had he been in a hospice, they would have legally provided him with morphine to ease his pain and ease the end of his life for him and his family.
2
@Susie Common sense seems to be in particularly short supply these days, that means your observations count more than you can know. Keep sharing your story, people will notice eventually.
2
@Erica Smythe
@Susie specifically mentioned that her father was being treated by "hospice nurses."
Thank you Susie for sharing your heartbreaking story. I'm sorry for his tremendous suffering and hope that, in sharing his story, some common sense, compassionate end-of-life care will become the norm across the U.S.
4
A friend's husband, who has stage 4 melanoma, was in the hospital for removal of a tumor from his spine. He was in great pain, and doctors refused to give him sufficient painkillers because of .... what... addiction? With stage 4 cancer? Please, stop it with the opioid horror stories, or at least include the ones about patients being denied opioids they need to go on living.
43
@trenton
Sadly, there are many horror stories with
Internal medicine Doc’s cutting off, no longer
prescribing, or not properly tapering patients
off opioids. A lack of education and training,
are one possible cause. Not ethical.
Since your friend is dealing with Cancer. one
would think that an Oncologist would be a bit
more empathetic.
Most overdose deaths, are now caused by
heroin and illicit fentanyl.
Would recommend a change to a more
compassionate Doc., and or a Patient Advocate.
18
@trenton , just went through the same with my dad. He was in hospice, dying of bladder cancer and he was yelling in pain every time I went to see him. I complained but they just would not take care of it. He died in terrible pain. I agree that the stories of overdose and addiction need to be tempered with how it has affected pain patients, especially chronic pain patients and terminal patients.
17
@trenton We have a terrible problem with addiction in the US. We have narcan in hopes of saving a person who has O.D.ed. We have subloxone to help addicts get off the drug.
We have campaigns to warn young people. We a kind of alarm that is protecting terminally ill patient from addiction, to the point of ignoring pain in hospice situations.
What we do not have is a serious attempt to counter the bleak outlook that has so many looking for a way to calm anxiety and DISPAIR amoung young people who have heard all their lives about climate change and extinction. When we have so fouled our planet out of denail and greed, which world state governemnt will take real action to try to save our planet? If you, older folks were raised under this kind of could, can you say you wouldn't be tempted to forget it for a bit? Sorry but worrying about an A-bomb like we did as kids really paless to concern that the whole living planet may be facing it's demise.
6
I am sad that the truth is covered up. The first "study" by a corrupt CDC, was headed by Rehab Owners. It was found in a true scientific study that OD's, of all of them, were only 1.6% out of 100% by "opioids"- what kind? Prescribed for pain control. Our Fed Govt stands to gain financial returns on online dealers of dirty fentanyl, dirty pills, coke, meth, they're all STILL THERE.
The reason we now have chronic pain is this: we are SURVIVING that injury which leaves chronic pain.
The CDC said, and continues to say, we have no replacement for pain management other than opioids.
It has been proven that treatment of an addict works very well in a public health department way- with physician run, aided by social worker, peer support, monitoring, "caring". Jobs, housing.
It has been proven, addicts become so due to: loss of hope, joblessness, a health condition unable to treat due to lack of care, no housing affordable; look at areas of addiction!! No JOBS. No Healthcare. No Mental care. No dental care.
This opioid lie serves the govt quite well. The lie has convinced new nurses & Dr's that pain is not REAL. The nurse harped at my 85yo father following thyroid/lymph nodes removal, as he was awakening & asked for pain med. They're all harping now. Pain is REAL. If unabated, it stresses the brain, and delays healing. I am a retired RN. I cannot believe the outrageous attitude toward patients these days. Well.........yes I can.
18
@Stephan , I agree with you. Although some of this has to do with increased pressure and surveillance by the DEA of class 2 providers. It makes them afraid and pushes them to doubt people. IT IS WRONG.
7
@Susie In truth it's the media and the legal profession using the media to amplify a story that could have been managed within the medical community itself.
Since it got amplified, every politician had to step to the microphone and answer the question "What are you doing to protect our children?"
You got the answer in the huge crackdown on even writing scripts for Oxy or other opiates.
4
First, as with most coverage of the issue, no distinction is made between physical dependence, psychological dependence, tolerance, and addiction. Those are each quite different. Unless this is understood no useful, accurate discussion of the issues can happen. Like most persistent problems, the issues are complex. Let's put in a bit of effort to understand the problem before loudly promulgating our (unsubstantiated) solutions.
Next, "The truth campaign responded that opioids were complicated, and that covering various scenarios in the ad would have been confusing." Well, accuracy is often more complicated than exaggeration, half-truths, and flat out agenda-driven hysteria. Claiming that the ends justify the deceptive means, particularly when we have no idea if this campaign does any good at all, serves no one. Kids are not dumb. "Just say no" and "this is your brain on drugs" inspired some good material for the class comedians in my day. I'm pretty sure the current generation is even more aware and creative than we were.
9
I know enough to NEVER take opioids... not like it is a well kept secret.
1
Well... congrats on your superpowers and thanks for sharing. You’re amazing.
11
@Mystery Lits I felt the same way until at age 53 while fit and trim and playing yet another tennis match...my L4/L5 blew out.
The next morning I couldn't stand or lay down. For the next 6 weeks I slept at a kitchen table with my head in my hands crying.
Without the cortisone shots and nerve blocks (opiates) I would have probably stepped in front of a Mack truck.
That's how bad the pain was and for 53 years prior to that..I had no idea the human body could provide that much pain and suffering.
Just like that...it'll happen to you someday..or perhaps not..if you're lucky.
17
@Mystery Lits - I’d be interested in hearing about your experience if you ever have a kidney stone.
6
The opioid crisis is only one of many addiction crisis. There was a crack Cocaine crisis, an Amphetamin crisis a Valium crisis, and crisis with various other Uppers and downers and mind altering drugs. There is a number of people with addictive personalities who will resort to anything to get stoned. It is difficult to treat this, but this is the direction in which research should go. Attacking pain relieving prescription opium derivatives makes o sense.
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It gives me great relief!
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The elephant in the room here is that drugs feel good. Opiates --- for many people --- take away not only pain but anxiety and worry, replacing them with a pleasant euphoria. Opiates don't cause people to stagger around, get violent or lose their judgment like alcohol does.
And cigarettes don't; begin to make people feel as pleasant as opiates do, so it's far easier to quit that habit. It's the feeling that addicts are after.
When my elderly friend was going into cancer surgery, she was so frightened I worried for her sanity. After a shot of an opiate, she became relaxed and optimistic. (The surgery was successful.) At age 80, she has never forgotten the feeling she got from the opiate and wishes she could feel that way again.
It's the very nature of the opiate effect that makes it so sought after by humans for virtually thousands of years.
I believe opiates in the U.S. should be legal, prescibed and quality-controlled to get the criminal element and deadly Chinese Fentanyl out of these drugs. No addict or person in pain should have to seek their Rx on the street.
Right now, the government is okay with people dying just on principle. "Either quit willingly or we will take it away from you" is the policy. Do we really want addicts to die? I don't need a painkiller now, but chances are that I will someday, and I foresee myself suffering.
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@Trista Let’s not forget about the benefits of harm reduction - which accepts the premise that people use drugs but since drugs have the potential of doing harm when misused - harm reduction teaches people how to stay safe.
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@Trista , in the UK and Canada you can buy what is basically Percocet (Tylenol + codeine) over the counter from the Chemist ie pharmacist. You can only take so much as it contains Tylenol. This makes sense to me. I also think that this problem has a lot to do with people who suffer from addictive issues first. It is not the particular drug that is the problem, it is their susceptibility to anything that they can use to escape their life. This "crisis" has had a very negative effect in that what it HAS done is made it much harder for legitimate patients to receive relief.
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@Susie
Yes, I don't see why people should writhe in agony while waiting four hours in an ER or Urgent Care only to behanded a couple of Motrin.
Ofcourse somepeople are such intense addicts that they will extract the drug from the Tylenol or even overdose on theTylenol to get their high (very lethal to the liver).
But offering such people help and not forcing them to go cold turkey or enter a costly rehab or cruise the streets for heroin can save their lives. It gives them space to get a grip on their emotional issues and habit without forcing them into desperate measures or jail time. They deserve to live, for heaven's sake! Some people simply will never, ever get clean and sober. Yet, they still have a life and it's well worth saving. Just ask their friends and families.
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Time to reboot the Meth: Not Even Once campaign
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The advertisement describing the person damaging his own body to acquire more opioids, reminds me of the TC Boyle story of a crashed drug runner pilot stranded on a desert island with nothing but his bundles of heroin.
With nothing to eat he starts consuming his own body. Since it is written as a diary, the last entry is "Ladyfingers. They tasted like ladyfingers."
It takes this type of shock value to get the point across.
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@Siebert The story you're referring to is "Survivor Type" by Stephen King.
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@what yo! tx for the correctx
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I know plenty of people with permanently injured backs, hips, and knees who worked as carpenters, plumbers, laborers, athletes, etc. For fear of addicting them and getting in trouble with the DEA, their doctors give them inadequate pain medicine year after year. What about their pain and ruined lives? the X-rays don't lie--they aren't faking to get more dope, but they get squat instead from cowardly doctors.
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@Hector
This is a huge, horrific crisis in itself - people living in agony now. Many people are only able to work and live normal lives with opiates.
I've worked with numerous people over the years in that situation. Some of them seem to be able to work harder. That doesn't happen with drunks - using the legal hard drug alcohol. Who would hire a drunk? Conservative superstar Rush Limbaugh was addicted to
opiates for a while as he rose to become a top paid radio host in America.
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@Hector , I hear you. I am one of those people. I have several damaged discs in my back. I was on long acting opioids for 8 yrs but it was a huge hassle to get them from my doctor and it caused all kinds of stigma with every healthcare provider I saw, "Oh...You're on OxyContin....... Who gives you that......?" Now I take a very low dose opioid along with enough Tylenol and Ibuprofen to sink a ship. Opioids are safe for the body. Tylenol can affect your liver, Ibuprofen WILL damage your kidneys taken in large doses over time and raises the risk of heart disease. As I take these others, I have to have my liver and especially my kidney levels checked twice a year. Great alternative.
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@Hector Which is why life expectancy for white males in the United States is declining.
Suicide is a leading cause and this overreach on banning/restricting opiates as a large casting strategy is just not healthy for American males who are often the recipients of mind-numbing pain.
If 1/2 the women had to go through this kind of pain...opiates wouldn't be so tightly controlled.
That's one more reason to go to college so you end up working with your brain more than your body.
it also explains why women should be required to do more of the manual labor work that men do currently.
If we want equal pay as part of the ERA...we have to be willing to go out on a rope 30 floors up cleaning windows to make the $40 an hour they make vs. staying indoors and cleaning the inside of the window and making $20 an hour.
Same job..different pay..head outside ladies. Time to test those delicate discs on your lumbar and the meniscus in those knees.
Let's bottom line it Tina, what history has taught us.
The best way to deal with a drug, dangerous object is legality, responsibility, regulation and non promotion.
It worked miracles re dramatic drops in deaths with cigs. and drunk driving and has been a horrible failure with gun deaths and opioids deaths because it has or was not employed.
The cure is simple, the will to do it is a Herculean task.
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@Paul
You are correct. Portugal has done this and
completely changed the overdose situation.
Portugal has the lowest drug-related death rate in Western Europe.
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@Paul Shindler thank you for your reply. Yes, any country that has try the formula completely enjoys lowest rates of deaths and injuries from drugs or dangerous objects like guns...
Completely is the key. If you only try it in part, the cure will be elusive.
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As a retired physician, I share in collective guilt over a part of the opioid epidemic. Many of us had experience with heroin users, and many of us thought that their addiction was in some way different. We trusted too much in advertising and in detailing from drug representatives. "Pain is the fifth vital sign". "Talwin is nonaddictive."
Physicians should be part of this truth campaign. Even if the visit is for routine matters, such as hypertension, a doctor can ask about substance abuse issues in a patient's family.
Many of my patients would come to the office with children or grandchildren. I would then open a discussion about tobacco and drugs with the child. I never had a single experience where a patient told me I was out of bounds in discussing the dangers of substances. Of course, doctors are all advised now about prescribing less and monitoring more when narcotics are necessary. We need to recognize populations that are at higher than average risk for narcotic use, witness the book by Paul Krugman and Robin Wells recently noted in the Times and on NPR.
Physicians can treat or cure but a fraction of chronic illness, but we can always tell the truth. Regarding substances that are dangerous and social practices that can be deadly, we can tell our patients and families the dangers of opioids. We can learn about pain, and we can better counsel about treatment of chronic pain.
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@Jeff I graduated in 1980 and we never prescribed schedule 2 opiates except in the most extreme situations.
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@Jeff
I'm sorry doctor but as a physician myself all ll I can say is that any physician who prescribed based on drug company advertisements or sponsored talks for any drug shouldn't have been prescribing them.
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Actually, what you as doctors can do is develop evidence-based methods to get people off drugs. I’ve never had a physician discuss what to do if you find yourself addicted to a drug that he or she prescribed.
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I frankly despair of this issue ever being treated reasonably (and, for that matter, covered reasonably in the press); we seem unable to stop this mad pendulum swing.
Why is the suicide rate on the rise? In part because physicians have been terrified into not prescribing effective pain medication. Why are people ODing on the streets? Because we (patients) are quite literally being thrown out onto the streets.
On balance, dealing with people in pain has become too much trouble, and too dangerous. Why risk your license for a bunch of "whiners" and "addicts," right?
People really don't understand what it's like to live in unremitting pain. It takes away your life. But--no matter!--on with the latest iteration of Prohibition. Always casualties in a (drug) war. Too bad if it happens to be you . . .
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@Don Unger People always go one about how Americans have to suffer pain....meanwhile the US accounts for roughly 95% of the global consumption of hydrocodone.
Are you telling me there is some pain that is uniquely American that requires them to take vastly more opioids than any other country on Earth?
I'm not convinced.
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@KW , let me see if I can help with that. Have you ever visited the US? Well, it is 40x bigger then the UK with as you know, 50 separate states. I live in a state where you cannot get opioids very easily. They prescribe them in small amounts for serious injuries, post surgeries, etc. However if you are a chronic pain patient, you are out of luck. The "pain clinics" around here are very conservative and just won't go very high with doses, despite diagnosed serious intractable pain issues. Now, part of the reason that we have some states with very high rates of overdose deaths and addiction (although we have both everywhere) is because some drs were basically selling their services and prescribing much more than needed, to enrich themselves. Open 24/7, people driving from all surrounding states to pay for a Rx for opioids. Many of them are in jail now. You may have read that in the 90's pain became the 5th vital sign, along with that Purdue and other drug companies that make opioids were sending their reps to drs, telling them how great and non-addictive their drugs were. Now it has swung the complete opposite way. Some states are considering signing laws telling drs how many pills a dr may prescribe a patient (3 days worth, etc). Our DEA (Drug Enforcement Agency) audits all class 2 Rx's written, all drs must justify them and this has intensified. These are just a few things that will help explain why this is.
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@KW There is some truth to this but I do know in places like India or Thailand where opiods are rare (and medical care isn't always great), people suffer with more pain than they need to.
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Kids are still taught in school that marijuana could kill you on the first try.
It's up there with street meth, even though you can buy it as a state-run shop right next to the grocery store and even though there are no instances of death from marijuana.
And then they talk about "trusting your doctor" if you need help, and only using drugs that come from the pharmacy.
Meanwhile, we have pill mills killing thousands (or more).
This type of messaging kills.
Any kid can see that people smoke weed regularly and don't die. They can see that people don't die right away from cigarettes. They can also see that long-term health complications are just as likely from sugar. They also hear about an opioid epidemic and learn that those pills often come from doctors.
Why on EARTH would they take any part of this message seriously? I know I don't.
Recently, two kids from an affluent suburb near Seattle died from pills containing fentanyl. The pills that killed them appeared to come from the pharmacy. Adults lied about beer, about weed, and about ADHD drugs. Why trust adults about these little blue pills?
The dishonesty is killing our kids. We have to earn their trust. We have to be honest. Weed doesn't kill. Sugar is addictive. Doctors sometimes hurt. Some legal things can kill you.
"Relatable" isn't enough.
We have to be honest with our kids. We have to start real conversations about money in politics, addiction, racism, and our own lives for them to trust us. That's what works.
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@L
Not true about no "there are no instances of death from marijuana". There now have been at least 3, one in Indiana and two in Canada. A link to a lay press article about the death of the 17 year old in Indiana that is readily understood is here: https://www.usatoday.com/story/news/nation/2019/09/20/indiana-boy-17-died-smoking-weed-chs-blame-what-chs/2387571001/
The two Canadian deaths were reported in the medical literature last year. There have undoubtedly been more deaths that have not been reported.
This is not to say that marijuana has as high a risk of death as do the other addictive substances, it does not. But there is plenty bad about it and turning any addictive substance over to Madison Avenue to encourage use is a mistake whether it is alcohol or marijuana. Fortunately, with tobacco, we have gotten better in how we handle it. We no longer allow it to be encouraged. Would that it were the same with alcohol and marijuana.
@L methinks some references to your claims are in order.
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@reb8
Marijuana causes paranoia and depression in some people, some times severe. It usually goes away after it wears off. I wonder if there's any studies saying it could lead to suicide during yhe high or afterwards.
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I know it's a high wind that blows most people away. I know it takes many people's souls away, and often their lives. I know that we are not powerless over it, but it is more powerful than some, as are Siberian Tigers and sharks, so when you get near it, if you must, be forewarned and forearmed. It takes few prisoners.
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Education — and harm reduction policies — are far more effective at combating the use of illicit substances than any kind of fear-driven campaign. I can only assert this fact anecdotally, of course, but my brain has yet to turn into the omelette that I was promised.
I’d also be interested to know who came up with the bright idea to ‘dare’ kids not to try drugs, after having school assemblies which involve police officers parading suitcases of drug paraphernalia around, for all the children to see.
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It makes sense to educate all age groups about opioid addiction, but people who are 24 and younger have fewer deaths than any other age group. Most deaths are for people 25 - 34 and people 35 - 44. It makes sense to look at data rather than relying on anecdotal evidence. It's not clear to me why we would want to focus on teenagers while ignoring other age groups.
https://www.kff.org/other/state-indicator/opioid-overdose-deaths-by-age-group/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D
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Opiates can be prescribed for pain, cannabis can't be and the NY Times thinks that's exactly the way it should be. Got a mirror handy, NY Times?
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@newageblues
First of all, while opioids have been proven to be beneficial for acute pain and cancer related pain, there is no evidence that they are for chronic pain and its why their use for this is contraindicated.
With regard to cannabis, there are no quality studies showing it is beneficial for any kind of pain. And if you believe anecdotal reports are sufficient then you should also believe pharmaceutical companies should be allowed to get FDA approval for their products just based on anecdotes.
If you want to argue that marijuana use should be made legal, fine. Just don't bring in faulty science to support medical use.
Another way to impress both young and old: indict the big-time pushers. I mean the CEOs of companies that have pushed addictive drugs on the American people--heads of tobacco companies, of Juul, and of Purdue and other pharmaceutical companies. Charge them with murder for profit. I doubt we'll see any long lasting changes in our society until people like that do at least as much hard time as the street corner dealer.
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@Martha Shelley
How about the street sellers, i.e., the doctors who misprescribed all those opioids.
We don't let street pushers of heroin off unpunished.
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Good article. However the medical community has no medication to address chronic pain. These teenagers have parents who can no longer work because of lower back pain. I watch the UPS, FedEx, men and women pulling on huge boxes with that little back brace on. If not this minute they are working back pain issues materializing in front of our eyes.
We allowed Johnson & Johnson and doctors to destroy communities with these opiates. The medical community knew what was going on and did nothing now its a crisis like dementia, they see the data and do nothing
We cant do one deed in isolation we need to educate young people and we need to work with people who are beginning the chronic pain syndrome. This back pain is real and we cant think thru the pain. We need to have real medical solutions and solutions for young people so they don't get addicted.
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Great article.
I think truth ads would help a lot with the tragedy of addiction.
I also think they'd help a lot with the tragedy of unwed teenage pregnancy.
Although, Mayor Bloomberg put the latter in the subways of NY, but was forced to take them down.
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Opioid use isn't like other substance abuse epidemics. Opioids are prescribed for pain - the opioid epidemic is an response to both a combined patient/physician misunderstanding and mismanagement of pain. People take opioids because they are in pain and, although problematically, they do provide a sort of relief.
Opioids are complicated, so too is pain, and people are clearly confused about both. Simple solutions in medicine or in advertising will not cure pain, and we should work for comprehensive and compassionate treatment of persisting pain. Campaigns to further label opioid dependence as merely junkies abusing substances alienates the majority of people who use opioids to their detriment, because they have no other options. Strategies to understand and cope with pain are poorly implemented in most places, because they take time, and time is expensive.
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@Brian
Not that long ago, opioids were NOT prescribed for any sort of pain with the exception of terminal cancer pain. People were in pain long before opioids were handed out like candy, and they managed without them.
It was the for-profit pharmaceutical companies that saw there was a fortune to be made because opioids are cheap to produce. All a company had to do was come up with a product and a convincing story that their new and improved opioid would not create addicts, to convince a generation of physicians they were safe to prescribe.
Well, the pharma companies lied, and here we are.
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@The Poet McTeagle Culture s have used opioids for pain for centuries. When I lived in Turkey in the early 70’s, local women would pick the poppies next to our apartment. We were told that they used personally for pain relief. By the way, I certainly hope you are not struck down with agonizing pain. Of course, a guy like you will just tough it out. “I don’t need no stinkin’ relief!”
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@The Poet McTeagle they have been in use for over 2000 years: https://www.ncbi.nlm.nih.gov/pubmed/17152761
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The ads likely had little to do with the reduction in teen smoking; the surge in vaping being a demonstration of that fact.
Beginning in the mid-1990s two things happened: 1) smoking began being prohibited in the vast majority of public venues (and presumably would have been frowned upon in a teenager's home) leaving the opening for smoking in a teens life much smaller (teens also became much more over-scheduled) and; 2) the cost of smoking ratcheted up rapidly as states added significant taxes making the trade off between money and smoking that much more stark.
The net effect was fewer teens smoking, yielding less peer pressure to start and fewer role models to emulate: a positive feedback loop.
Opioids are a completely different problem since, it appears, most opioid addiction in teens does not start with experimentation, but with a legal prescription. The change then is not in ads directed at teens, but ads directed at doctors and parents to encourage them try everything else before prescribing opioids for pain.
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@OneView , beware experimentation. It is still out there. I told both of my sons when they were teens that it would be stupid to accept a pill from friends at a party. In general, they would have no idea what they were being given. Benzos? Opioids? What strength? People who are not tolerant to opioids can die from one dose, especially with alcohol. Often they are the leftovers from a teen's legit Rx or someone stole pills from a relative's pill bottle. People on long term opioids, most contracts recommend or require patients to obtain a drug safe.
IMO drs now already try alternatives. What they really can do better is to better explain the risks of taking an opioid and that they will suffer physical dependence and withdrawal (past a couple days) so will need to taper off in order to not feel ill but that is normal and to call if they need help.
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