The opioid crisis keeps accelerating. While watching NBC News last night we saw yet another heartbreaking story about the devastating impact opioids are having across America. Three people in Dayton, Ohio were brought back from the brink of death thanks to naloxone (Narcan). Many other people aren’t so lucky. There is no doubt that opioids have caused countless overdose deaths and untold misery.
Controlling the Opioid Crisis:
If you follow the news you have seen it called the opioid crisis, the opioid epidemic and the opioid emergency. Politicians bemoan the ongoing disaster but seem stumped about what to do about it. Every day emergency medical teams across the country have to rescue people from opioid overdoses.
It wasn’t supposed to be like this. Three years ago the DEA (Drug Enforcement Administration) clamped down on prescription pain relievers containing opioids. Prior to 2014, hydrocodone (Lortab, Norco, Vicodin, etc) was a Schedule III drug. Doctors could fax or call in a prescription or refill to a pharmacy. They could also write electronic prescriptions that went straight to the pharmacy computer.
Physicians must now write a paper prescription that is only good for one month at a time. There are no refills. The FDA and the CDC have also warned physicians to be extremely cautious about prescribing opioids like hydrocodone and oxycodone (OcyContin). And many pharmacies have made it much harder for patients to get access to such medicines. And yet the opioid crisis worsens.
What Went Wrong?
Despite the DEA’s war on opioids, the epidemic has seemingly worsened over the last few years. If physicians, pharmacists and drug companies are making it harder for patients to get powerful pain relievers, how come so many people are overdosing and dying?
Illicit Fentanyl:
Part of the answer seems to come from China. Synthetic opioids like powdered fentanyl (and chemical cousins) are flooding into the country. These illicit, manmade compounds are far more potent than heroin. Sometimes they are made into pills that resemble weaker prescription analgesics. But these potent chemicals are killers.
According to NBC News:
“The death rate of synthetic opioids, which includes fentanyl, rose more than 72% from 2014 to 2015, according to the Centers for Disease Control and Prevention.”
NBC News attempted to order fentanyl using the Internet:
“Attempting to order fentanyl online from China came with a dose of customer service — complete with smiley face emoticons and an explanation of paying with bitcoin. NBC News did not go through with the purchase of the drug, but the Drug Enforcement Agency says mainland Chinese companies are known to manufacture and distribute fentanyl and other illegal drugs using e-commerce.”
Pill mills, where unethical doctors wrote huge numbers of prescriptions for opioids, have mostly been shut down. But that has not solved the opioid crisis. The current epidemic seems to stem more from illicit manufacturing abroad than the diversion or abuse of legally prescribed opioid analgesics at home.
The History of Opioids:
While federal officials focus on the devastation caused by opioid abuse, they seem to be ignoring the suffering of people who no longer have access to the pain killers they need to function.
People have been using opioids for more than 5,000 years. That’s because the active ingredient from the opium poppy remains one of the most effective pain relievers known to humankind. From the ancient Sumerians, Assyrians and Egyptians to today’s manufacturers of oxycodone and hydrocodone, humans have found ways to use-and abuse-opioid compounds.
The Opium Wars:
Nineteenth-century China had its own opium abuse crisis. Both the British East India Company and American traders found it profitable to ship opium into southern China, even after it was declared illegal. The British and the Chinese fought two wars over this trade.
Opioids for Pain:
No health professional disputes the value of powerful opioid narcotics for treating severe pain. Such drugs as hydromorphone (Dilaudid), methadone (Dolophine), morphine (MS-Contin), oxycodone (OxyContin) and fentanyl (Duragesic) are all used to control intractable cancer pain.
Patients in hospice or hospitalized cancer patients are still treated with such medications. But people with chronic, non-cancer pain are now feeling abandoned. That’s because the measures taken to control the opioid epidemic have left many of these patients without recourse.
One reader shared this sentiment:
“Isn’t it time people like me who are disabled and suffer from severe nerve pain fight back? I can’t function, walk, sleep or cook for myself without opioids for my pain. How many thousands of legitimate chronic pain sufferers are being adversely affected by the opioid crisis?”
Phyllis in N. J. is desperate:
“My quality of life is horrible now without my pain medication. I guess the government is now in the business of practicing medicine. I’ve written so many letters, comments, tweets, editorials, signed petitions, you name it to get this law overturned. I hope it is in our lifetime, mine and yours, fellow sufferers, that we are treated more fairly. Our doctors have had to watch us suffer unduly. May God help us all find relief in getting back our medicine or getting something better that no one can take from us.”
S. in PA is also beyond desperation:
“From the time I needed pain management until now, my patient experience has been nothing short of demeaning, disrespectful and disgusting. The office staffs at numerous clinics acted like I was an inconvenience instead of a person. I am a health professional myself–an x-ray technician.
“I have 4 children, a greenhouse business I am attempting to begin and a life to live. I understand the opioid addiction problem is a real issue in the United States. But the opioid addicts are going to get what they want no matter what. The only people suffering here are the pain patients.
“I have herniated disks from t3-t4 disk space down and through my spine. I also have bidirectional scoliosis, levoscoliosis, degenerative disk disease, osteophytes, sciatica, arthritis, SI joint dysfunction, and hip popping syndrome to name just a few. I’m 33 years old.
“I’m out of medication, sick and in pain and they don’t care. And they have the nerve to ask if we are depressed. No, we are in pain and no one will help us!
“All I want is to be able to work and live with a quality of life that allows me to live my life a little bit. Because this isn’t living. It’s existing. Being scared month to month because we may or may not get medication from the doctor – or we failed one of the millions of hoops that we have to jump through. Or the pharmacy doesn’t have it. Or won’t let us have it. Or the insurance company won’t authorize it.
“People in chronic pain are dying. People are committing suicide. And the cause of death will be listed as suicide. Depression. No! They died because they couldn’t live with the daily minute-to-minute pain. No one can live with it. And when the physicians won’t help or listen – someone should be held accountable.
“Someone has to speak up for chronic pain patients. But we have no voice. And that, my friends, is the most depressing thing of all.”
Another reader shares:
“I’ve been through six failed lower back operations resulting in damage and scar tissue on the nerves. In my upper back I have multiple bone spurs sticking me in my nerves and two bulging discs in my neck. I need to have both knees replaced. I’m at the very end of my rope. My pain management doctor has cut my pain medications way back and I just can’t take it. I’m thinking of ending my life.”
We have heard from hundreds of desperate pain patients who can no longer access medicines that allowed them to function. Most insist that they have never abused the opioids their doctors prescribed. Yet many are now faced with suspicion from physicians, nurses, pharmacists and insurance companies.
Can We Solve the Opioid Crisis?
Well-meaning federal officials thought they could overcome the opioid crisis by cracking down on prescription opioids like hydrocodone. If anything, the crisis has gotten worse since the DEA changed the classification of this drug.
We need to find more effective strategies to stem the tide of illicit fentanyl and other synthetic opioids flooding into the country from abroad. We should not make chronic pain patients suffer because of this growing illegal drug trade.
Equally important, the pharmaceutical industry needs to develop safe and effective pain relievers to replace opioids. NSAIDs, antidepressants and anticonvulsants are not the answer. And regulators need to make sure that their policies do not punish people in severe pain unfairly.
