Opioids are in the news. We're told regularly that we're in the middle of an "opioid epidemic," which resulted in more than 28,000 deaths in 2014 -- more than 18,000 of them from prescription opioids like oxycodone, hydrocodone, hydromorphone and others.
The problem of opioid dependence, abuse and addiction has created a public health crisis, and this crisis is at least partly of our own making. As a society, we have (rightly) endorsed the use of opioid pain management, which can be life-saving for those with terrible acute and chronic pain. But our skill in managing the complete life-cycle of opioid use -- including helping patients to wean off the drugs -- has not kept up with our physicians' prescribing practice.
So now opioid treatment is in the news. Congress has just passed a historic bipartisan bill that reframes opioid addiction as a health problem, provides increased avenues for treatment, and strengthens prescription drug-monitoring programs.
The bill, however, did not include complete funding for the proposals, which Republicans insisted be voted on separately after the summer recess. This is hardly a surprise; bills like this always raise the question: where should we spend our precious public dollars? Even if you can convince everyone that public health is a good place to expend resources, the issue of opioid abuse has a certain stigma attached to it, raising -- to some minds -- the question of whether the best use of our money is trying to save the lives of drug addicts.
The opioid epidemic, however, does deserve our dollars. Although prescription opioids are incredibly important to modern medicine, we haven't been careful enough with these powerful drugs. We've allowed our physicians to prescribe medications that they don't always know how to manage, and the opioid epidemic is the result. If we want the pain-management abilities of opioids (and I know from my own experience with medical trauma, we do), then we must embrace the responsibility for managing the downstream effects of that choice.
Yes, there has been some straightforwardly wrong prescribing of opioids (read: pill mills). And yes, some of those who suffer and die from opioid abuse disorder each year developed an addiction to opioids without entering the medical system (read: recreational street drugs). But a lot of those suffering the ill effects of opioids are like me -- trauma patients (or cancer patients, sickle-cell patients, and others suffering from severe chronic pain) who are legitimately prescribed high amounts of opioids over a fairly long term and as a result, develop a biological dependence to the drug. And with dependence, comes severe, debilitating withdrawal when the drug is taken away.
What, exactly, is withdrawal like? In short: it's living hell. Imagine the worst flu you've ever had, multiply it by one thousand, and then add on restlessness, insomnia, anxiety, and crushing depression, and you'll start to get a sense of what opioid withdrawal is like. It's so bad that those of us who have experienced it completely understand how some people become life-long addicts: because anything seems preferable to going back into that horrible, dark, terrifying place.
Patients and others suffering from opioid dependence need not go it alone, however -- professionals can assist opioid users through withdrawal, detoxification, or maintenance (for those not ready to detox). Expert counseling, detox assistance medication such as Suboxone or maintenance medication like methadone, and even medicated withdrawal symptom management make the process easier (or even possible).
But these resources are not free, and we don't currently have enough physicians and counselors trained in how to handle this aspect of opioid management. And so we return to the question of public funds.
A recent opinion in The New York Times argues powerfully that the bill passed by Congress isn't enough, because it allows the federal government to award grants for opioid treatment, but doesn't include the funding. And they are clearly right: while it's an important start, that's all it is -- a start. Now it's our job to make sure that lawmakers don't forget how important this issue is, and that they are held to task when it comes time to vote on a funding package.
Thousands of opioid users began treatment legitimately, but now face unmitigated suffering if they are to withdraw without assistance, or the life of an addict if they don't wean themselves free. This is not a choice they should have to make.
Need help with substance abuse or mental health issues? In the U.S., call 800-662-HELP (4357) for the SAMHSA National Helpline.