I’ve spent a lot of of my life in pain, and often in a LOT of pain. I’ve taken a lot of pain killers.
The best, in most cases, were opiates. Codeine and morphine (forget all the fancy pills designed to cost more, morphine does the job).
Now, in the US, white middle class people are getting addicted to opiates in large numbers and there are screams to make it harder to get opiate prescriptions for pain.
But the simple reality is this: According to the large, annually repeated and representative National Survey on Drug Use and Health, 75 percent of all opioid misuse starts with people using medication that wasn’t prescribed for them–obtained from a friend, family member or dealer.
…
In general, new addictions are uncommon among people who take opioids for pain in general. A Cochrane review of opioid prescribing for chronic pain found that less than one percent of those who were well-screened for drug problems developed new addictions during pain care; a less rigorous, but more recent review put the rate of addiction among people taking opioids for chronic pain at 8-12 percent.
It is already hard to find a doctor who will prescribe opiates for chronic pain. They’re worried about law enforcement coming for them, and they’re paranoid about addiction. When I was in my 20s and in a lot of pain, it took me seven doctors to find one who who would prescribe opiates, and I was in so much agony, standing from sitting down was nearly impossible and I often didn’t sit at all, knowing I might be stuck for hours.
This level of pain, in Canada, and it took seven doctors before one was willing to chance that I might not be lying. One asshole rushed me out of his office after screaming at me that I was a fucking addict who just wanted a fix.
In one of those neat catch-22’s, if I hadn’t been in so much pain, I would likely have beat him to a pulp. (Yes, yes, I said that someone like that is someone I would have broken if I could. It took almost a month for me to find a doctor who would help me, that man put me through agony most people cannot even imagine.)
People who are in serious pain need serious pain killers. That often means opiates, sometimes it means cannabis. People who stop chronic pain sufferers from getting the pain relief they need are responsible for huge amounts of suffering.
Don’t do that.
When I was in hospital, in so much pain I could not even push myself up in bed, I said to my doctor at the time, “What if I get addicted?”
He replied, “Take the pain relief you need and we’ll worry about the addiction later.”
Later I was slightly addicted–I couldn’t sleep without a pill. One night I simply stayed up until I slept without it. As it happened, that was about a 40 hour day. But the addiction was broken, and it wasn’t much of an addiction to begin with.
Even if it had been a terrible addiction, I still would have said that the pain killers were worth it, because without them I was in so much pain I could barely walk. I remember taking well over ten minutes to walk a single block. I once ate breakfast at a restaurant standing up, because I knew if I sat down I might not be able to stand again.
Pain.
It sucks.
Don’t deprive people who need pain killers of them.
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markfromireland
@ Ian
You were fortunate in finally encountering a sensible doctor, the more I read stories like yours the more I realize how very fortunate I was that the doctors treating me when I was first diagnosed with cancer laid quite as much emphasis on tackling the pain as on getting rid of the cancer.
Coming off the pain killers was mildly unpleasant but mildly is the operative word. I found stopping smoking far more difficult.
There seems to be an ideological obsession in the medical establishment with not prescribing drugs that are addictive or that could be addictive.
I recently attended the funerals of two friends whose last few months were horrific. How on earth did “first do no harm” become so twisted that it’s used to deny people with terminal cancer the only drugs that will control the pain?
Ian Welsh
It seems most related to pain killers, though. Drugs like Zanax, SSRIs and so on, with serious mental effects, seem to be prescribed very often. SSRIs, in particular, are apparently terrible to come off of.
I’m sure it can still be hard to get these drugs sometimes, but somehow pain drugs seem like the hardest general class to obtain.
Honestly, if it were up to me, I’d make simple growing and possession of poppies legal. One of my friends grandfather’s was a pharmacist pre-prohibition, he just grew them out back then processed them himself for his customers.
Stirling Newberry
It is legal in white rural counties.
someofparts
Planning for old age gets tougher every day. The first post I read this morning reminded me that I need to prepare for my pension fund to go broke. Now I come here and learn that I had better find some black market source of pain killers while I can still get around, because doctors will deny me that relief if the day comes when I desperately need it. A person needs to mutate faster than bacteria just to keep up.
DZ
http://www.diffen.com/difference/Addiction_vs_Dependence
Drug dependence and drug addiction are different affecting different parts of the brain.
https://www.drugabuse.gov/publications/teaching-packets/neurobiology-drug-addiction/section-iii-action-heroin-morphine/10-addiction-vs-dependence
Yes prescribed pain relief rarely leads to addiction.
Get law enforcement out of medical care. Let medical bodies review doctors prescribing patterns. End the drug war. Compassionate care and humane policies for the ill, the pain ridden and the addicted.
Steeleweed
Chronic pain is severely under-treated in USA, partly because the Drug War has scared a lot of MDs out of the business and partly because many of them don’t really practice Pain Management as their primary skill – most are anesthesiologists doing pain management on the side. My wife has been in chronic pain since 1978, after getting run over by a Mercedes (Irony Alert – driven by a doctor). Many surgeries, fused ankle, four joint replacements, scoliosis, stenosis and severe general arthritis. Plus IBS, just to keep her busy. And she’s prone to migraines. She’s happy if meds can bring the pain down from 8 or 9 to 5. She has been on Oxycontin + Oxycodone, then Morphine, now Fentanyl Patches + Dilaudid. Morphine pump post surgery in most cases. Went through 5 MDs to find one who just does pain management and it makes all the difference The opiates are aggravating (if not causing) her IBS and doctor may move to electrical stimulation, hoping to reduce the opiate load. Wrote up a post on the subject at http://agonist.org/managing-the-pain/
V. Arnold
someofparts
June 22, 2016
A person needs to mutate faster than bacteria just to keep up.
Indeed, and that’s the whole point.
The U.S. government wants seniors to die off as fast as possible; S.S., Medicare/Medicaid, food stamps, and any form of social assistance are expensive.
I’m already there (old, 71) and I left more than 13 years ago, knowing old age would be hell there (it’s more complicated than that, but I’ll leave it there).
I am reminded of something Frederick Douglas said;
Find out just what any people will quietly submit to and you have the exact measure of the injustice and wrong which will be imposed on them.
Frederick Douglass
Ivory Bill Woodpecker
John Ehrlichman admitted (boasted, maybe) in the 1990s that the whole War On (Some) Drugs was a scam, designed to disenfranchise black citizens and white progressive citizens, while locking in the votes of the stupid bigots of the non-elite white majority.
Of course, the stupid bigots fell for it–hook, line, sinker, and flopping in the boat. It is one of the major reasons the Republican Party of the USA has not gone the way of its ancestral parties, the Federalists and the Whigs.
When anyone says the War On (Some) Drugs has failed, that person has failed to recognize its true purpose, in which it has succeeded, and continues to succeed.
Bill H
The current media hyperventilation in which they conflate prescription medication and heroin addiction is maddening. They almost always lump the statistics together, and they manage to convey the impression that taking opiod pain medication after surgery leads inevitably to becoming a herion addict, not by saying so, but by talking about the first and then showing the second as if the portrayal was consequential. They never interview heroin dealers, they interview “doctors” who are running “clinics” that write hundreds of prescriptions daily and then have a nice long interview with a heroin addict.
Sanctimonious Purist
Bruce Alexander, Gabor Mate and JoHann Hari proven right again. Chronic addiction isn’t due to the drug as much as it’s due to our own sense of isolation–our cage. Psychic, spiritual and emotional pain, without solace from the love of others, is the real cause of chronic addiction. This is why people not prescribed drugs turn to them. Our society must reduce the pain. House people, feed them, make their lives easier, help them to stay in their own community. Displacement kills, yet most of our policies–from trade to immigration to tax policies that favor gentrification to the privatization of schools–contribute to displacement. Any communities inflicted by this type of pain will have more addicts among them. This is what we are seeing across the country.
someofparts
Seems like people who run this place create problems and then kneecap us for trying to deal with the messes they create. Make us homeless and unemployed, then howl with censure when we drink to numb our fears. Force unwilling women to have children, then cut their access to food and housing, because nothing demoralizes an uppity woman like watching her children starve.
Good times.
Peter Van Erp
About six years ago a friend in constant pain threw himself off a building. He had been on a prescription for opiates which controlled his pain well, his doctor at the “Pain Clinic” decided that he was a drug seeker, and cut him off the prescription.
In the US, growing poppies is legal, but growing them knowing they are P. Somniferum, extracting the opium, or making tea from the straw are illegal.
Bill Hicks
I’m currently in this boat as a result of severe chronic neuropathy brought on by chemotherapy. The one advantage I have so far is that they rarely deny painkillers to cancer patients.
As Peter Van Erp mentions above, if I ever get cut off from the drugs my life would indeed be such a hell that it could well drive me to suicide. Which would be ironic since the drugs that caused the neuropathy also saved my life.
markfromireland
@ Bill Hicks – I sympathise I have fairly mild neuropathy courtesy of chemotherapy. I’m lucky that it is mild and am not looking forward to it getting worse as it will over time. I sincerely hope that you’re never in the situation where you’re in such unremitting pain that you take your own life.
Neuropathy is also a problem for diabetics both types I and II. Then there are those who develop type II diabetes as a side-effect of chemo – one of my neighbours is in that particular boat and is finding it hard going and that’s even with a good pain-control regime as she says the alternative is probably worse but she’d rather not find out the hard way. I don’t know what it’s like in the US but over here it seems that diabetics with neuropathy have a harder job getting their pain-control teams to prescribe medication strong enough to cope than cancer patients do.
John
Papaver somniferum seeds are readily available over the web and in gardens stores. Mine have just had a wonderful burgundy bloom and now the seed heads are oozing with black resin. Ultimately they will produce millions of seeds that I can use to make poppy seed bread and poppy seed lemon pound cake.
Thomas Jefferson grew them at Monticello. Thomas Jefferson was addicted to laudanum towards the end of his life to deal with pain.
When I spent a year on the road in India a good while ago, I always carried a small wad of opium and would occasionally place a small bead under my tongue to ease the stress of Indian street life that the regular doses of hashish did not ease.
That was one of the most vivid, magical years of my life.
When I returned, I found my Dad to be dying of a very painful pancreatic cancer. The methodone they gave him was crap…all the down side of narcotics without being an effective pain killer. And even tho he was terminal, his doctor indignantly refused to prescribe stronger pain killers for fear of addiction.
Fortunately we found a wonderful and true physician and pharmacist in a neighboring town who put together what he called Baker’s Cocktail that had morphine, cocaine, and valium that took care of pain, kept him up and alert and eased anxiety. The last month of my father’s life was as high a quality as could be expected for someone with such a disease.
We live in a society where cruel, deranged psychopaths get to make many important decisions about the quality of our lives. That is very sad.
We can have it another way. Especially when considering the genesis of the Drug War was to suppress the blacks and the hippies by the right wing criminal Nixon administration.
Grrrr. I feel a rant coming on…so I think I will go down to the garden and contemplate my beautiful poppies.
Not my website, but beautiful pictures and I really like the name:http://www.onestoppoppyshoppe.com/#!papaver-somniferum-seeds/cuz9
Just be kind, don’t be greedy! And may all beings be relieved of their pain!
Jill
I’m sorry that people have so much pain. For a while pain was being more openly acknowledged and treated, but it seemed this trend in medicine only lasted a short time. Now, it’s back to crazy.
Doctors do seem more reluctant to prescribe much needed medicine in dosages that will work. I also know a doctor who was busted for this. Yes, you can fight and likely win, but that takes time and money.
Anyone who is in pain or has been in pain understands how it effects your life. Some US states have legalized medical marijuana but still hassle growers and dispensers. It’s a terrible shame.
I’m not certain why this new war on pain medicine popped up. I”m guessing it’s part of keeping the population in a state of fear–drugs will kill your children, etc. But the effects of this fear mongering are devastating.
Ramona
I am just released from hospital after a fall involving unintended withdrawal from pain meds. My falling has nothing to do with pain meds, and everything to do with stress and complicated issues.
For the second time in my life, a doctor decided I was ‘part of the drug epidemic.’ He nearly killed me (longer story which I will write and make available here now that I know Ian is fellow pain traveller.)
I only have one hand to use, so this will be short.
I managed to fire the doctor and get orthopedists on my case.
I have broken left thumb and left pelvis and concussion.
Agree that studies make clear that pain patients do not become addicted. more later
my life was in danger
Jen
Thank you for posting about this Ian. I am a long time reader of your blog but have never commented because everyone else says what I want to, only more eloquently without any f-bombs. That said, I am one of the patients suffering because of this “opiate epidemic”.
I have CIDP (chronic inflammatory demyelenating polyneuropathy), SFN (small fiber neuropathy) and was just recently diagnosed with fibromyalgia (which I think is just a name for “I have no idea what is going on with you”).
The only medications offered to me over the past 2 years have either been antidepressants or anti-seizure meds. None of them worked, although they all had some kind of awful side effect. Since September 2014 I’ve tried: Pamelor, Cymbalta, Savella, Topimax, Amitriptyline, Lyrica, Gabapentin, Gralise, LDN (low dose naltrexone), Lidocaine patches, Lidocaine/ketamine cream, Voltaren Gel, Trazadone, Mobic, Amrix, Flexiril.
I’m having weekly IVig infusions to stop the progression of the CIDP and was prescribed Imuran to get my body to stop attacking my small fiber nerves as well as the myelin sheath, but I’ve been doing this since January of this year and I feel no improvement. I cannot stand for more than 30 seconds without searing pain in all of my muscles. I can no longer dry my hair because the muscles in my arms and shoulders burn. I have to sit on a plastic stool in my shower. I am no longer able to do the most mundane everyday activities (that I used to take for granted), like go food shopping, cook, clean, do laundry, vacuum, walk a block, lift anything – you name it and I can’t do it because if I do I will be in excruciating pain within 10 minutes of the activity and the pain will last for 2-3 days.
On a scale from 1-10, 10 being the best, my quality of life score is a zero because of the pain, yet neither my rheumatologist or my neurologist are willing to even discuss actual pain medication (the 2 times I’ve mentioned it both of then said, “I can’t prescribe that kind of medication for you.”)
So, here I am, 50 years old, mom of 2 teenagers, ex-actress/comedian, ex-house cleaner/organizer extraordinaire, unable to get SSDI because I didn’t work enough before becoming disabled and completely unable to see any kind of future besides me just sitting around for the rest of my life doing nothing and every single time I bring this up to my doctors (like yesterday for instance) they nod their head and say, “I know” with a bullshit sympathetic tone and always see me off with a, “Stay positive!” As if being positive can stop an autoimmune disease in its tracks.
I apologize for the novel, your post just hit a nerve (no pun intended).
highrpm
@steeleweed,
liked your agonist post on managing the pain. right on about pain of meaningless in life. want to read a depressing narrative about such? These are the people Dylann Roof stayed with before the Charleston church shooting . how really important is purpose, short term — 1 hour long todo list items, or long term multiyear personal projects.
mb
My dad recently had a total hip replacement surgery. The months he was in pain before the surgery where he couldn’t sleep at night from the pain the doctors were literally just prescribing him extra strength Aleve. After the surgery they gave him some Lortabs. If even a total hip replacement isn’t enough to get Oxycontin who the fuck is getting them?
Ian Welsh
Jen,
yes, absolute bullshit. I’m so sorry to hear this.
Dwight
You may be interested in this interview of Richard A. Lawhern, a passionate defender of pain medications.
http://prn.fm/the-dr-peter-breggin-hour-04-27-16/
Lawhern writes here:
http://nationalpainreport.com/opinion-stop-the-war-on-chronic-pain-patients-8830555.html
Ivory Bill Woodpecker
I wish I had remembered this song earlier.
“Legalize Heroin”, by Iron Curtain