Every day I read about the “opioid crisis,” and there is no question that the false promises of an addiction free pain treatment have led to needless deaths and broken lives. Opioid deaths have risen five-fold from 1999 to 2018. Most opioid users are people like me – a middle aged man with a back injury resulting in massive chronic pain – pain that was not touched by non-opioid medications, pain that was not reduced by even the maximum dose of Vicodin, and so my physician added Fentanyl. In the combination I found a reduction in pain that made life bearable. For three years I took cortisone shots, acupuncture, physical therapy, with no relief. By the end of the third year, the bone pressing on the nerves in my back had desiccated and the pain subsided. My doctor and I worked as partners, and over 7 months I weaned first from the Fentanyl and then from the Vicodin. Some seven months later I took my last opioid pain killer – now some ten years ago.
The lessons of this story are:
- Pain should be treated progressively – Certainly, the use of opioids should now be recognized as carrying with them the risks of addiction and should be a last resort after less adverse ridden treatment are used. The easy “write a script” practice should give way to consideration of the full range of treatments while remaining committed to pain relief. This takes more time for the practitioner and more patience by the patient.
- When the underlying cause is addressed, create an effective exit plan – Most pain is not forever; when the underlying pain is reduced, the level of chemical treatment should be modified as well. Research has found that patients taking an opioid for 30 days have a 30% of still being on them a year later. It is likely that a committed practitioner might have nuanced at least a portion of these patients over the course of a year. It takes more time for a practitioner to adjust treatment to retain pain control while working to use the least adverse impacting medication and dosage. It takes trust by a patient that a physician will work through this pain management process with them.
- The success of the plan depends on a partnership between an attentive practitioner and a motivated patient – The long-term use of opioid medications creates a physical addiction which must be addressed . The sudden cessation or over-reduction of dosage can create the very problem we seek to address . One epidemiological study reported that 80% of people with a heroin addiction first abused an opioid prescription. Detoxification is not a simple or easy process, and the gradations of reduction and the use of assistive medications requires time and careful attention. While some practitioners have the time and skills to do this, there are programs that provide this crucial step. One example is the Centrec Center in St. Louis which offers a variety of programs to address the physical addiction. A physician who leaves a patient suddenly without medication that has established a physical addiction is likely creating a user of illegal drugs. Referrals to programs such as the Centrec Center are a critical step in the pain treatment program.
I wake up each morning – pain free and medication free – thanks to a physician who was committed to treating pain progressively, carefully, and who invested the time, attention and trust in me to carry through our seven-month plan for success. The media call for stopping opioid use in the absence of other effective ways to treat otherwise intractable pain leaves patients untreated. Until non-addictive medications are developed, it is the responsibility of practitioners and patients alike to value the pain relief of the medication and carry through the treatment of the unwanted effects it brings.