One of the problems with curbing the opioid epidemic is the problem of pain. Opioids are addictive, and some people take them for illicit reasons of pleasure rather than medically necessary reasons, but opioids can help manage pain.
If there were no legitimate uses for Vicodin, Percocet, and OxyContin, if they didn’t work, we could make the manufacturers stop selling and manufacturing them. But they do control pain, at least in the short term, so their risks must be managed. Once the genie is out of the bottle, it is difficult to put it back.
The pharmaceutical manufacturers are being sued for the harm they’ve caused – perhaps knowingly or by failing to use due vigilance – by nearly every state attorney general plus Washington, DC.
People living with chronic pain want relief. Getting rid of these drugs won’t stop the pain or undo the addiction. If people with chronic pain or substance use disorder (SUD) can’t get relief from the pharmacy with a doctor’s prescription, many will seek alternative remedies. Heroin has had a resurgence and fentanyl – a rarely prescribed drug – has become a scourge.
Addiction is easy; addiction rehab is difficult and takes time., Even then, it seems that addiction cannot be “cured”. Whatever the cause of addiction – a genetic predisposition seems most likely – once triggered, addiction never goes away entirely. Even after years of sobriety, a person with SUD can resume use.
With opioids, there are medication-assisted treatments (MAT) that can help people with opioid use disorder (OUD) – methadone, buprenorphine (Suboxone), and naltrexone (Vivitrol) – but two are opioids themselves and one only prevents users from getting high on opioids. No similar drugs are helpful for treating addictions to stimulants such as cocaine and methamphetamine.
Other possible treatments are problematic.
- Kratom, an herb that some believe can treat opioid addiction and manage chronic pain, is not Food and Drug Administration (FDA)-approved. Worse, kratom has been linked to several deaths due to interactions with other drugs or adulteration of the product (again, it is not regulated).
- And those who hoped marijuana might be a treatment for opioid addiction were dealt a blow last month. A new study, replicating an earlier study that found fewer opioid overdose deaths when medical marijuana was available, came to the opposite conclusion, suggesting the conclusion was just a statistical coincidence.
If early data are correct that drug overdose deaths declined in 2018 – the first such decline since 1990 – the biggest reason may be the greater awareness and availability of naloxone (Narcan), the opioid overdose reversal drug, now available in many pharmacies without a prescription and carried by Emergency Medical Services technicians, firefighters, and even many librarians.
In the long term, we need safer pain management. We need more MAT for more drugs, especially for non-opioid drugs. We need better access to drug rehab treatment. And we need for that treatment to be easier to obtain and less expensive than more drugs.