Progress and social change rarely advance at a steady rate, be it voting rights or drug treatment. They operate more like a pendulum, swinging forward, then swinging back, and then forward again. Incremental changes result.
Slavery in the United States ended after the American Civil War, and there was a brief wave of freed slaves in elected office. Then subsequent voting rights restrictions and Jim Crow laws made this almost impossible for another 100 years. Then the leading African American activists were assassinated. Four decades later, the US elected an African American president. Slow progress.
Treatment for pain is another example. Surgery originally needed to performed without painkillers, and so mostly was limited to speedy amputation. Then anesthesia was developed, allowing for more complex surgeries. For a time, general anesthesia was used routinely for procedures that didn’t require knocking out a patient, leading to needless deaths.
Modern painkillers and localized anesthesia were introduced, allowing the patient to remain conscious and with manageable pain. When some of these proved addictive, their use was restricted and newer, less addictive substitutes were marketed instead. (Heroin was thought to be a safer alternative to morphine when Bayer introduced it.) These often proved addictive as well.
For a time, doctors were reluctant to prescribe any painkillers stronger than aspirin, especially for long-term pain because almost all painkillers lose their efficacy over time, eventually requiring larger, life-threatening doses.
The latest generation of painkillers – such as OxyContin, Percocet, and Vicodin – were sold to doctors as truly safe from addiction, and doctors – bombarded by complaints from their chronic pain patients – believed them and prescribed them probably too freely.
Now the pendulum has swung again. These miracle drugs are harder to come by now, but no less needed. Chronic pain patients often now have to choose between illegal behavior – stealing the drugs from friends and family, buying them on the black market, or switching to even more dangerous, addictive, but strangely more available and cheaper drugs such as heroin and fentanyl.
Fentanyl – which is 100 times as strong as morphine and 50 times as strong as heroin – often is pressed into pill form and substituted by drug dealers for drugs such as OxyContin, resulting in accidental drug overdoses (Prince, Tom Petty). (Fentanyl is less expensive and easier to obtain than black market Oxy, but a small error can make a big difference in potency. Users want Oxy so the dealers let them think they’re getting what they want.)
Government oversight aimed at curtailing the illegal or over-prescription of these prescription painkillers has led some doctors to avoid scrutiny by not having any chronic pain patients. They even have dropped longstanding legitimate pain patients at short notice, leaving them with no place to go for relief.
Because of tolerance, long-term use of opioid painkillers can lead to dependence, but that’s not the same thing as addiction. Diabetics are dependent on insulin, but they aren’t addicted to it. Addiction is to be compelled to continue using a substance despite the negative, destructive effects it has on one’s health, social relationships, and employment.
If someone is taking Oxy to cope with pain so that they can function, that is dependence, not addiction. Now they some are having so much trouble obtaining relief that they are killing themselves. The pendulum has swung too far again.
The opioid epidemic is real and deadly. People who need alcohol or drug rehab, need to find their way into substance use disorder treatment. People with chronic pain need help, too. If drug-free therapies can help them cope, they should explore that option, but some will need painkillers for the rest of their lives. They shouldn’t suffer for the addictions of others.
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