We're on drugs. Nationwide, we're on a lot of drugs. Those drugs kill a bunch of us every year. Lately, the nation has been focused on one class of drugs: opiates.
Opiates are drugs that affect opiate receptors in our brains. They come in prescription and street varieties. They are commonly prescribed for the treatment of pain. Prescription opiates include morphine, OxyContin, Percocet, methadone, and everyone's favorite, Vicodin. Any prescription drug can become a street drug, and street drug opiates include the infamous heroin, the indiscriminate slayer of suffering people across race and class.
It's hard to have a fair conversation about our opiate epidemic without acknowledging institutionalized racism. The opioid crisis is all over the news now. Legislators are convening hearings. Policy makers are drafting response strategies. Aggrieved family members are holding press conferences, begging people in charge to do something. The front page of the New York Times today tells us we set a record for annual overdose deaths last year. For white Americans, the opioid crisis seems like a new threat. But for many communities, the ravages of opioid addiction are historic, and their pleas for help went unanswered by the white institutions that controlled access to treatment. So we have to acknowledge that the reason everyone suddenly cares about opioids is now young white kids are dying after being given prescriptions for dental work and sports injuries. So there's that. But this post isn't about racism in healthcare. It's about drugs. And you. And us.
How do we get hooked on opiates? The basic mechanics of addiction is that there is some way our brains don't feel good, we find a substance that makes our brains feel better, but we have to take more and more of that substance to get the same effect, mostly because of how our brains regulate neurotransmitter receptors. All pain happens in the brain: physical pain, emotional pain, all of it. (Recent research shows your brain responds similarly to physical and emotional pain.) Opiates, whether they come from substances we take, or our own opioid substances we make ourselves, relieve that pain. When we take high powered opioids like prescription pain-relievers or heroin, the pain relief can bring feelings of blissfulness that people yearn to experience again and again. So they take another pill. Then they can't get more pills legally, so they buy pills on the street. Then maybe the pills aren't enough, so they get some heroin. Then they die, because they took too many pills or too much heroin, and their breathing stopped.
The story of prescription opioids is complex. It involves the misapplication and misattribution of a very small scientific study, combined with the considerable marketing power of big pharma and the pressure on physicians to prescribe drugs and move the patient along, rather than take the time to dive into the patient's complaint and refer for non-drug therapies that cost more to provide. Just like institutional racism, the origin story of the 21st century opioid epidemic isn't the focus of this post.
My concern is now. What's happening to my neighbors right now, and what can I, and we, do about it? You may think you are not touched by addiction, but you are. Addiction is why your sketchy neighbor steals your stuff. It's why the houseless folks living in the park near you leave trash lying about. It's why you can't go to that dog park anymore because you saw some needles. It's why your acquaintance lied to you about their kid dying in a car crash, when really it was an overdose of heroin. It's why your child's teacher was fired. Or your coworker.
Even in the face of a destructive epidemic, physicians continue to prescribe massive amounts of opiates; insurance companies continue to put up barriers to effective non-opiate pain treatments like acupuncture, chiropractic, and physical therapy. Congress would rather see your relative die from an overdose of prescription painkillers rather than permit investigation of non-lethal marijuana as a treatment for chronic pain. The state of Oregon simultaneously declared a medical emergency about opiates and cut access to non-opiate care for public health recipients. This mobilization in response to dead white kids remains primarily lip-service.
I do have some advice. First of all, if you are a person with a history of serious addiction, please make sure your physician and dentist know that, and ask them not to prescribe you opiates. As a healthcare provider, I find it infuriating when one of my patients has worked so hard to stay clean, and a thoughtless prescriber gives them a month's supply of Vicodin. It is far, far easier to not take a bunch of Vicodin if you don't have any, versus resisting taking it when you do. If you don't have a history of addiction, and your doctor wants to prescribe an opiate, tread carefully. Make sure the opiate is really necessary. There may be other classes of drugs that can cover your pain. Many people need opiates for pain after surgery, but often not for as long as the physician prescribes them. You can ask for your prescription to be fewer days, so you have to refill it instead of just having extras lying around. This is especially important if a loved one with addiction shares your living space.
If you live with chronic pain, demand non-drug alternatives. Get a referral to physical therapy. Come for acupuncture. Acupuncture is great for pain relief. I work with pain patients every day. It's rare that it doesn't help at all. It's always worth a try.
If you are struggling with opiate addiction, demand treatment. Just because you are taking them on prescription doesn't make it o.k. to leave you without care. Acupuncture can be helpful in easing the symptoms of withdrawal as you reduce your use of opiates. Many drug treatment centers include acupuncture as part of their programs for this reason.
Be a compassionate neighbor. Remember that addiction isn't a moral failing; it's a medical condition that stems from the interplay of pharmacology, neurobiology, and psychology. The scope of the epidemic speaks to the vulnerability of our communities as well as the potency of these excessively prescribed drugs. We are in this together, and together we have to demand change.