Thursday, February 14, 2013

Walk a mile in my shoes: : The FDA and opioid labeling and restrictions, where does the problem really reside?

It is important to set atop the sky scraper, looking down on both sides of the building, weighing concerns in either direction, with the wind or against it.  I have deliberated over the power of addiction from any source, whether it be food, drugs, gambling, smoking, video games, shopping, sex, alcohol.  As I look into the wind and away from it, I question, “Is addiction a behavioral choice or an illness?” “Does restricting opioid medication from chronic pain patients reduce risk or increase it?”

Pain trumps all other basic functions. We are facing a critical turning point in our culture, and the consequence of wrong choices could be devastating. Why aren't we concerned with pain related deaths in this country? Could it be because we are afraid to admit our system is failing?  Will banning or limiting opioids increase the epidemic of untreated, pain? Does the potential for addiction outweigh the risks of not treating pain?

Addiction is the illness not the substance or behavior that feeds it. Have we stopped selling alcohol even though we know it has the potential for abuse and can kill instantly or slowly over a period of time?  Aren't programs like Alcoholic Anonymous a better answer? Is banning certain foods going to stop the obesity epidemic?  Do we treat addictions to gambling, smoking, video games, shopping, or sex by making it illegal to participate in any of these activities? As I sit on this grandiose pentacle, I realize to restrict the use of opioids as a choice in management of chronic pain is not the answer. Relieving pain is necessary; the use of alcohol, playing video games, etc is not. That does not mean I am in favor of government regulation, it means I am in favor of protecting our freedoms to choose how to relieve our pain.

Gaining favor as an alternative to opioids is antidepressants or anti-convulsants which we know create suicidal ideation in some patients, and can cause diabetes and a host of other serious medical problems.  These medications, in the medicine cabinet of a great many homes across America, have the potential for abuse. But why would we deprive patients who need them to function on a daily basis or prevent a very serious seizure disorder? Then I question, why these would be prescribed for pain when many patients report they are only minimally helpful, if at all, or that they come with a laundry list of interactions and side effects, when we already have effective pain medication?  Here we are atop the skyscraper once again.

I ask each person to relive their experience with pain and imagine it on a continual basis with no interventions possible.  Then I ask, “How long could you endure this pain before wanting to end it all?”  Is there any doubt you would be emotionally distraught?  Many pain patients feel alone and abandoned, because they are. Should we not address the emotional, mental, and spiritual affects of chronic pain, and provide education on how to use opioid medications safely and effectively?

We are missing the core problem of any addiction, poor access to mental health programs, lack of funding, and cultural attitudes. I would argue that the epidemic is not the use of opioids to treat chronic pain; the problem resides in our perception.   The days of using words like crazy or addict in a demeaning way should be long gone. The social injustice of ignoring those in need of professional council is the real epidemic. 

Those who take opioid pain medication to improve their activities of daily life and use them responsibly should not be vilified, and neither should those fewer people with a genetic tendency toward addiction. We must ask, before we make the decision to stand into the wind or away from it, choose one side of the building or the other, “Is it fair to deny a basic human right to have our pain treated by restricting access to medications that will help?” Addiction is not a moral collapse, it is a disease, and isn't addiction best treated by professionals rather than withholding the tool of addiction? Can we withhold food, sex, video games, alcohol, tobacco, gambling from everyone, and will that really solve the problem? History tells us from our experience with prohibition, that it will not.

Have we turned into machines worried about numbers rather than human beings? I hope not.


elana r. snyder said...

yes, the whole societal situation is despicable. no one will put me on pain meds even though i writhe through the night and day, sleepless. my subsidized apt. does not allow us to have alcohol in the home or medical marijuana! i don't think anybody cares

lisainkc said...

I completely agree with you Celeste. The basic human right to have our pain treated is being so overshadowed by the people that have CHOSEN to abuse these drugs. We have NOT CHOSEN to have a life filled with Chronic Intractable Pain. I just still can't understand why they are giving so much more credence to the ones that are abusing the drugs than they are giving to millions of American's in pain that use their medications safely and as prescribed by their physicians. The government should not be able to make this change and it needs to be stopped. They ONLY way our right to effective pain management will not be changed is to have a multitude of patients share their opinions and outrage with the power's to be in the Government. The biggest problem is that the majority of them have probably never lived with more than a day or two of pain. It would be alot different if those who are making these decisions lived a month in our pain stricken bodies. All the best to you Celeste! :) Lisa

Muscle Pain said...

Excellent article with lots of new information ...also for doctors and therapists!

Please talk more about what is contained in local anesthetic trigger point injections and how they assist.

How big a role does nutrition play in all this as an effective therapy? What else...?

Again, thanks for an enlightening read. Myofascial pain in Taiwan

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