5 thoughts on “The Opioid Crisis: A Dissenting Voice

  • February 7, 2018 at 12:49 pm

    Well said!

    There are better ways to handle the opioid epidemic than by simply banning. In fact, many countries implement harm reduction strategies that improve circumstances for the addicted while keeping the drugs available for its intended purpose.

    Throwing the baby out with the bath water is counterintuitive!

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  • February 7, 2018 at 2:38 pm

    The * young thoroughbreds* are the ones being hit by this crisis the hardest. We are the ones that are feeling threatened, our pain meds are being taken away because of the misuse of them by others.

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    • February 7, 2018 at 3:21 pm

      I’d like to hear more about that. When I used the term, I meant the young uninjured people who are eager for the jobs. People who misuse pain meds are ruining it for everyone who needs them, young and old alike. But I can see why they fall into that trap; I don’t blame them as much as I blame the economic philosophies and practices that lead to everyone frantically struggling to support themselves, when we as a society could choose to allocate our resources differently. But that’s for another forum. Every time I see a tired middle-aged grocery cashier wearing wrist braces and wincing in pain, I think of all the younger and/or fitter people who would love to take that job, if only she could go home and rest.

      Reply
  • February 7, 2018 at 4:21 pm

    Ms Noreen:

    There are multiple factors that play roles to this “Opioid Crisis”, a label I find a bit disingenuous when opiate addiction has been prevalent across this country for several decades, just more pronounced in the past 10 or so years because of the prescription element to it now. One of those factors I find concerning that I feel you illustrate, a bit mind you, is when you write about how getting your prescription is like your “Precious” analogy. I respect it, again a bit mind you, per the need for pain relief, but, one needs to be very careful when dependency is rigidly rationalized as I read it at your column here.

    I firmly believe that opiates were never intended to be used indefinitely as a prescription intervention. That said, the time line to limited use is individual specific, but, there needs to be a conversation between doctor and patient when the time line seems to be reaching a conclusion, or a referral to another colleague who is willing to extend that time line per an expertise to look at implementing alternative interventions to respect the extension. Extend it but with intent to an eventual later but eventual termination of said medication use.

    The problem going on too often is unfortunately somewhat simple to me: even people who do not abuse or frankly take opiates for an addiction agenda do in fact develop qualities of a darker form of dependency per the way patients challenge providers to continue the prescriptions. Drugs of physical dependency do run the risk of altering personality, and not in a positive way most often.

    And that is what concerns me, that I have colleagues who feel intimidated, coerced, if not downright threatened to have to continue these medications beyond a reasonable endpoint. I don’t have a problem with this presentation in my office for two reasons, one that I do not write for opiates as I have no expertise nor clinical role in pain management as a psychiatrist, and two, people who try to intimidate, coerce, or threaten me are shown to the door and told to find another provider. When the patient-physician alliance is lost, so are future appointments.

    Sorry to write, but opiates do alter frustration tolerance and quick fix expectation to potential immature and pathological levels, not saying that to you here.

    The one problem I see with your explanation in your column is that you seem to be advocating for premature disability determination because people are allegedly forced into return to employment too quickly and then fail. That has validation at times, but, part of pain reduction is also healthy distraction and opportunity for productivity, which a job can offer depending on the job responsibilities and physical demands.

    Sorry, but more often than not, people on opiates, especially higher daily dosages, are not easily distracted nor able to appreciate efforts to be productive. Opiates dull those appreciations. Hence why people need to lower opiate dosages to attempt to feel again.

    Just my opinion, one of over 20 years working with people who have chronic pain and resulting psychological distress and dysfunction from it.

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  • February 11, 2018 at 6:03 am

    I agree with you. Sometimes people need opioids. It’s called suicide prevention.

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