Opioid Crisis

In the present day there is a harsh stigma towards the use of opioid narcotic medication. Stories of addiction and overdose are passed around. The media is brimming with panic over the use of these medications. By and large, this can be seen as more of an overdose crisis than an opioid crisis. Federal and medical guidelines for prescribing opioid medications have changed drastically over the last several years because of this epidemic. Unfortunately, due to the increasing level of abuse that these medications are associated with, people with chronic pain are untreated, undermedicated, and suffering. Opiate narcotics, when used properly by responsible patients, are invaluable in alleviating acute or chronic cases of moderate to severe pain.

According to the National Health Interview Survey, an estimated 25.3 million American adults experience chronic pain. As both someone who has endured severe, unremitting pain since childhood and now works in the medical field, I have become well-versed in the topic. I know firsthand that chronic pain patients suffer not only from physical discomfort, but secondary emotional discomfort and a loss in quality of life. Pain places stress on the body, particularly in the sympathetic and autonomic nervous systems. In turn, this can have other negative effects, such as heart rate issues, muscle tension, fatigue, and sleeping problems. According to Forrest Tenant, MD, “Persistent, unremitting pain may adversely affect the body’s endocrine, cardiovascular, immune, neurologic and musculo-skeletal systems and require aggressive treatment of the pain as well as the resulting complications” (Tenant 1). The amount of FDA approved treatments for chronic pain are slim. Several of them are invasive procedures or risky surgeries. Because of increasing rates of addiction and abuse, patients looking for more conservative treatments who are in severe pain are left untreated, suffering from unrelenting pain. In the midst of the opioid epidemic, have the original medical uses and benefits of these medications been pushed aside and forgotten?
Formerly, a prescription for pain medication wasn’t difficult to obtain. In the late 1990s, pharmaceutical companies ensured medical and healthcare professionals that most opioids, especially newer, synthetic types (such as Oxycontin, Vicodin, and Fentanyl) didn’t pose potential for addiction. There was an uprise in dispensing rates until new studies showing greater health risks posed a threat. Now, doctors are following new, strict prescribing guidelines. These prescriptions for opioid narcotics are rarely written. Pain clinics are under fire and stringent supervision. As a Certified Pharmacy Technician (CPhT) myself, I see directly how pharmacies scrutinize prescription rates from certain prescribers and are mandated by law to report them. Still, even with the efforts against accessibility for illegitimate use, people with opioid misuse disorder and those seeking recreational use are finding illegal ways to obtain these medications. These drugs are often made in illicit manufacturing facilities or being smuggled in from other countries. Actual chronic pain patients who were properly prescribed opioids constitute a very small proportion of those who abuse and become addicted, as small as 8%, reports the National Institute of Drug Abuse.
Annually, thousands of people die from opioid overdose. The overdose crisis is the leading cause of death in people under the age of fifty. Drug users will most commonly administer more medication than their body is able to handle. In turn, their nervous system is unable to function properly and their respiratory system may begin to shut down. However, approximately 63% of drug related overdoses are the result of combining two or more different opioids, or opioids mixed together with alcohol (Lewis 1). While prescription opioids do play a part in contributing to the opioid overdose epidemic, the majority of drugs used are Schedule I drugs and are not available by prescription, such as illicitly manufactured heroin.
It is imperative that policymakers and medical professionals are sensitive to the issue that many people are currently being undermedicated and untreated for their pain. In the midst of the increasing amount of addiction and overdose, there must be a balance between preventing misuse and the treatment of people who are forced to live their lives in severe pain. Other chronic pain treatments, such as Low Dose Naltrexone, are not FDA approved. Medical marijuana, another hotly debated chronic pain treatment, is still illegal on a federal scheduling level. Consequently, many doctors are hesitant to prescribe these medications as well, even if the pain patient is not taking opioids.
As someone who struggles daily with chronic pain due to an incurable underlying genetic condition, I have witnessed the suffering that patients have undergone during the opioid epidemic. I was first given narcotics as a child because I was in too much pain to move. This, of course, was in combination with other types of therapy and was used as a last resort. Although the narcotics didn’t completely eliminate my pain by any means, I was able to attend school and do simple day-to-day activities while undergoing pain treatment. Because I was a child, there wasn’t much of a risk of misuse on my end due to my parents handling my medications.
As I grew older into my teenage years, my pain became worse.

This was nearing the climax of the opioid epidemic and doctors were becoming more stringent. I needed several surgeries and wasn’t able to attend school due to being in the hospital. Doctors tried to treat my pain with unorthodox remedies to avoid keeping me on traditional painkillers. I was removed from them “cold turkey” and underwent abrupt withdrawals. I was put on other strong medications, such as GABA analogues (Gabapentin, Pregabalin) for nerve pain. I developed severe brain fog and seizures from taking these medications. I endured many side effects that I didn’t have previously while taking opioids. I wasn’t taking the medication that had helped me for so long. Fortunately, I was able to find a doctor who was able to put me on opioid antagonist drug, Low Dose Naltrexone. This medication is not FDA approved and is not covered by my insurance, so it is very expensive. I must have it compounded in a specialist pharmacy and shipped in from out of state. Most doctors are not willing to take on the risk that comes with prescribing a drug that is not FDA approved. These medications also do not work for everyone. This medication allows me to get out of bed every day. Before this medication, since opioids, I was unable to go to school or work. Now I am able to have relief from my discomfort. Although I have many underlying health issues and medication is simply one facet of my treatment, it provides me reprieve I so desperately needed. I am lucky, but so many people that I know who are in chronic pain are not. Many patients are suffering in the interim of doctors not being able to prescribe their pain medication and not having a solution to replace opioid

use.
People in pain, most often, do not want to become drugged or addicted. They want their lives back. They want control over being able to do things that they aren’t able to accomplish while in severe amounts of pain. In many cases, there are patients who genuinely benefit from opioids and their pain-relieving properties. Treatment for pain relief can benefit patients and our society in miraculous ways. When used properly, opioids can help keep patients off of disability and allow them to be a part of the community due to relief in symptoms. When pain relief comes, so does happiness for people who have struggled for so long.
I implore the consideration of the negative effects that the opioid epidemic has had on patients who are in pain. We as a community must strive for balance in both protecting from misuse, abuse, and addiction, while maintaining the treatment and relief from pain in those who are suffering. It is unjust and unfair to have sets of laws that can bring so much upset and harm to a patient’s treatment regimen. In this type of scenario, it is necessary to protect everyone involved. Over 100 million Americans suffer from pain. The widespread comorbid symptoms that pain causes are devastating. Chronic pain patients should not be held accountable for crimes they have not committed in the overdose epidemic. When opioids are prescribed properly, dosed accordingly, and taken responsibly, they can be one of the strongest components in pain treatment and provide the relief that is so desperately sought