When high doses of painkillers led to widespread addiction, it was called one of the biggest mistakes in modern medicine. But this was no accident.
Jane Ballantyne was, at one time, a true believer. The British-born doctor, who trained as an anaesthetist on the NHS before her appointment to head the pain department at Harvard and its associated hospital, drank up the promise of opioid painkillers – drugs such as morphine and methadone – in the late 1990s. Ballantyne listened to the evangelists among her colleagues who painted the drugs as magic bullets against the scourge of chronic pain blighting millions of American lives. Doctors such as Russell Portenoy at the Memorial Sloan Kettering Cancer Center in New York saw how effective morphine was in easing the pain of dying cancer patients thanks to the hospice movement that came out of the UK in the 1970s.
Why, the new thinking went, could the same opioids not be made to work for people grappling with the physical and mental toll of debilitating pain from arthritis, wrecked knees and bodies worn out by physically demanding jobs? As Portenoy saw it, opiates were effective painkillers through most of recorded history and it was only outdated fears about addiction that prevented the drugs still playing that role.
Opioids were languishing from the legacy of an earlier epidemic that prompted President Theodore Roosevelt to appoint the US’s first opium commissioner, Dr Hamilton Wright, in 1908. Portenoy wanted to liberate them from this taint. Wright described Americans as “the greatest drug fiends in the world”, and opium and morphine as a “national curse”. After that the medical profession treated opioid pain relief with what Portenoy and his colleagues regarded as unwarranted fear, stigmatising a valuable medicine.
These new evangelists painted a picture of a nation awash in chronic pain that could be relieved if only the medical profession would overcome its prejudices. They constructed a web of claims they said were rooted in science to back their case, including an assertion that the risk of addiction from narcotic painkillers was “less than 1%” and that dosages could be increased without limit until the pain was overcome. But the evidence was, at best, thin and in time would not stand up to detailed scrutiny. One theory, promoted by Dr David Haddox, was that patients genuinely experiencing pain could not become addicted to opioids because the pain neutralised the euphoria caused by the narcotic. He said that what looked to prescribing doctors like a patient hooked on the drug was “pseudo-addiction”.
Portenoy toured the country, describing opioids as a gift from nature and promoting access to narcotics as a moral argument. Being pain-free was a human right, he said. In 1993, he told the New York Times of a “growing literature showing that these drugs can be used for a long time, with few side-effects, and that addiction and abuse are not a problem”.
Long after the epidemic took hold, and the death toll rose into the hundreds of thousands in the US, Portenoy admitted that there was little basis for this claim and that he had been more interested in changing attitudes to opioids among doctors than in scientific rigour.
“In essence, this was education to destigmatise and because the primary goal was to destigmatise, we often left evidence behind,” he admitted years later as the scale of the epidemic unfolded.
Likewise, Haddox’s theory of pseudo-addiction was based on the study of a single cancer patient. At the time, though, the new thinking was a liberation for primary care doctors frustrated at the limited help they could offer patients begging to get a few hours’ sleep. Ballantyne was as enthusiastic as anyone and began teaching the gospel of pain relief at Harvard, and embracing opioids to treat her patients.
“Our message was a message of hope,” she said. “We were teaching that we shouldn’t withhold opiates from people suffering from chronic pain and that the risks of addiction were pretty low because that was the teaching we’d received.”
But then Ballantyne began to see signs in her patients that experience wasn’t matching theory. Doctors were told they could repeatedly ratchet up the dosage of narcotics and switch to a new and powerful drug, OxyContin, without endangering the patient, because the pain, in effect, cancelled out the risk of addiction. To her dismay, Ballantyne saw that many of her patients were not better off when taking the drugs and were showing signs of dependence.
Among those patients on high doses over months and years, Ballantyne heard from one after another that the more drugs they took, the worse their pain became. But if they tried to stop or cut back on the pills, their pain also worsened. They were trapped.
“You had never seen people in such agony as these people on high doses of opiates,” she told me. “And we thought it’s not just because of the underlying pain; it’s to do with the medication.”
As Ballantyne listened to relatives of her patients talk about how much the drugs had changed their loved ones, her misgivings grew. Husbands spoke of wives as if a part of them were lost. Mothers complained that children had become sullen and distant, their judgment gone, their personality warped, their character altered. None of this should have been happening. Pain relief was supposed to free the patients, not imprison them. It was all very far from the promise of a magic bullet.
As the evidence that opioids were not delivering as promised piled up, the Harvard specialist began to record her findings. By then, though, there were other powerful forces with a big financial stake in the wider prescribing of painkilling drugs. Pharmaceutical companies are not slow to spot an opportunity and the push for wider prescribing of opioids had not gone unnoticed by the drug-makers, including the manufacturer of OxyContin, Purdue Pharma, which rapidly came to play a central role in the epidemic.
As the influence of the opioid evangelists grew, and restraints on prescribing loosened, the pharmaceutical industry moved to the fore with a push to make opioids the default treatment for pain, and to take advantage of the huge profits to be made from mass prescribing of a drug that was cheap to produce.
The American Pain Society, a body partially funded by pharmaceutical companies, was pushing the concept of pain as the “fifth vital sign”, alongside other measures of health such as heart rate and blood pressure. “Vital signs are taken seriously,” said its president, James Campbell, in a 1996 speech to the society. “If pain were assessed with the same zeal as other vital signs are, it would have a much better chance of being treated properly. We need to train doctors and nurses to treat pain as a vital sign.”
The APS wanted the practice of checking pain as a vital sign as a matter of routine adopted in American hospitals. The key was to win over the Joint Commission for Accreditation of Healthcare Organizations, which certifies about 20,000 hospitals and clinics in the US. Its stamp of approval is the gateway for medical facilities to tap into the huge pot of federal money paying for healthcare for older, disabled and poor people. Hospitals are careful not to get on the wrong side of the joint commission’s “best practices” or to fail its regular performance reviews.
In response to what it called “the national outcry about the widespread problem of under-treatment” – an outcry in good part generated by drug manufacturers – the commission issued new standards for pain care in 2001. Hospital administrators picked over the document to ensure they understood exactly what was required.
Every patient was to be asked about their pain levels, no matter what the reason they were seeing a doctor. Hospitals adopted a system of colour-coded smiley faces, to represent a rising scale of pain from 0-10. The commission ruled that anybody identifying as a five – a yellow neutral face described as “very distressing” – or above was to be was to be referred for a pain consultation.
The commission told hospitals they would be expected to meet the new standards for pain management at their next accreditation survey. Purdue Pharma was ready. The company offered to distribute materials to educate doctors in pain management for free. This amounted to exclusive rights to indoctrinate medical staff. A training video asserted that there is “no evidence that addiction is a significant issue when persons are given opioids for pain control”, and claimed that some clinicians had “inaccurate and exaggerated concerns about addiction, tolerance and risk of death”. Neither claim was true.
Some doctors questioned the value of patient self-assessment, but the commission’s regulations soon came to be viewed as a rigid standard. In time, pain as the fifth vital sign worked its way into hospital culture. New generations of nurses, steeped in the opioid orthodoxy, sometimes came to see pain as more important than other health indicators.
Dr Roger Chou, a pain specialist at Oregon Health and Science University who has made long-term studies of the effectiveness of opioid painkillers and helped shape the Centers for Disease Control and Prevention’s policy on the epidemic, said the focus on pain caused patients to give it greater weight than made sense.
“When you start asking people: ‘How much pain are you having?’ every time they come into the hospital, then people start thinking: ‘Well, maybe I shouldn’t be having this little ache I’ve been having. Maybe there’s something wrong.’ You’re medicalising what’s a normal part of life,” he said.
One consequence was that people with relatively minor pain were increasingly directed toward medicinal treatment while consideration of safer or more effective alternatives, such as physiotherapy, were marginalised. Another, said Chou, was the increased expectation that pain can be eliminated. Chasing the lowest score on the pain chart often came at the expense of quality of life as opioid doses increased. “It’s better to have a little bit of pain and be functional than to have no pain and be completely unfunctional,” said Chou.
Health insurance companies piled yet more pressure on doctors to follow the path of least resistance. This meant cutting consultation times and payments for more costly forms of pain treatment in favour of the direct approach: drugs.
The joint commission needed a way to judge whether its 2001 edict on pain was being adhered to and latched on to patient satisfaction surveys. It took a determined doctor to resist the pressure to prescribe. Physicians could spend half an hour pressing a person to take more responsibility for their own health – eat better, exercise more, drink less, find ways to deal with stress – only to watch an unhappy patient make their views known on the satisfaction survey and face a dressing down from hospital management. Or they could quickly do what the patient came in for: give them a pill and get full marks.
In Detroit, Dr Charles Lucas’s three decades of experience as a surgeon told him it was possible to do what was easy and sign the prescription, or to do what was hard. Lucas grew up in the city and had been instrumental in establishing Detroit’s publicly owned hospital as the highest-level trauma centre in Michigan and one of the first top-tier centres in the country.
Emergency departments became beacons for the opioid dependent, who quickly learned to game the system to get drugs on top of their prescriptions. They turned up feigning pain, knowing harassed medical staff under pressure of time and the commission’s standards were likely to prescribe narcotics and move on without too many questions.
“Some of the old-time nurses, they have that jaundiced look in their eye and say ‘So-and-so’s complaining of pain’. You can tell by the look in their eye that they don’t think it’s justified that they get any more medicine,” said Lucas. “The younger nurses, they say we have to treat this pain – because they’ve been indoctrinated – they’ve got to get rid of the pain. God forbid you don’t get rid of the pain. That would be like a mortal sin.”
But there was a price for resisting the pressure to prescribe ever higher doses of pain relief.
Lucas was knocked back in surprise, and then infuriated, to be summoned to appear before his hospital’s ethics committee after a nurse reported him for failing to provide adequate pain treatment.
The surgeon’s longstanding patients included Gail Purton, the wife of a well-known Michigan radio personality. Lucas operated on Purton a few times, and she was back for surgery after her ovarian cancer spread. “It was a big operation. Cut off all sorts of cancer.” The next day, a nurse asked Purton if she was in pain. Purton said she was. The nurse reported Lucas for failing to properly address a patient’s pain. “I got reported because I wasn’t giving her enough pain medicine. She had a big cut from here to here,” Lucas said, running his finger across the front of his shirt and scoffing at the idea that she could be pain-free after an operation like that.
The surgeon responded with a five-page letter to the ethics committee chairman, whom he happened to have trained, challenging the questioning of his professional judgment. Purton wrote her own letter, praising Lucas’s care and saying that she never expected not to have pain after a major operation.
The case was dropped, but it was not an isolated incident. Lucas has worked closely with another surgeon, Anna Ledgerwood, since 1972. She too was hauled before the ethics committee on more than one occasion, on the same charge. It cleared Ledgerwood, but Lucas said more junior surgeons buckled to the pressure to administer opioids just to stay out of trouble.
Lucas regarded the new pain orthodoxy as a growing tyranny. He also thought it was killing patients. He began to collect his own data.
As the joint commission was pushing out its new standards for pain treatment in the early 2000s, the industry was driving a parallel effort to influence the prescribing habits of doctors in small clinics and private practices across the country. Many were still hesitant to prescribe narcotics, in part because of fear of legal liability for overdose or addiction.
The American Pain Society and Haddox, who was by then working for Purdue Pharma, were instrumental in writing a policy document reassuring doctors they would not face disciplinary action for prescribing narcotics, even in large quantities. The industry latched on to the Federation of State Medical Boards because of its influence over the health policy of individual US states which regulate how doctors practise medicine.
In 2001, Purdue Pharma funded the distribution of new pain treatment guidelines drawn up by the FSMB that sounded many of the same themes as the standards written by the joint commission.
The document picked up on Haddox’s pseudo-addiction theory. “Physicians should recognise that tolerance and physical dependence are normal consequences of sustained use of opioid analgesics and are not synonymous with addiction,” it said.
The FSMB pressed state medical boards to adopt the guidelines and to reassure doctors that adhering to them would diminish the likelihood of disciplinary action.
Over the following decade, the FSMB took close to $2m (£1.52m) from the drug industry, which mostly went to promote the guidelines and to finance a book, Responsible Opioid Prescribing, written with the oversight and advice of a clutch of doctors who were strong advocates of wider use of prescription narcotics. The book was sold to state medical boards and health departments for distribution to physicians, clinics and hospitals. The drug industry paid for the publication but the FSMB kept the $270,000 profits from sales.
Within a few years, the model guidelines were adopted in full or in part by 35 states, and the floodgates were open to mass prescribing of what Drug Enforcement Administration agents came to call “heroin in a pill”. Opioids were soon the default treatment even for relatively minor pain. Dentists gave them to teenagers after pulling their wisdom teeth. Not just one or two days’ worth of pills, but a fortnight or a month’s worth, which, if they did not draw the intended recipient in, frequently sat in the medicine cabinet waiting to be discovered by someone else in the family. The lack of caution in prescribing left an impression among the users that the drugs were harmless, and some people shared them with others as easily as they might an aspirin. Prescribing escalated year on year. So did profits. OxyContin sales passed $1bn a year in 2000. Three years later they were twice that. Other opioid makers were pulling in huge profits too.
By the time the FSMB guidelines were landing in doctors’ inboxes in the early 2000s, Ballantyne had reached her own conclusions about the impact of escalating opioid prescribing. In 2003, she co-authored an article in the New England Journal of Medicine highlighting the dearth of comprehensive trials and saying that two important questions remained unanswered even as mass prescribing of opioids took off. Do they work long term? Are higher doses safe to take year after year? The drug industry and opioid evangelists said yes, but where was the evidence for it?
Ballantyne wrote that there was evidence that putting some patients on serial prescriptions of strong opioids has the opposite of the intended effect. High doses not only build up a tolerance to the drug, but cause increased sensitivity to pain. The drugs were defeating themselves.
Her assessment seemed to warn that if there was an epidemic of pain, it was partly driven by the cure. On top of that, there was evidence that the drugs were toxic. Then came the conclusion that stuck a dagger into the heart of the campaign for wider opioid prescribing. “Whereas it was previously thought that unlimited dose escalation was at least safe, evidence now suggests that prolonged, high-dose opioid therapy may be neither safe nor effective,” she wrote.
Ballantyne was also increasingly aware that the claim that pain neutralised the risk of addiction was false. Quantifying addiction, and who may be vulnerable, is notoriously difficult. Ballantyne, like a lot of doctors, estimated that between 10 and 15% of the population is vulnerable, but that it depends on the substance and circumstances. What she was certain of was that Purdue’s high-strength pill, OxyContin, had been a game changer. “The long-acting opiates suddenly put much higher doses into people’s hands and much more of it, and taking it around the clock made them dependent on it.”
From her research, Ballantyne concluded that OxyContin supercharged what was already widespread dependence on weaker opioid pills by drawing a new group of people into the category at risk of addiction and death. The danger was compounded by OxyContin’s failure to live up to its promise of holding pain at bay for 12 hours. For some patients, it wore off after eight, causing them to take three pills a day instead of two, greatly increasing their overall dose of narcotic and with it the risk of addiction.
Ballantyne thought the article would at least cause her profession and the drug industry to take stock of the impact of mass prescribing. By the time the article appeared, the documented death toll from prescription opioids was running at around 8,000 a year.
“When the 2003 New England journal article came out, I thought it was going to make the medical community sit up and say: ‘Wow. These drugs that we’ve been thinking are helping people are not. We have a real problem.’ But the medical community didn’t at all say: ‘Wow,’” Ballantyne said with half a laugh, 15 years later.
“People in my field who had been, like me, taught we have to do this – people who’d been lobbying to try and increase opiate use, like the palliative care physicians – said: ‘What are you doing? We worked so hard to get to this point, and now you’re going to turn it all around. They become so rattled when you suggest you shouldn’t give the opiates – it’s partly people in the pain field and especially people in pharma – because it’s big business.”
Lucas and Ledgerwood had their own study on the impact of opioids in the works. They came to believe the tyranny of the colour-coded smiley faces was costing lives. Years of surgery have given Lucas a healthy respect for pain as a tool for recovery. To suppress it was dangerous. But as large doses of opioids became the norm, the surgeon noted an increasing number of incidents of patients struggling to breathe after routine operations and being moved to intensive care.
Lucas and Ledgerwood visited trauma centres to collect data on deaths before and after the joint commission standards on pain treatment. In 2007, the two doctors published their findings. Before the commission’s dictum, 0.7% of trauma centre patients died from “excess administration of pain medicines”. The death toll rose to 3.6% after the commission’s policies kicked in.
“In each case, administration of sedation led to a change in vital signs or a deterioration in the respiratory status requiring some type of intervention which, in turn, led to a cascade of events resulting in death,” the paper said. Those were only the deaths in which there was little doubt opioids were responsible, and the real toll was almost certainly higher. “Overmedication with sedatives/narcotics … clearly contributed to deaths,” the study concluded.
“I’m convinced that because of the pressures brought to bear by the joint commission, we are killing people,” Lucas told me. The study said the medical staff lived in fear of the joint commission standards which created “great psychological pressure on caregivers” to use narcotics.
In a damning critique, the paper said that the commission’s reliance on pain scales to guide treatment had created an “excessive emphasis on undermedication at the same time ignoring overmedication”. The obsession with ensuring people were not in pain came at the expense of ignoring the dangers of giving large amounts of opioids to people recovering from surgery or serious injury. The drugs may kill the pain but they also risked killing the patient.
The two doctors made no secret of who they blamed for “this preventable cause of death and disability”. “It’s about money. Money has influence, and it influenced the joint commission,” said Lucas.
The surgeon presented the paper to a meeting of the Central Surgical Association and saw it published by the Journal of the American College of Surgeons under the headline “Kindness Kills: The Negative Impact of Pain as the Fifth Vital Sign.”
Afterwards, Lucas got a stream of letters and emails from doctors who recognised the problem. But, unlike Ballantyne, he wasn’t surprised when the policy remained the same. “Did I expect a change? No. It is too ingrained into the medical profession. It’s become financial just like the drug industry is financial. It’s nothing to do with right or wrong. It’s about how the money flows,” he said. “When you write a paper you want there to be unemotional data out there. You want that unemotional data to be analysed and interpreted in one way or the other, but you don’t expect the Renaissance.”
In 2012, nine years after Ballantyne’s cautioning against the mass prescribing of opioids as a quick fix for pain was published in the New England Journal of Medicine, a renowned British pain specialist, Cathy Stannard, called the doctor’s paper “a distant warning bell”, challenging the opening of the floodgates to strong opioids.
Ballantyne continued to collect data and publish ever more detailed insights into the impact of painkillers. A less rapacious drug industry might have paused in its headlong charge to sell opioids, and less blinkered and compliant regulators might have determined that this was the moment to weigh the claims made in favour of permitting such widespread prescribing.
Instead the pharmaceutical companies took the warnings as a challenge to their business interests. Through the 2000s, industry poured money into a political strategy to keep the drugs flowing. It funded front groups and studies to claim that there was indeed an epidemic – but it was of untreated pain. The millions coping with chronic pain were the real victims, the industry said, not the “abusers” hooked on opioids they often bought on the black market or obtained from crooked doctors. That one frequently became the other was conveniently overlooked.
Pharma’s lobbyists worked to persuade Congress and the regulators that to curb opioid prescribing would be to punish the real victims because of the sins of the “abusers”, and it worked. As a result, the devastation ran unchecked for another decade and more. By 2010, doctors in the US were writing more than 200m opioid prescriptions a year. As the prescribing rose, so did the death toll. Last year, more than 72,000 Americans died of drug overdoses, the vast majority from opioids, nearly 10 times the number at the time Ballantyne published her warning.
The head of the FDA at the time OxyContin was approved for distribution two decades ago, Dr David Kessler, later described the opioid crisis as an “epidemic we failed to foresee”. “It has proved to be one of the biggest mistakes in modern medicine,” he said.
Kessler was wrong. It wasn’t a mistake. It was a betrayal.
License to “practice” medicine.
Find the key word….
Check this out gats, while I’m not particurly religious, i find this interesting.
Number G5331 in Strongs concordance of the bible.
φαρμακεία
pharmakeia
far-mak-i’-ah
From G5332; medication (“pharmacy”), that is, (by extension) magic (literal or figurative): – sorcery, witchcraft.
EX..
And still they would not give up their sorcery’s. Pharmeka. I remember about 30 years ago a biblical scholar wrote a book and said that very thing and I never forgot it but I forgot the writer and title of the book.
It appears to me that doctors think you should have no pain.
I had my hip replaced several months ago. The pain was quite tolerable. I was taking 500 mg of Tylenol, and that helped. However they sent me home with a huge bottle of oxy and some Fentanyl patches. I threw the shit away.
an addict might want to know where you threw them
Yeah Dutchy, where did you throw them?
Asking for a friend.
This opoid epidemic is the reason US troops have been in Afganistan for 17 years.
https://www.activistpost.com/2018/03/before-us-troops-protected-poppies-in-afghanistan-there-was-no-opioid-epidemic-in-america.html
Who remembers Iran/Contra? Who do you think learned the most from it?
The number of drug overdoses soared around here ( Manatee County, Fl ) when the DEA shut down the ‘pill mills’ and even if you had a legal Rx for Oxycodone it was hard to find and the pharmacies that still carried it engaged in price gouging.
I never used the stuff though I was on a morphine drip once when I broke 4 ribs and it was miraculous how I went from being in agony to resting comfortably in just a few minutes. But for those who are addicted I would rather them be able to buy cheap pills of known dosage and purity than have Mexican drug cartels supplying heroin/fentanyl street drugs and fueling crime as addicts must steal and rob to support their habit.
Prohibition never works so lets just have legal pill mills provide the dope as they can be taxed and monitored. Sure some people will fake injury to get a Rx for oxydone but so what? They will also buy illegal street drugs if they can’t get pharmaceutical grade pills and that creates a far worse problem.
People who use illegal street drugs tend to get the money for that illegally or illicitly.
During the early 1950’s I had an infected tooth that hurt like hell. My sister had a boyfriend with Mafia connections who had access to some “pain pills”. Instant relief. I’m thankful to this day.
Where’s the American version of Duterte when you need one? Big Pharma and the allopathic healthcare system are indeed drug dealers. Little shoot up would either end them or increase their profits.
Perhaps the saddest thing of all, they’ll call you depressed if you say no to the happy pills. More drugs for you. Forget my hero Rodrigo Duterte, where are the “my body, my choice” gals? Now back to enjoying my drug free, albeit achy,
arthritis on this damp, dreary day.
Of course the overprescribing was no accident. If you go back and look at the dates you’ll notice the efforts to destigmatize the mass prescribing of opiates really ramped up right around the time the U.S. corporation was invading a lil country called Afghanistan. For the first roughly 12 years of the twenty first century it was remarkably easy to get massive doses of opiates prescribed for nearly anything. I know cause I did! However, for the last approximately 6 years or so, they have been methodically restricting the ability to prescribe opiates, to the point where it’s nearly impossible to get them today, and the ridiculous hoops one has to jump through to get them deter most folks. So, what is a hopelessly addicted man or woman with chronic pain to do!? Don’t worry, U.S. Corp. got ya covered! Heroin is more abundant than ever, thanks to our brave poppy field security forces in Afghanistan! I bet if you look you will see that the statistics show( if they aren’t “doctored “ themselves) a steady increase in the number of heroin related deaths for about the last decade or so. Fetanyl laced heroin being the culprit in a lot of cases. Does the media tell you this? Nope, they still represent the opioid crisis as being caused by greedy big pharma and overprescribing docs. Not so! It’s the heroin baby! You gotta hand it to those evil fucking geniuses! They create the problem, profit from it, cut it off, all the while knowing the addicts will turn to use of their incredibly abundant heroin, which they also profit from , but exponentially more, they procure it, ship it, launder the money, sell it here, then they have their LEOs arrest and incarcerate, profiting from the commercial transaction that all crimes are converted to in this fucked up system, and from their for profit prisons! Oh, and then they lace a batch here and there with some fetanyl, and help their eugenics plan along in the process! You gotta hand it to them, even though they will burn in a lake of fire for eternity, they are some evil genius motherfuckers!
Raisballs,
You got it exactly right. There is a lot of the Hegelian dialectic to the story.
Ralls..
Right you are.
It can all be traced back to Nam when we took the opium trade from the French and suddenly our troops and our kids at home were exposed to cheap scag. when that gig was up it died down and was replaced by cheap coke but it was the same actors, some of whom I knew from the trade in Nam. The crack scourge was no accident. Now, many of the kids of those same bad actors are running the opium trade in Afghanistan. It does more than just pay for black budgets, it also goes in the pockets of Senators. I’m sure there are a lot more angles being played but that much I know for sure.
Be sure and vote in the next election and the one after that and the one after that so we can win the war on drugs and because big brother likes it when we vote.
“to the point where it’s nearly impossible to get them today”
That’s not my experience. They are offered at every visit that I have …
Pain only hurts when you have it. You can’t feel another’s pain level and an incredible mix of factors go into each person’s pain level and perception of how it affects their life. The judicious use is indicated for a large number of people. I’m a chronic pain patient and have been responsibly using oxycontin for over 8 years without any problems. There is no euphoria after a couple of weeks of taking them, only offering much appreciated pain relief.
As usual, psycho govt intervention screws it all up. The pendulum has swung from too easy access to now a clamp on their use. As with most everything there is a happy medium but when govt gets involved things go off the rails. As the pendulum swings to restriction it will force people to the black market with the outcome Ralsbals describes in his post, profits for narcos and more deaths of users and abusers.
This is a topic no one should ignore. When there are more and more natural therapies and herbal medicines becoming available, why is there a need for stronger synthetic painkillers? It is because the addiction of millions of people in this country is profitable, therefore must be sustained.
Daily/regular use of opiates creates a physical dependency, even when taking just enough to dull the pain as it occurs. The tolerance leads to requests for higher doses, which leads to addiction in many. An addict needs stronger doses to maintain the mental acuity the drug barely provides. Eventually, an addict might take so many pills or grams or snorts to stop the craving and pain that their heart stops. Many of us know of that happening, with relatives and friends shocked they were secretly addicted to painkillers.
Since Big Pharma doesn’t want to lose a customer, more potent pain killers must be developed that maintain the dependency but do not kill the customer. The customer pays the bills for Big Pharma. Big Pharma has Congress Critters to pay. And Bureaucrats to buy. And Courts to court. And a few medical associations to bribe.
Because, when the Law of the Land depends upon what the Social Scientists and Social Justice Warriors say it is, well… we are all entitled to be pain free, aren’t we? Isn’t that in the Constitution? Or the Bible?
We all know what mob violence looks like on Tee Vee. We just didn’t know our strongest warriors would be sedated by the Military Industrial Complex and its partnership with Big Pharma.
[How many people know our troops are supplied with Ambien and other psychotropic drugs while on combat duty, at least for initial jet lag issues. The stories about Ambien’s crazy effects on many people are well documented and compacted somewhere in the small print “sleepwalking has been reported” which seems rather tame for people who’ve driven while unconscious into bridges or been found on the roof of their home at 3 a.m.
My point is this: People have psychotic reactions to some of these drugs and the FDA knows it.]
This article suggests the epidemic we are facing is neither accidental nor coincidental. Was it planned?
Well, I think there was once a Big Holy Book that said we would know the end was near when people could not tell wrong from right. Supposedly, there will be mislabeling, as well, with some people calling that which is Good “Evil” and what is Evil will be called “Good.” I suspect there may be gender confusion and mob violence to protest facism. I suspect the signs are all around us, but our citizens are too sedated with prescription narcotic and psychotropic drugs to read them.
And no one listens to Common Sense anyway.
I guess introducing a painkiller a thousand times stronger than the last one introduced is considered to be Good by those who are Evil. But, really? Who can say?
I brought the pain, some would say. Most would say I fixed the pain. Or gave treatment designed to stay the pain. I saw pain every day in the form of toothaches AND in the form of emotional pain. An infected tooth or gum can be quite painful. Some pains are fixable with a surgical intervention, a restoration eliminating a hulking cavity or removing the dental pulp/nerve and replacing it with a medicated obturation. And a one time Rx. Those are the easy ones to deal with.
There is another class of dental pain. It most often presented as a form of myo-facial pain, commonly labeled under temporomandibular joint pain. I came to call it emotional pain presenting as a somatic symptom.
35 years ago I attended a lecture from a psychiatrist from the Mayo Clinic. He told the tale of a young bonafide beauty queen who had complaints of pain in her tooth. All treatments were done, fillings, crowns, root canals and finally extraction of the implicated source of pain. One after another until she had lost all her top teeth on one side. That is when she was referred to him. In his evaluation and work up he asked her what was happening in her life when the pain began. She responded with a tale of abuse, sexual in nature I think – it was really traumatic for her but evidently she had no way to express her emotional pain over her persecutor’s actions – it festered, repressed. The shrink said that is why she had dental pain.
Thirty five years of prescribing pain pills and treating facial pains I find much truth to his conjecture.
I once had a man said he chose me to be his dentist because he worked for an insurance company and he knew my stats for treating TMJ pain along with the normal procedures. It was good he said. That I used conservative treatments and had excellent success rates. I saw many vague complaints of pain, not traceable to an offending tooth. Some clients just wanted drugs, my BS detector was refined over the years, and by being married to an incorrigible opiate addict.
The key to my success in treating TMJ was understanding the psychosocial aspects of pain. Many cases came down to asking the client what was going on at the time the pain started. Or asking them if they are under extra stress; a death, divorce, abusive relationships, money desperation… etc.
Almost always the answer was yes. I could supply palliative care but told them it was common to have physical complaints in those situations. I sometimes would direct them to mental health providers. Though that is a last resort because no one wants to be labeled mentally dysfunctional. But in fact that is how I achieved success on refractory cases; by listening closely to what and how they described their pain. I applied TLC and compassion.
When your endogenous endorphins are insufficient to handle an emotional load, somatic pain results. Most times pain meds give relief from a temporary problem. Thank heaven for it. But often opiates do not treat an underlying psych cause and/or mask a real physical condition. Very effectively opiates lift your mood. And exogenous opiates simply shuts down the internal production of the bodies natural pain killers. Dependency develops and the cycle spirals down.
Everyone has different levels of pain tolerance. I have had clients sit for 20 full crowns and several root canals without a drop of local anesthetic. And I had one guy request I pull a tooth with a normal root structure (bad cavity) without any anesthetic. They never even flinched or complained. And then there are those who flinch when I grasp their cheek with the pressure to hold a grape.
The left hand side of the bell curve folks are the 10% with the propensity to get and stay dependent on drugs. And many more are merely susceptible, believing the hype of the Big Pharma and their physicians.
I do not have an answer but I know how many get relief. It is not easy to create a psychic conversion, a “bottom” when a spiritual answer helps. AA and 12 steppers offer impressive results. And more education telling of the dangers to warn the unsuspecting, innocent and guilty. This article does a good job.
And just for fun, Is It Safe?
Am reviewing a couple old posts I knew were here somewhere and came across this gem from Whosie Susie, the dentist across borders.
https://www.youtube.com/watch?v=7j2GQqu18J0
Sounds familiar.
https://inpursuitofhappiness.wordpress.com/2007/10/01/the-sassoon-opium-wars/
I guess old tricks are best tricks.
Fast forward to today:
https://www.newyorker.com/magazine/2017/10/30/the-family-that-built-an-empire-of-pain
https://www.forbes.com/sites/alexmorrell/2015/07/01/the-oxycontin-clan-the-14-billion-newcomer-to-forbes-2015-list-of-richest-u-s-families/
https://theweek.com/articles/541564/how-american-opiate-epidemic-started-by-pharmaceutical-company
AC…
Amazing coincidence, 1860 to 1890 is when most of Americas railroads were built with cheap Chinese and Irish labor. Cheap whiskey for the Mics and cheap opium for the Chincs. Both escaping extreme conditions at home.
The pain clinics in Florida where hundreds of thousands pain prescription were ‘stamped’ by doctors,
not one doctor was charged or one license revoked and they were the real villains – first do no harm.
Totally reprehensible.
Is that what I’ve heard called Pill Mills? Or were they just issuing prescriptions?
I watched the documentary on ‘American Greed’. The episode called them pain clinics.
The speaker specifically emphasized no doctors were charged. These pain clinics could
not have existed without doctors prescribing the pain meds. They said no type of
physical or subjective assessment was performed. Took a good while for authorities
to shut them down so it makes one wonder if the clinics were allowed to go on
unmolested by design.
Sorry I can’t name the Dr. but somebody from fla is doing something like 40 years for gross RX abuse
Somebody should.
https://www.usatoday.com/story/news/health/2018/11/16/alcohol-deaths-emergency-room-increase-middle-aged-women-addiction-opioids/1593347002/