Opioids and Humane Treatment

We have two opioid problems in the U.S. The first one, I am certain you have heard of. It is opioid addiction, which is arguably fueled by the widespread availability of opioids. The second problem is one that was created by how government agencies and businesses decided to address the first problem.

For people with chronic health conditions, access to opioid pain killers can restore some normalcy and improve the quality of life. Many people who, like myself, suffer from chronic pain, have very few good days, good hours, or even good minutes in which we must complete all our errands. Restrictive pharmacy policies, where a person can only receive a seven day supply of an opioid painkiller, can be devastating to individuals with chronic conditions or those recovering from major surgery.

Many of us have compromised immune systems, so spending more time in public places increases the likelihood for additional illness.

Some of the restrictive measures are hardly new. In 2014 the DEA (Drug Enforcement Agency) moved many painkillers from being classified as schedule III drugs to schedule II drugs of the Controlled Substances Act. When this took effect, prescriptions that could once be phoned in by my physician had to be written out, picked up by me (with showing photo ID), and hand delivered to the pharmacy. There were more hoops to jump through.

What strikes me as insanely ironic is that a doctor who prescribes opioids to a person who becomes addicted can lose his or her license to practice medicine and face prison time while someone who sells a man guns and ammo that he then kills numerous people with cannot be held accountable. That is seriously messed up!

Studies (https://www.ncbi.nlm.nih.gov/pubmed/25785523) have shown that the rates of opioid addiction among chronic pain sufferers is 8-12%. I would argue that the figure doesn’t warrant the hurdles chronic pain sufferers face when they are seeking the medication they need.

I don’t blame doctors for being afraid of potential consequences. I don’t blame individuals who have had family members become addicted to opioids for asking for regulations to be imposed to help curtail the prevalence and availability of these drugs. I just ask that all of us put a little more thought into what we are doing to solve this epidemic, and to understand that there is another opioid crisis; one that is causing a significant amount of suffering.

I ask that people consider other possible solutions, have conversations, and reach out to their legislators.

Here is a list of ideas I have arrived at for addressing the opioid epidemic in a more thoughtful, humane way:

1) Pass legislation that requires health insurance plans to cover TENS (transcutaneous electrical nerve stimulation) devices including Quell. Many of these devices actually perform better than opioid painkillers for addressing chronic pain, but can be cost prohibitive. Some insurance providers, including Medicare, will cover the rental or purchase of TENS devices under certain circumstances, but most insurers will not cover the purchase and maintenance of a Quell unit which is the most effective unit for certain individuals. If we want to get serious about reducing the usage of opioids among those experiencing chronic pain, we need to offer a viable option for treating said pain.

2) Require hospice and home care workers to drive unmarked vehicles. During my grandfather’s last days, we had a hospice nurse coming to the house on a daily basis. She expressed frustration with driving a vehicle with the clinic’s “hospice at home” logo on it. She explained that the logo serves as a big advertisement for drug addicts to come and burglarize the house they are at, and told us to be extra careful with keeping the house locked up and the medications secure.

3) Mind your meds needs to be more than a public service announcement. When someone is prescribed opioids, there should be an opioid educator/counselor that meets with the patient or calls the patient to make sure the individual has a plan of action for keeping their medication secure. The educator/counselor would also talk about side effects, potential interactions, and activities that need to be avoided while taking the medication. Currently, a person may see a sticker on the prescription bottle that reads, “May cause drowsiness,” and be told by their pharmacist, in passing, that they should avoid using heavy machinery while taking the medication. For many people, driving a car does not equate to using heavy machinery, even though it clearly is. Many people feel pressured to go to work while sick or in pain, and take these medications while using heavy machinery at work. The patient needs to fully understand the meaning and intentions behind these warnings, and an educator/counselor could help the person develop strategies for safe usage (eg. have a family member drive them to appointments, or have someone shop for them).

4) Workers need not to be penalized for taking sick leave. We need better protections for workers in this country, and that is going to require legislation. Labor unions have helped to advance safety in many workplaces, but there are fewer and fewer union jobs, and the labor unions have lost a lot of their bargaining power in much of the U.S.

I encourage others to add to this list and keep the conversation going.