I recently read a blog about opiate addiction. The author addresses what he terms addiction in both legal and illegal contexts and shares a personal story of a family member suffering from chronic pain labeling him an addict. He presents this story under the heading ‘Desensitization through the decades: tolerance built over time’ and uses it as his prime example of the legal context of opiate addiction. He is specifically referring to pain medications prescribed to patients in order for them to be able to function in the face of their daily, chronic, and debilitating pain. But this author doesn’t see prescription opiate use as a treatment, and I have an issue with that. Because I too am a chronic pain patient. And I am NOT an addict and deeply resent being classified that way.
First, let me explain the full concept of tolerance. It is the fact that the human body becomes used to having a medication on board in order to work. Almost all medications have the ability to build up some sort of tolerance factor with long term use. It is the reason doctors try to start any treatment at the lowest possible dosage or with the weakest medication available. This holds true for many chronic conditions as well as chronic pain. I was originally diagnosed with an autoimmune condition 20 years ago. At that time, it did not include much pain. Treatment was a single medication to control flare ups. But my body got used to the medication, then the new dosage, and then multiple combos. I am now on a cocktail of seven meds to keep my condition under control. Does my history of such tolerance make me an addict? Does the fact that my body will attack itself to death unless I take Plaquenil-the one med I have consistently been on for 20 years- make me addicted to that med? Think about it.
Which brings me to my second point: physical dependence vs addiction. While on the surface, they sound like exactly the same thing, in reality, the are very different. I touched on physical dependence above when I explained that my body simply will not work correctly without the medications I take. That is also true for the majority of pain patients as well. At this point in my disease process, my joints, lungs, and digestive system have all been severely compromised. The medications I have taken for the past 20 years have also weakened my spine causing two compression fractures in the past three years. I have also developed facial neuropathy and migraines. There is no cure for what I have. Only pills. Including opiates, usually hydrocodone. So I take it. And I can function when I do. I can be Mom. I can cook. I can clean. I can go to the movies with my family. Maybe even out with a friend. Without it, I spend my life in bed. My body now depends on this type of pain management to function.
But does that make me an addict? I ask because for those of us in such pain that the willingness to take an opiate simply to function need those of you labeling us to understand this issue. We do not take these medications just because. We take them to be normal. To hold down jobs and to hold together families. Compare that with the accepted construct of addiction where the addict takes the drug, prescription or not, only to feel good at the expense of all else. Family, friends, jobs… all rank far behind that drug. I would never assume to know the author’s family situation, but for me and the people I have met with chronic pain issues that are incurable, this simply isn’t the case. We just want to live and experience life as pain free as possible. And that makes all the difference between physical dependency and addiction. I’m the first to admit I need my opiates, but I sure as hell don’t want them.
And that is the heart of my last point. I don’t think addressing the heroin epidemic and chronic pain prescriptions in the same article is appropriate. Whatever the author’s personal feelings are about how doctors prescribe opiates, they are prescribed, quite thoughtfully actually. Other pain management methods usually have to be proven ineffective before opiates are relied upon as the sole pain management tool. Most pain clinics require drug testing before refilling prescriptions. We pee in cups more regularly than all the athletes in the nation. That is how well opiates for chronic pain are managed. But heroin is a street drug. It is not prescribed, it is unmanaged, and it must be actively sought after. And it is very illegal. While I concede there may be some crossover from people originally prescribed opiates for pain and do develop an addiction and move on to heroin, I believe the greater issue is the movement from one street drug to another.
So while addiction is indeed an issue of great concern in our nation and there has indeed been an increase in addiction statistics, the recent trend of pointing to opiate prescriptions and chronic pain patients as the problem is alarming and potentially life threatening. While there may be room for initial prescriptions of opiates to be better regulated or downsized, the idea that those of us who have been through decades of chronic and increasing pain can now be classified as addicts and put through some sort of rehabilitation is frightening. Giving us a label that you can “treat” will not make our pain go away, it will just make society feel better because you will be able to pat yourselves on the back and say you saved us all from ourselves and our “addictions”. However, more of us will likely commit suicide due to the unbearable levels of pain we are currently managing with our meds and being productive while at it. Addressing addiction needs to be done in a thoughtful and non-judgmental way. Please, I wouldn’t wish a day of my pain on any of you, but I also do not wish to go through it without my medication either.