Dear Reader:
This article regisnated with me because I'm semi in the same boat.
All the diagnosis I've been sharing with you are all the things I've been diagnosed with. Almost all say “causing debilitating pain” yeah, I know! I get Tramadol 50mg which barley works and feel insulted when someone tells me to take tynelol. Do they not think I've tried that?! It's so frustrating.
I ask every doctor I see how I can fix this so I don't need these medications, they tell me I can't. I've had so many injections, physical therapy and alternative treatments that I'm done. I've resolved myself that some days I can walk and other days I can't. It's a terrible place to be in.
You're in Pain and Your Doctors Won't Help? Blame the Opioid Backlash (newsweek.com)
Danny Barcelona lives in constant fear that doctors will stop the medications he considers lifesaving. The 66-year-old has suffered for more than two decades with a debilitating nervous-system disorder and severe back and shoulder pain, forcing him to close his once-thriving dental-lab business in Asheville, North Carolina, and sometimes leaving him bedridden for 18 hours a day. That he can function at all, he says, is due to his ongoing prescription for oxycodone, an opioid.
In the middle of an epidemic of opioid overdoses, doctors, hospitals and pharmacies across America are facing intense pressure to sharply cut back on prescribing and dispensing the drugs. About 8 million patients in the U.S. who depend on opioids to face constant, intense pain are at risk of losing access to the one treatment that seems to make the pain bearable. That includes Barcelona. "I don't think I could have lived without the drugs I've been taking," he says.
The number of opioid prescriptions has plummeted from a high of 251 million in 2010 to well under half that number in 2020—the last year for which figures are available from the U.S. Centers for Disease Control and Prevention (CDC). Yet the number of opioid overdoses has only continued to climb, even as drugs such as buprenorphine that can help overcome addiction and slash the risk of overdose are becoming harder to access than opioids themselves
The twin problems of patients with a legitimate medical need losing access to opioids, while the addiction and overdose rates swell, add up to a new opioid crisis that may be worse than the original one that emerged at the turn of millennium. Federal and state governments, along with health care, bungled the response to that original crisis, say a range of experts.
As a result, patients and the addicted are caught between the pincers of prescription cutbacks and increasingly difficult-to-access options for dealing with addiction. "Pain was poorly treated in America up through the 1980s before we started paying attention to it," says Keith Humphreys, a psychiatry professor at Stanford University and a drug policy adviser in the Bush and Obama White Houses. "Today we're still failing."
The National Institutes of Health reckons that more than 80,000 people died in America from opioid overdoses in 2021, the most recent year for which figures are available. That's roughly double the number in 2015, when synthetic opioids started to take off. Nearly a million people have died from opioid overdoses since 2000. Public health experts forecast another half-million deaths in the next 10 years.
The criminal prosecution of Purdue Pharma, owned by the Sackler family, over its zealous promotion of opioid products did much to bring the crisis to the public's attention. In 2007, three Purdue executives pled guilty to criminal misdemeanors and the company itself was prosecuted in 2020. The episode also left many people with the impression that the crisis was entirely the fault of Purdue and other pharmaceutical companies, who downplayed the addictiveness of opioids. But that claim is misleading.
Although pharma's aggressive, deceptive tactics were a big factor in the rise in addiction, the idea that opioid addictiveness was largely a myth, and the resulting drive to prescribe them more aggressively, originated within medicine itself. In 1980, findings published in the New England Journal of Medicine concluded that "addiction is rare in medical patients with no history of addiction." As a result of this and other research, doctors shifted their focus in the 1990s toward doing more to treat pain.
Those findings were badly flawed and now largely discredited, but not until opioids had been trumpeted prominently as nonaddictive wonder drugs in feature articles in Scientific American and Time magazine, and much of the media had followed suit. Doctors and hospitals readily embraced a new means for leaving pain-ridden patients feeling better treated.
"The Sacklers and Purdue have stolen the spotlight in the opioid problem, but there's plenty of blame to go around," says Andrew Kolodny, a physician and medical director of the Opioid Policy Research Collaborative at Brandeis University's Heller School for Social Policy and Management. "Researchers were downplaying risk and promoting aggressive prescribing. And we have a health care delivery system in which patients are customers, and that favors a quick fix like a prescription," he says.
Opioid makers and distributors have since faced a reckoning in the courts, leading to combined settlements of about $50 billion in the past two years—money earmarked for states to fund addiction prevention and treatment efforts. In 2016, the CDC moved to address the medical side of the problem. It issued new prescribing guidelines that called for making opioids a relatively rare last resort and for getting most patients who were on opioids off of the drugs. "The whole culture of prescribing opioids has radically shifted toward a crackdown on prescribing," says John Kelly, a professor of addiction medicine at Harvard Medical School.
Legitimate patients can’t get the opioids they need, says John Kelly.COURTESY OF JOHN KELLY
Since the prescription cutbacks took hold, the number of opioid overdoses—the best and starkest measure of the damage done by opioid abuse—has skyrocketed in the U.S. The simple reason: street drugs.
Prescription opioids may have helped trigger the opioid crisis, but the ready availability of illegal fentanyl has sustained it. Fentanyl, the most powerful of opioids and the most profitable to smuggle and illegally sell because a small pill packs such a potent, if potentially deadly, punch, is mostly manufactured in China and smuggled into the U.S. through Mexico or South America.The big problem, as it turns out, was never really with patients who were legitimately prescribed opioids. Initially, in the early aughts, doctors were giving out prescriptions to too many patients, and prescribing each of them too many pills on average. But the dangerous fallout from that overprescribing wasn't that too many patients were becoming hooked and overdosing; it was that hundreds of millions of excess prescription pills were finding their ways to people who weren't prescription holders.
In 2016 the deputy director of the federal National Institute on Drug Abuse (NIDA) estimated that the pills of one in five patients prescribed opioids were getting into the hands of other people. More than 70 percent of prescription opioids that are abused were prescribed to someone else, according to a 2019 study of opioid use in Colorado. When the U.S. Drug Enforcement Agency began a campaign to recover unused prescription opioids in 2010, it gathered up more than 2,400 tons of pills over four years.
"It was 'the medicine cabinet problem,'" says Amy Bohnert, an epidemiology professor at the University of Michigan. "When there are that many pills being prescribed, some of them get diverted to curious teenagers and others, and some of those people will get addicted."
This misuse of prescription pills essentially introduced opioids to a huge population of people who were then using and abusing the drug outside of a doctor's oversight. Addiction and overdoses followed, but the misuse—and the problems associated with it—quickly shifted from prescription to illicit opioids.
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