The “Opioid Crisis” and What it Means to Me
Most of you who read my blog know that I am a totally disabled veteran and that I live with chronic severe pain. Because of that, I have a very different take on the “Opioid Crisis” than most do, and I’d like to share that here.
There have been a recent spate of settlements in Federal and State lawsuits against pharmaceutical companies and large pharmacy chains for producing and dispensing opioids in various fashions.[i] Among these is the vilification of long acting opioids such as MS-Contin, OxyContin, Opana and Avinza.
Avinza was a 24-hour morphine capsule, but it is no longer available in the US.[ii] I can tell you, however, that Avinza enabled me to get my life back. Thus, I deeply resent the way the Government vilified this drug and others like it. Further, the long and delayed release drugs were formulated and constructed in such a way that it was very difficult to break them down to get the drugs out of them, so abusers really had a difficult time with them, contrary to what we may have seen on TV. It is much easier to abuse the immediate release pills, which haven’t been so much of an issue.
The push has been away from opiates to non-opiate therapy. In my case that has been an epic failure. I have tried every alternative therapy at least twice with no success. Due to my genetic makeup, I do not respond to the drugs used to treat neurological pain (off label usage of anti-seizure drugs). Worse yet, it was just revealed that these drugs are not really effective against neurological pain anyway![iii] And when people suggest I try alternative drugs, my response is that I’ve tried cannabis and psilocybin under doctor’s orders, and they didn’t work either. I will not buy street drugs for many reasons.
The biggest impact that the government actions have had is on those like me, who suffer chronic pain. When the government first acted, it was a “knee-jerk” reaction, and most of us were cut off, essentially cold turkey, from our pain medications. I went through three months of withdrawal, and I literally had several life-threatening reactions to drugs meant to counter the effects of the withdrawal symptoms.
When we are cut off from the narcotics, and after withdrawal is complete, we have three choices.
1 1) Attempt to just live with it, which is what I did for about
seven years, until things got so bad, and the pain got so unbearable, that I
had to return to a pain doctor and go back on opiates. Yet, despite updated
prescribing guidelines, he is still under-dosing me, so most of the time, I am
still living with out of control, unmanaged pain. There are, in fact many studies that show that chronic pain literally kills. So this is a horrible option!
2 2) Use alternative therapies – if one is fortunate enough to find an alternative therapy that is successful, that’s wonderful. As I stated above, none of them worked for me, but I’m sort of unique. Others are more fortunate.
3) Turn to street drugs. There is, in fact, unfortunately a drug newer than fentanyl on the streets as well. Isotonitazene is a drug reported to be several times stronger than fentanyl, and also imported from China.
Those who have turned to street drugs have brought about (not by their own fault, however) the TRUE Opiate crisis.
Like me, all chronic pain patients develop substantial tolerances to opiates (and in my case Ketamine as well). This means that we need progressively larger doses for effective pain management.
Standard heroin turned out to be largely ineffective for many pain patients. So, the drug cartels contacted the Chinese producers, who mailed them Fentanyl, the extremely powerful synthetic opiate. The cartel then started cutting heroin (and everything else as it turned out) with Fentanyl. For some users, Fentanyl wasn’t even strong enough, so they accessed CarFentanyl (designed for elephants and rhinoceri).
The issue is that these drugs are so powerful that if non-users such as first responders or others who try to render aid, inhale or touch the drugs, they can instantly go into respiratory arrest. Most do not know the protocols for treating overdoses in this case, and there is usually not enough Narcan (Nalaxone) available on scene to treat a heavy Fentanyl overdose anyway.
The government CAUSED this crisis by ill informed decisions and ignorance. And they refuse to walk it back because of egos. Further the damage has been done with the Fentanyl on the streets. It’s just too lucrative, so I do not see the cartels willingly making a change, unless they are hugely incentivized by the DEA to do so (and I really do not see that happening either).
But as with all things, change can only come about by an overwhelming push from the electorate, so PLEASE contact your senators, congresspeople, governors, etc., and get the laws changed. Change the course of this opiate crisis so we stop killing people.
And stop prosecuting and persecuting those who provide opiates. The result is that providers close and patients lose ability to get treatment. There is never a positive outcome from these actions.
I am quite certain that, like many things I say, people will disagree and argue with me vehemently, and that’s fine. But I’m living with this issue. Unless you are living with it yourself, or have CONSTRUCTIVE ways of addressing the issue, please keep your comments to yourself or post them elsewhere. If you would like me to directly reply to a concern of yours about this, please use my contact form at http://www.rabbahrona.us/p/contact-me_27.html.
Thank you, Rona
[i] See for instance: https://www.fiercehealthcare.com/finance/federal-jury-holds-cvs-walgreens-and-walmart-responsible-for-role-opioid-crisis, https://www.reuters.com/business/healthcare-pharmaceuticals/cvs-walmart-walgreens-reach-tentative-12-bln-opioid-pact-bloomberg-news-2022-11-02/, https://www.nytimes.com/2022/11/15/health/walmart-opioids-settlement.html. This is just a very small snapshot.