At http://www.psychcentral.com/blog, I read a column that I had to comment about, and include it here although it was printed as well there.
First the link:
and the comment:
There are multiple factors that play roles to this “Opioid Crisis”, a label I find a bit disingenuous when opiate addiction has been prevalent across this country for several decades, just more pronounced in the past 10 or so years because of the prescription element to it now. One of those factors I find concerning that I feel you illustrate, a bit mind you, is when you write about how getting your prescription is like your “Precious” analogy. I respect it, again a bit mind you, per the need for pain relief, but, one needs to be very careful when dependency is rigidly rationalized as I read it at your column here.
I firmly believe that opiates were never intended to be used indefinitely as a prescription intervention. That said, the time line to limited use is individual specific, but, there needs to be a conversation between doctor and patient when the time line seems to be reaching a conclusion, or a referral to another colleague who is willing to extend that time line per an expertise to look at implementing alternative interventions to respect the extension. Extend it but with intent to an eventual later but eventual termination of said medication use.
The problem going on too often is unfortunately somewhat simple to me: even people who do not abuse or frankly take opiates for an addiction agenda do in fact develop qualities of a darker form of dependency per the way patients challenge providers to continue the prescriptions. Drugs of physical dependency do run the risk of altering personality, and not in a positive way most often.
And that is what concerns me, that I have colleagues who feel intimidated, coerced, if not downright threatened to have to continue these medications beyond a reasonable endpoint. I don’t have a problem with this presentation in my office for two reasons, one that I do not write for opiates as I have no expertise nor clinical role in pain management as a psychiatrist, and two, people who try to intimidate, coerce, or threaten me are shown to the door and told to find another provider. When the patient-physician alliance is lost, so are future appointments.
Sorry to write, but opiates do alter frustration tolerance and quick fix expectation to potential immature and pathological levels, not saying that to you here.
The one problem I see with your explanation in your column is that you seem to be advocating for premature disability determination because people are allegedly forced into return to employment too quickly and then fail. That has validation at times, but, part of pain reduction is also healthy distraction and opportunity for productivity, which a job can offer depending on the job responsibilities and physical demands.
Sorry, but more often than not, people on opiates, especially higher daily dosages, are not easily distracted nor able to appreciate efforts to be productive. Opiates dull those appreciations. Hence why people need to lower opiate dosages to attempt to feel again.
Just my opinion, one of over 20 years working with people who have chronic pain and resulting psychological distress and dysfunction from it.”
Share it here because, well, frankly I find it a bit disingenuous that America is now in the midst of an “Opioid Crisis” when we have been dealing with opiate abuse for decades, but, when heroin abuse as the primary form of opiate abuse was a back alley issue in big cities up to the 1990s, well, not a crisis for America, eh?
Only when middle class teenagers and middle aged women started dying more frequently, and it involved prescription drugs written by allegedly respectful doctors in the community, then it became a crisis? Perhaps readers can comment where I am wrong, but, until then, I think this is the “Opioid Convenience”.
Not that this matter should not be addressed with urgency, but, why the hell did it take over 20 years to publicly admit too many people take opiates recklessly, irresponsibly, or just plain addictively? Maybe because it is easier to blame doctors in offices than hunt down dealers on the streets??
Think about it…
Yep, this is the image to capture the opioid crisis for America, you remember the couple found by Ohio police with the kids in the back seat?…