Beyond Opioids (April 9, 2019)

As everyone out there must know by now, we have an opioid epidemic. And we know whose fault it is, too. Doctors spent the last twenty years handing out opioid prescriptions like candy at Halloween, and when you do that, this is what happens.

Thanks to this - er - unfortunate behavior, drug overdose deaths have increased in America from about 8,000 in 1999 to over 70,000 in 2017. But deaths are only a small part of it. It is estimated that over eleven million people are addicted to opioids and that it will cost the American economy $500 million over the next three years. The human and financial carnage is staggering.

Of course doctors have been severely disciplined for their little lapse in judgment. Some very harsh language has been used. Many doctors have suffered loss of income – some of them as much as the cost of a couple of days' vacation at a good ski resort. And probably one day, very soon, someone will say something to the pharmaceutical companies about it all. So you see, it’s all good.

How did this happen? Opioids have been understood to have tremendous potential addiction since forever, and they have been tightly controlled here for over a hundred  years. Why did doctors suddenly start dispensing them so casually? Apparently it's because pharmaceutical companies told them that it would be ok. So it's really not their fault at all. (I ran out of gas! I got a flat tire! I didn’t have change for cab fare! I lost my tux at the cleaners! I locked my keys in the car! An old friend came in from out of town! Someone stole my car! There was an earthquake! A terrible flood! Locusts! IT WASN’T MY FAULT, I SWEAR TO GOD!)

Still, even if we accept this irresponsible bit of finger-pointing, “greedy pharmaceutical companies” is not a complete answer to the “why did this happen” question. (Although it IS a great answer to a good many similar questions.) What’s still missing from the equation is the reason WHY, in spite of their extensive education and better judgment, doctors were so pitifully anxious to believe whatever drug companies told them. 

The reason is because they really have no other treatments for pain. That is one thing that 21st century medicine has in common with medicine in every other century since humans began keeping track of time. The only drugs that ease pain quickly and easily enough to satisfy most people are opioids.

Although they do not do a single other good thing for you, opioids DO do the job of killing pain quite nicely. And if you've ever had any real pain, you totally get that. So people are happy to take opioids, for the most part, although they’ll tell you otherwise. (People will also tell you that they’d keep working their crummy job even if they won the lottery. People are liars, and we lie to no one as much as we do to ourselves.)

If you have severe pain, and it's the rare person who never will, opioids will make you feel LOTS better. Doctors have few tools in their kit to treat pain. So the opioid epidemic needed only a few persuasive, unscrupulous businessmen promoting their nice new patented opioids to a profession desperate to hear their message in order to get started. And America seems to have a never-ending supply of persuasive, unscrupulous businessmen. It must be our national gift.

Opioids were always a Thing just waiting to happen. They never did anything other than kill pain. They don't heal anything. They don't fix anything. They don’t get rid of inflammation, or fever, or tissue damage. They don’t prevent diseases, or cure them. They don’t do anything but make you feel better – for a while – and then make it impossible for you to give them up. Sometimes you really need them, and when that happens, they can be a blessing. But overall, they suck.

So, then, what CAN you do for pain? There are a lot of things around that are actually more effective for treating painful conditions than opioids, that do things to fix the underlying conditions that opioids never did. Sadly, all of them take more time and effort and money to deliver than does an opioid prescription. Plus, even if you can squeeze payments for those modalities out of your insurance company (all of whom consider money spent on their policyholders as money wasted), you’re still in pain while you’re getting them. And it may take you a while to find a treatment, or a combination of treatments, that works well enough to give you adequate relief.

All of this, then, has led to a resurgence in the use of – you probably guessed it – OTC (over-the-counter) painkilling medications. In fact, doctors have actually started prescribing them! How the mighty have fallen.

You know what this means? That you can go to the drugstore and basically buy the same stuff that your doctor would prescribe you. So why not learn a little more about them? 

That will be my subject next time, since my rant took up more room than I thought it would. But for the moment, let's finish up with this.

OTC pain relievers work. They don't just relieve pain, and relieve it well. They can also treat conditions that opioids don’t work on, and do helpful things in the body that opioids don’t. Because you don't get stoned when you take them, they have been way underappreciated these last few decades. We are all fortunate that they are finally making a comeback. 

--dr. diane holmes
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