Friday, March 23, 2018

Disability and the Opioid Crisis


By Amy Hasbrouck and Taylor Hyatt
Toujours Vivant - Not Dead Yet.

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This week, we’re talking about the “opioid crisis” and its impact on people with disabilities. For many people, the first picture that comes to mind when hearing the term “opioid crisis” is a person who, addicted to doctor-prescribed pain medication, dies of an overdose of that medication.

The current “opioid crisis” is just the latest go-round of the repeating cycle of anti-drug hysteria that has marked drug policy in North America for a century. Earlier cycles focused on alcohol, marijuana, cocaine, psychedelics, and, of course, opioids. Some features of the anti-drug hysteria cycle:

  • Exaggerating the numbers of addicts 
  • Prohibition measures are increased  
  • Drug prices rise and people commit crimes to get money to buy drugs.  
  • Drugs are mixed with other substances and new drugs are developed, resulting in more dangerous compounds and more deaths.  
  • Governments use high crime rates to justify increasing penalties for drug offenses and law enforcement budgets, instead of providing addiction treatment services. Poor people and people of colour bear the brunt of criminal penalties, social and economic hardship.  
  • Scare publicity (drug prevention slogans, urban legends and exaggerated claims of risk) draws attention to the targeted drug, rather than warning people away, thus making the drug more popular. 
  • Law enforcement and organized crime benefit from increased funding and higher profits.
  • Eventually someone figures out (or remembers) that these policies have never worked and cause more problems than they solve. The publicity is toned down, and the severe drug laws may or may not be repealed. 
A 2017 news release from US Senators John McCain and Kirsten Gillibrand claimed that addiction often begins with drugs given after “a broken bone or wisdom tooth extraction.” However, this exaggerated claim gets the most important facts wrong.

First, the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) said that only 22 percent of misused pain relievers were accessed through doctors in 2013 and 2014. About half were pills shared by friends or relatives, while the rest were stolen, purchased through a dealer, or obtained using multiple prescriptions. 


Second, the lethal substance is rarely the prescribed painkiller, like Vicodin (which contains hydrocodone) or Percocet (which contains oxycodone). It’s actually a deadly cocktail that combines strong medications (like fentanyl) used off prescription, with illegal drugs, (like heroin). This combination was found in two-thirds of opioid related deaths in 2016, according to the US Centers for Disease Control and Prevention. U.S. officials also believe that counterfeit, mislabeled and re-manufactured drugs containing fentanyl are being sold as mild pain relievers or anti-anxiety medications. 

Addiction rates are also much lower than sensationalized news reports would have us believe. A 2016 study conducted by SAMHSA found that, of the 87.1 million Americans who used prescribed opioids that year, only 1.6 million (or two percent) developed any kind of opioid-related disorder. A review of medical studies from the Cochrane Library database showed that “long-term, high-dose” opioid use to treat pain related to “neurological…musculoskeletal or inflammatory conditions” resulted in addiction rates of less than one percent. 

Fear of enabling addiction has led health professionals to implement a number of disturbing measures, that fall mostly on the shoulders of people with disabilities. Monitoring programs at the state level prevent prescriptions from being filled at multiple pharmacies. Staff at those pharmacies turn patients away and interrogate them about the purpose of the prescriptions. Doctors are afraid of being penalized for prescribing opioids beyond state guidelines, so they refuse to see people who need pain medication. These “dropped” patients are left to face abrupt opioid withdrawal along with their underlying pain. 

For people with disabilities or illness that include chronic pain, the use of opioids can increase independence and quality of life. Chronic pain affects every aspect of life, from mood (it has been linked to depression), to quality of sleep, to performance of everyday activities. Lack of pain relief can lead to suicidal feelings or behaviour. In 2015, the rate of suicide among people with chronic pain was 23/100,000, nearly twice the normal suicide rate. 

The many myths around chronic pain are born of ignorance and outdated moral ideas about the cause and effects of illness. These myths include:
  • Chronic pain isn’t that bad, you get used to it after a while; 
  • If you can do something one day, you should be able to do it the next day; 
  • If a person looks neat and well-groomed, they can’t be in much pain; 
  • Chronic pain is all in your head; 
  • If you are being treated with pain killers, you don’t feel any pain; 
  • If you take opiates for pain you must be an addict, or people who claim to be in pain are just addicts trying to get drugs. 
  • People who take prescription pain killers are weak or lazy; 
  • People with chronic pain are just complainers who want attention. 
Most of these myths are attempts to deny that chronic pain exists. What most people don’t understand, or don’t want to understand, is that having severe pain, every day, wears a person down. As well, dealing with a medical system that operates based on these myths makes getting pain relief even more difficult. Finally, addiction is seen as so terrible that society is willing to let people suffer rather than easing their pain.

Until about a century ago, many middle-class and professional people carried on ordinary lives while being dependent on opium, morphine or other opiate drug. While it was affordable and easy to obtain, opium did not pose any problem in society greater than did alcohol. “Death from heroin overdose” was unheard of, even though many people used large amounts on a daily basis. There was no black market, opium was taxed and regulated (producers of patent medicines had to clearly indicate the amount of opium on their products’ labels). The social problems that are now associated with drug abuse and addiction (poverty, crime, social breakdown) were caused not by the drug, but by making it illegal. The fear of addiction should not be used to deprive people of pain relief. 


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2 comments:

Pamela Parker said...

For people with disabilities or illness that include chronic pain, the use of opioids can increase independence and quality of life.
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Pamela Parker said...

Yeah the effect you're talking about is exactly the same as the one I've discussed in the article. Most of the research in the area is done with animals because it's the easiest way to control for all the variables, but there are human studies looking at the effect of environment and context on alcohol consumption.
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