Substance abuse treatment is vital for anyone suffering from substance use disorder. A common occurrence during the last 20 years of the opioid crisis has been patients with real underlying pain issues falling victim to substance use disorder because of reliance on opioids to manage chronic pain. In the intervening years we have seen many great doctors try to find non-opioid treatment regimens to help with chronic pain, thus leaving opioids for those with acute pain. This is because those with chronic pain may rely on a specific treatment approach for long periods of time and using opioids in these cases can make it difficult for many people to avoid negative side effects associated with prolonged opioid use. Over the last 10 years, more evidence has surfaced which leads experts to believe that long term opioid use can cause increased opioid tolerance and increased sensitivity to pain. I would point to a specific study that suggests tolerance and increased pain sensitivity can happen within 1 month of prescription opioid use as directed by a physician. This makes past protocols around drugs like Oxycontin look particularly harmful, as people who were given Oxycontin or other opioids by a doctor for chronic pain could soon after begin experiencing worse pain than they started with. As ailments that include pain increase with age, we have begun to see older Americans seeking substance abuse treatment as a result of being prescribed opioids for pain by a doctor. The substance abuse treatment facility associated with this blog is Florida Springs Wellness and Recovery Center in Panama City, and it stands to reason that in a state with an older population such as Florida, we would see this pattern play out even more often.
The Oxycontin Lie
When we look at the opioid epidemic in its proper context, it becomes even more sad that we deal with so much stigmatization of substance use disorder and substance abuse treatment. The only people who “asked for this” were companies like Purdue Pharma, the makers of Oxycontin. We now know that they intended to lie to doctors and the public about the addictive nature of Oxycontin in order to enrich themselves. The baby boomer generation, many of whom were the first victims of the Purdue Pharma formula, did not ask to become victims or drug addicts. They sought the consultation of a doctor, and they were given powerful and addictive opioids for chronic pain by doctors who should have known better. As a non-doctor, it is sickening for me to go back and look at the lies that drug makers were telling, and to then see that many doctors went along with those lies. It should have been incredibly difficult to believe that a drug so similar chemically to other opioid pain medications would be “non-addictive” and it is impossible for me to imagine a credible physician believing that, but that is the history of Oxycontin and that is what Purdue Pharma was able to get many doctors to tell their patients.
The Way Forward
Now that Purdue Pharma has been outed as a criminal enterprise, and doctors have gone to jail for criminal prescribing practices, we are left with multiple generations of people who need substance abuse treatment. We have curbed the prescription opioid pipelines, but now we deal with cheap and powerful opioids like fentanyl that are flooding our streets. Older Americans with pain problems that never dreamed they would turn to street drugs have gotten hooked on heroin or fentanyl, because doctors were told to stop prescribing opioids and we did not have the capacity or resources for all the opioid use disorder treatment that has now become necessary. Older Americans with substance use disorder must now strive towards recovery, while also working with good doctors and therapists to alleviate chronic pain problems. For me, every substance abuse treatment patient is in the same boat. People with substance use disorder have a disease, a deadly disease, and medical treatment of that disease should be no more stigmatized than the treatment of any other ailment, regardless of the age of the patient.
By T.A. Cannon (Contact me at TACannonWriting@gmail.com)
Chu LF, Clark DJ, Angst MS. Opioid tolerance and hyperalgesia in chronic pain patients after one month of oral morphine therapy: a preliminary prospective study. J Pain. 2006 Jan;7(1):43-8. doi: 10.1016/j.jpain.2005.08.001. PMID: 16414554.