There is an opioid epidemic in the United States, with a death toll comparable to 9/11 every three weeks.
The president recently said he would declare it a national emergency and, last month, his specially appointed opioid commission released recommendations to address it. The focus of both was triage, which makes sense. When your house is on fire, your first step should be to run outside and find a bucket of water.
However, then what?
America’s “house fire” didn’t accidentally start on its own. There was a spark at its center. Unless we talk about that spark, too, new fires are going to erupt.
The pharmaceutical industry and health care professionals didn’t create the opioid epidemic by producing and prescribing medications for allergies or heartburn. They created it by producing and prescribing medications for pain.
Those medications weren’t given to a few thousand people, but to hundreds of thousands who were (and still are) showing up in doctor’s offices in so much pain they’re unable to live their lives.
One of the reasons why we have an opioid epidemic is because we have a pain epidemic — and no one wants to talk about it.
We can’t just take away opioids with the assumption that people in pain will just use “other stuff” to get better. The “other stuff” doesn’t really exist.
We used to have more clinics that took a multidisciplinary approach to pain management, but we closed many of them after opioids hit the market.
We also stopped educating doctors on how to treat pain without the use of these drugs.
Basically, over the past few decades, we dismantled much of our infrastructure for treating pain, thereby creating a system in which opioids were people’s only safety net.
If we take that safety net away, we need to be clear that there is currently nothing with which to replace it:
• Medical marijuana remains illegal or ridiculously hard to obtain in most states.
• Insurance often does not cover nondrug therapies such as acupuncture, chiropractic or massage.
• Doctors often lack the training and expertise to give advice on nontraditional treatment options such as hypnosis, biofeedback, EMDR (eye movement desensitization and reprocessing) or meditation. When they do, there’s usually no guidance on how, when, where, how much or how often to do these things.
• People with chronic pain, injuries and/or conditions often require special attention or accommodations for pain-relieving exercise programs like yoga, Pilates, water therapy or strength training. As a result, the classes they attend are often harder to find and/or afford.
Replacing the pain safety net won’t require us to fix one of these options but all of them. Because alone, none of these options is as powerful as opioids, but combined (and also incorporating mental health care and support), they are even more effective in recovering from chronic pain than opioids alone.
The problem is, that kind of multidisciplinary approach to pain management takes a ton of resilience and resources, both of which people in pain have in short supply. They’ll need help to pull it off.
Thankfully, help is out there. In 2010, the National Institutes of Health contracted with the Institute of Medicine to study pain and come up with ideas to help people recover from it. The result was the creation of a national pain strategy.
The strategy was a good first step. However, it’s one we haven’t finished taking.
The strategy is going to take time to implement, and some of its recommendations are getting more attention than others. (Why address complex, long-term changes to our health care system when you can just declare war on opioids and win votes and headlines instead?)
Whether we are able to follow through on all of the strategy’s recommendations or not, at the very least we must start talking more about the needs of people with pain. Because just focusing on stopping the flow of drugs without addressing why people needed those drugs in the first place is punishing people in pain.
Eliminating opioids may help us put out a fire, but it’s also going to leave hundreds of thousands of people burned.
Jennifer Kane, of Minneapolis, is an author and advocate for people with chronic pain.