Thursday, February 14, 2013
Walk a mile in my shoes: : The FDA and opioid labeling and restrictions, where does the problem really reside?
It is important to set atop the sky scraper, looking down on both sides of the building, weighing concerns in either direction, with the wind or against it. I have deliberated over the power of addiction from any source, whether it be food, drugs, gambling, smoking, video games, shopping, sex, alcohol. As I look into the wind and away from it, I question, “Is addiction a behavioral choice or an illness?” “Does restricting opioid medication from chronic pain patients reduce risk or increase it?”
Addiction is the illness not the substance or behavior that feeds it. Have we stopped selling alcohol even though we know it has the potential for abuse and can kill instantly or slowly over a period of time? Aren't programs like Alcoholic Anonymous a better answer? Is banning certain foods going to stop the obesity epidemic? Do we treat addictions to gambling, smoking, video games, shopping, or sex by making it illegal to participate in any of these activities? As I sit on this grandiose pentacle, I realize to restrict the use of opioids as a choice in management of chronic pain is not the answer. Relieving pain is necessary; the use of alcohol, playing video games, etc is not. That does not mean I am in favor of government regulation, it means I am in favor of protecting our freedoms to choose how to relieve our pain.
Gaining favor as an alternative to opioids is antidepressants or anti-convulsants which we know create suicidal ideation in some patients, and can cause diabetes and a host of other serious medical problems. These medications, in the medicine cabinet of a great many homes across America, have the potential for abuse. But why would we deprive patients who need them to function on a daily basis or prevent a very serious seizure disorder? Then I question, why these would be prescribed for pain when many patients report they are only minimally helpful, if at all, or that they come with a laundry list of interactions and side effects, when we already have effective pain medication? Here we are atop the skyscraper once again.
I ask each person to relive their experience with pain and imagine it on a continual basis with no interventions possible. Then I ask, “How long could you endure this pain before wanting to end it all?” Is there any doubt you would be emotionally distraught? Many pain patients feel alone and abandoned, because they are. Should we not address the emotional, mental, and spiritual affects of chronic pain, and provide education on how to use opioid medications safely and effectively?
We are missing the core problem of any addiction, poor access to mental health programs, lack of funding, and cultural attitudes. I would argue that the epidemic is not the use of opioids to treat chronic pain; the problem resides in our perception. The days of using words like crazy or addict in a demeaning way should be long gone. The social injustice of ignoring those in need of professional council is the real epidemic.
Those who take opioid pain medication to improve their activities of daily life and use them responsibly should not be vilified, and neither should those fewer people with a genetic tendency toward addiction. We must ask, before we make the decision to stand into the wind or away from it, choose one side of the building or the other, “Is it fair to deny a basic human right to have our pain treated by restricting access to medications that will help?” Addiction is not a moral collapse, it is a disease, and isn't addiction best treated by professionals rather than withholding the tool of addiction? Can we withhold food, sex, video games, alcohol, tobacco, gambling from everyone, and will that really solve the problem? History tells us from our experience with prohibition, that it will not.
Have we turned into machines worried about numbers rather than human beings? I hope not.