If you've been paying attention to almost any form of media the last 7 – 10 years you will often find that you are being led to believe that Central Florida is home-base to the worldwide Opioid Epidemic. A scourge that's sweeping the nation like one of those college dance shows from the 1950’s. But what law enforcement doesn’t seem to address is specifically what kind of opioid addiction issues they are seeing. Rarely do I hear about a police shootout with a dealer when all that he’s carrying is opiates. They are always equipped with an entire pharmacy of items, none of which were properly prescribed by a physician. These dealers are using stolen drugs to sell to unsuspecting people, who consume too much at one time, and their body stops functioning.
While this kind of death from opioids is growing in scale I don’t believe that this makes up the majority of opiate deaths in the US. According to NIDA* this is a number that has gone from 50k in 2019 to 82k in 2022, that looks like a pretty hefty increase. According to the same study those deaths were not ‘accidental’ the way this one seems, this covers anything opiate related, classified as an “overdose.” I think there are some levels of distinction that need to be worked out, for example if you take a very commonly prescribed anxiety drug, this is given to school teachers and Sr. Citizens alike, and you forget to tell the ER Dr. about it, you only take it occasionally when you're stressed, so he prescribes you some Tylenol III. Guess what, that combination can stop your breathing while you're asleep, and you will go to sleep under this combo.
Then there are the plain old people who just don’t feel there's any use in sticking around, so they grab moms prescription from her Wisdom teeth extraction, or dads old bottle from when he had surgery, and drink them down with a Monster energy drink. Deadly? Absolutely, but does this need to be in the same classification as leading to an epidemic? I've been involved in working with at risk teenagers most of my adult life, one thing I am certain of is if a child wants to delete themselves, they will, your old prescriptions are just the easiest way they can think of at the moment. The other thing about teens in crisis is 99% of the time they will exhibit signs of seeking help, we just have to be paying attention, and respond appropriately. Often times these folks will ‘sneak’ pills a little but at a time over a course of weeks or months, because the high that they get allows them to forget, whatever is making them miserable.
The reason I’m trying to give some clarity to these numbers is because it hurts US, patients who, through no fault of their own, have reached a point in life where they have so traumatized their physical body that they need some help with pain control. My dad once said “You have certainly done more damage to your body than I ever did to mine.” now if that was meant to make me feel better it may have worked, until I experienced how much pain he was in, when he passed. My dad couldn’t take opiates, his Dr’s told him he was allergic, he hallucinated his mind out, my older brother had the same situation. I thank the lord I didn’t get that particular gene.
Something that I have learned over the years is that there are actually two different kinds of ‘addiction’ that medicine recognizes when dealing with pain medicine like opiates. There is Physical Addiction and General Addiction. Two vastly different forms of the disease, that can end up hurting all of us.
With General Addiction which may or may not have a component of Physical Addiction, your mind has equated the “high” feeling, or buzz, with being pain free. If you're not feeling the buzz, than obviously the medicine isn't working. So everything you feel or don’t feel is all reduced to an equation of ‘are you feeling high’ If you are, than great, your thinking is impaired and you “feel” pain free. Unfortunately pain is entirely subjective and there is no way to measure or detect whether the things that you are experiencing are real or are being imposed upon you by your drug reduced brain.
Then there is Physical Addiction, and this is what happens to actual patients. After consuming the medicine there is a natural “desire” in your body for the chemicals that are being sent to your brain to stop your pain. Unfortunately if this is artificially stimulated long enough, your body stops producing these chemicals naturally, and waits for the medicine to kick in, then all is right with the world. This is not changed at all by feeling high, and in fact, most folks who have this type of addiction gain it because they do not like, or ‘don’t give in to’ that buzz or brain fog or high feeling caused by high doses of the chemicals. This form is the hardest because when it occurs the patient rarely ever knows they are addicted. They typically only take the amount of medicine recommended by their Physician, and when they feel that's not sufficient to do their job, they describe it in a way that the Doctor can recognize it as a genuine experience.
Because of the subjective nature of pain Physicians are under a huge amount of pressure to determine if the patient is actually feeling what they describe, or they’re just looking for a way to get more medicine. There are certain tests that Physicians and Insurance companies have agreed wil help identify which type of pain and how they are feeling it, can be identified. These are visual tests, unknowingly performed by the patient, while the doctor observes, allowing him to make a judgment call on the patients pain.
If, however I still insist that I don’t “feel” that its working, he may refer me to a different kind of specialist to either address a different problem or address a different type of pain. I was introduced to a concept a few years back called Neuropathic Pain, wow THAT was a game changer. The medicine has nothing to do with opiates, cant and shouldn’t be treated by opiates, but can be relieved in different ways. I believe that folks suffering with Fibromyalgia experience this type of pain.
Many Doctors hesitate to talk with their patients about pain relief for a variety of reasons, here in Florida I can tell you that a great deal of the reasons have nothing to do with what they describe to you, and have everything to do with the law. If I die from an overdose, for example, they will always go straight to the prescribing Doctor and look for validation of why I was taking X,Y or Z. Additionally the record keeping required by the state is very strict and voluminous, and brings along with it, increased testing, more one on one face time with the Doctor (not his nurse), and insurance issues. All of this adds up to increased costs to the patient. For example, if you are a self pay patient and you have a pain relief Dr. who prescribes 2 different medicines and the required follow up here is what your world looks like. Doctors Visit about $250/mo Testing once every six months $35, blood testing annually, $300. Then the medicine, Bottle 1 = $1600/mo Bottle 2 = $625/mo.
If his patient is a 26yo college student without insurance the Dr. wont even want to start the patient down that path, knowing that its expensive and without insurance they may not be able to afford it. This then leads to a sudden stoppage of the medicine, which is always a bad idea, and the resulting complications, which of course all point back to the doctor. SO when you say, “Doc isn't there anything, I can take”, he will tell you about the OTC medicines that you've already taken and then say, “Of course there is a course of opiate based medicine that is only prescribed by specialty clinics and those are very expensive, and if you've seen methadone clinics on the news, you know those are not a place a young girl, or man, like you, wants to be.” Lets stop right there, While I was between Pain Doctors I actually toured 3 methadone clinics in my area. One of them came straight out of an afterschool special, it was small, cramped, dirty and had people sleeping on the sidewalk on the way into the clinic. The other two looked like any other Doctors office, albeit with more foot traffic that a podiatrist.
I trust my physicians, they know that and they know that I am not the type of person, that goes on a drug seeking binge. One of them actually had me work with a Psychiatrist to determine this on paper. There are other ways that they learn that as we go, but the fact is that today, on my current regimen, I carry more pain with me than I ever have, yet I still find ways to get through my 40+ hour work week. All of my Doctors agree that this is not something that we will cure, I will experience pain all my life. There are things I can do to lessen it, these also increase the effectiveness of the medicine.
Things like losing weight. Last year I was 235lbs, not horrible, but I’m not 24, I’m not 5-8 anymore and I don’t lift weights and practice Martial Arts 5 days a week, finally I wasn't really watching what I ate. Today I weighed in at 192lbs, I’m about 5’-6 and I am definitely watching what and when I eat. For many years my physicians have told me about the horrors of processed food, but they never gave me any idea of what they meant. Then one day my Primary explained that certain types of artificial sweeteners, a derivative of corn oil for example, triggers the production of cortisol in your blood. This is the “aggravation chemical” related to your fight or flight response. When you get too much of this your blood pressure goes up, these spike in your BP over time wear out the walls of your vessels and arteries and cause things like, death.
Additionally these same chemicals also cause ‘inflammation’ in areas that don’t need it. When I was little and I would fall on my knee, it would swell up, and cause stiffness and pain. I would complain to my dad, who hated to see his kids hurt. Therefore he explained that an injury swells because there is an injury and the 2 things your body needs most at the injury site is oxygen, carried by the blood, and new blood, to carry away the trash from the injury. It didn’t make the swelling go down, but now I had a reason for it. Imagine eating something, and then your knees start to swell, you didn’t twist it you didn’t fall on it, you may not have even been out of your chair all day. But get that one potty break and you feel it bad!
That's what I believe the core of the “opioid” addiction issue rolls down hill to, and I know some folks are not going to appreciate this. In my opinion we have a control issue in this country. We are massively (Americans not OI patients) overweight, we eat poorly and we don’t exercise.
Now lets bring this home to OI patients. In many cases, exercise, as traditionally seen is not open to may of us, but there are GREAT physical coaches (Hey 
Tony Jacobsen!) out there who can help us find ways that we can exercise, we just need to be consistent about it. I lift weights because in my mind you're accomplishing something, but I just read the Biography of a Navy Seal who only ran and did calisthenics. According to his photos and referrals the dude is built like a Greek god. All by watching what and when he eats as well as exercising everyday.
Lets talk about eating, there are things that your Doctor can recommend that you change in your diet that can really help. In America, the 2 most common reasons people give for not eating healthy is it doesn’t taste good and its too expensive. I can agree with both of those. However it does seem when you're not paying so much for Bp medicine or pain medicine, and you're not buying all the junk and snacks that you normally do, its not really that expensive. As for taste, your cooking it wrong. I do all the cooking in my house so if someone doesn’t like the taste of something they can come to me and Ill do my best to make it more palatable. But to my 18yo, there is NOTHING I can do to change the taste of green beans, sit down and eat them! Sheesh when I was living at home at least I complained about the really bad stuff. Ever had canned spinach or very limp Brussel Sprouts? I recall one Christmas, being at the table until 8pm because I wouldn't eat the sprouts. My brother and sister were so mad at me they each ate 1 and gave the dog the 3rd, I only had to whole swallow, one. Still took a while.
Bottom line, control what you do and do not do with your body and what you put into it and two things will happen. 1 – You will feel better, be healthier and avoid certain types of addictions that can be life altering. 2 – If you do find yourself taking medicine to help with the pain, don’t wait until its excruciating, take it ONLY as directed, and if you find yourself unable to think clearly, decrease the amount with your Doctors help. If you wait too long and the pain builds up too much there is little modern science can do that still allows you to be a functioning member of society. However there are far more invasive options available, but in my family we have enough planned visits with surgeons, so we don’t accept the term “Elective Surgery” as a valid part of the english language.
Please remember, your mind can do things with, about and to your body that your reasoning self, can not begin to grasp. As a matter of fact I have a book that has a process included that would allow me to remain pain free without ANY medicine. Unfortunately in my case (I’m sure I’m doing something wrong) it needs 3 hours of my attention when I first awake, and 3 hours of attention just before I go to sleep. Oh and a drastically scaled back scope of ideas and goals for my life, and trust me I am just getting STARTED, I cant afford to slow down. I am however always open to ideas.
It is also critically important that you set and discuss, with your care givers, physicians and loved ones, what realistic goals are for this section of your life, and how you can best meet them. No you may never feel completely pain free another day in your life, but if carrying a little more pain in my daily routines will allow me to think better, remember more and be more creative, I am all about int. I have too much love and passion for myself, my life, the people around me and the God that created me to do any less. You should to.
This has been an opinion piece submitted for your review by, TheOIGuy,
*https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates
