Opioids and pain: the cure and the cause

How opioid pain killers have caused an epidemic of drug abuse and what’s being done to address it

By Moira Blazi
When most people think of a drug addict, they imag-ine a dirty, disheveled, rail thin, glassy eyed junkie who is shooting up heroin in an abandoned building or smok-ing crack in an alley. We have all seen these characters in countless movies and TV shows. They are always peo-ple we don’t know personal-ly.
Sure, these unfortunates do exist, but today more than ever, in the real world, drug addicts are people you prob-ably do know. They could even be your family and friends. They might live next door, sleep in your home, or sit next to you while you are waiting in the doctor’s office.
According to the website drugabuse.gov, in the late 1990’s, big pharmaceutical corporations began to flood the prescription drug market with amazing pain relieving medications that were thought to be totally safe.

In many ways, these medications did work mira-cles. Many people with seri-ous injuries and illnesses who had previously suffered severe uncontrolled pain, even with aspirin, ibuprofen and acetaminophen, were now able to live pain free.
These new drugs with names like Vicodin, Percocet, and OxyContin literally worked miracles for patient’s pain management. Doctors were inundated with free samples, gifts, perks, and even free vacations from pharmaceutical companies endorsing their products.
It was good for manufac-turers, doctors and patients. So what happened?
Some patients got well and stopped taking the pain pills, but some did not stop taking them.

These “miracle” drugs work by fooling the brain. If the brain doesn’t sense pain, then no pain is experienced. The source of pain is not treated with these medica-tions, but taking them al-lowed patients to live their lives as if nothing was wrong as long as the prescriptions were filled.
Eventually though, the human body and brain can become tolerant to and de-pendent on these medica-tions requiring more and more of them to produce the same effect. Stopping them can then cause serious with-drawal symptoms.

In addition, what wasn’t necessarily clear to patients or prescribers in the 1990s was that these drugs, chemi-cally speaking, are similar to heroin. They are opioids that suppress pain and can also produce feelings of euphoria which increases their poten-tial for addiction and abuse.
Over subsequent years of use, the problems with ad-diction and abuse grew.

According to the U.S. Dept. of Health and Human Services (HHS), in 2016, 116 people died every day from opioid-related drug overdos-es and 11.5 million people misused prescription opi-oids.
Center for Disease Con-trol (CDC) data paints a simi-lar picture of the significance of the problem. From 1999 to 2010, the sale of prescription pain medications increased by 400% in the U.S.. During roughly the same period, 1999 to 2008, the overdose death rate from these drugs rose by about 400%, and from 1999 to 2009 drug re-lated in-patient admissions increased by approximately 600%.

Drug overdose has now become the leading cause of accidental death in the U.S. according to the American Society of Addiction Medi-cine.
Many treatment centers and clinics have been created to help deal with this crisis. The majority of treatment centers follow the tried and true Alcoholics Anonymous, 12 step model of treatment. This treatment model, used by millions, regards sub-stance abuse as a choice and focuses on abstinence. It is believed that with powerful, loving support from others an addict can break free of their addiction. Millions of people say they owe their lives to 12 step programs, yet studies have shown that a high percentage of those seeking recovery through abstinence alone fail.
Another treatment model called medication-assisted treatment (MAT) has been around for a long time but has gained ground in recent years. According to the Sub-stance Abuse and Mental Health Services Administra-tion (SAMHSA) “MAT com-bines behavioral therapy and medications to treat sub-stance use disorders.”
Although still a small percentage of the recovery pie, MAT clinics are becom-ing more common, even here in Montana.
Ammon Stuart, Opera-tions Director of the New Life Clinic, an outpatient drug addiction treatment center in Kalispell said, “Our goal is to help addicts get their lives back, 100% drug free.”
New Life is one of just under 20 clinics in Montana licensed to dispense Subox-one. Suboxone is a drug giv-en to addicts to alleviate withdrawal symptoms and help them get adjusted to life on a more sober note.

Suboxone works by satis-fying addiction cravings, while not delivering narcotic effects. Critics of MAT point out that treatments of this type substitute one drug for another. Stuart’s answer to this criticism is that, “An addict’s biggest fear is with-drawal symptoms” which Suboxone alleviates.
He said, “Patients on Sub-oxone are not getting high, they are just not feeling bad. A patient using Suboxone as prescribed, is not impaired, and can drive or operate heavy machinery safely. The goal is to get folks stable so they can benefit from coun-seling.”
Much opposition in the recovery community to MAT revolves around a potential for abuse. The main ingredi-ent in the drug Suboxone can be abused, is easy to find on the street, and when used in excessive quantities can cause overdose, Stuart ad-mits.
He also said, “Suboxone has a high safety profile,” which means it is very diffi-cult to overdose on.
Stuart clarified that Sub-oxone which was approved by the FDA in 2002 is very different and much safer than Methadone which was the MAT drug of choice used in the past. Methadone did cause many overdose deaths, he said.

In October of 2017, HHS declared a public health emergency to address the national opioid crisis. This measure was taken in order to improve access to preven-tion and treatment and re-covery services. It was also intended to help target avail-ability and distribution of overdose-reversing drugs, to strengthen public health data collection and reporting, and to support research to ad-vance the practice of pain management.
The opioid epidemic is not isolated to big cities. There have been more than 700 deaths from opioid over-doses in Montana since 2000.
Governor Steve Bullock announced the passage of HB 333 in November, 2017. The law broadened access to the life-saving opiate overdose reversal drug called nalox-one which can now be ad-ministered in drug overdose emergencies through a standing order issued by Montana’s Department of Public Health and Human Services. Bullock’s press re-lease said, “lives will be saved by this action.”

The State of Montana recently filed an individual lawsuit against Purdue Phar-ma, makers of OxyContin. The lawsuit alleges misrep-resentation of the likelihood that long-term use would lead to addiction and falsely claiming OxyContin was safe for use in treatment of chronic pain. Montana state attorney general Tim Fox said in a press release, “Pharmaceutical companies that knowingly and decep-tively harm consumers must be held accountable.”
Doctors the world over are now taking a hard look at prescription pain medica-tions. The pattern of increas-ing dosage until a patient is in an abuse situation is be-