There is little doubt that ours is a polarized nation. We have elected, but constantly complain about, our “do-nothing” government wherein every disagreement leads to impasse. There is no longer such a thing as a civility in political discourse. Whereas disagreement and debate conducted with respect for one’s opponents’ views is central to a democracy, no longer do those on opposite sides of the aisle view the other side as their noble adversary – as ethical and patriotic as those on one’s own side. Both sides, it was once taken for granted, in the end want only what they truly believe is best for America and Americans. Instead, the other side’s positions are dismissed as extreme, crazy or simply disingenuous (disagreeing simply to stall and cause failure or garner attention). WE are the normal, ethical and thoughtful ones, THEY are crazy zealots.
Guns. Abortion. Healthcare. Opioids.
Can people who believe that opioids are potentially helpful to a (sizeable) subset of those with chronic pain ever reconcile with people who believe that they are good for nearly nobody and worse are killing people? Two divided factions have emerged, as cantankerous as Democrats and Republicans, as Progressives and Tea Partyers, as diehard as the Boston Red Sox and the Yankees, as Left and Right, Oil and Water. Our government can be completely stalled and shut down even when leaders want to find compromise but cannot, because they have to hold together their coalition, but each have vocal constituents with polarized experiences and views. The opioid debate has similarities. The pro-Opioid and anti-Opioid movements are made up of professionals, lay persons and others with highly disparate views and experiences, not to mention loss and catastrophe.
Imagine trying to reconcile:
You will never see your child again because of a narcotic overdose
You will never see your spouse again because of suicide from unrelenting pain
Yet both sides really want one thing and one thing only, what is best for America and Americans with pain, addiction and suffering of all kinds. And what we have going for us is we have 30 intelligence quotient (IQ) points on the average modern politician.
Can’t we all just get along?
There are potentially over 100 million people in this country with chronic pain. If there is one thing we might be able to agree on is that any discussion of a therapy that is good for everyone is too stupid to have. And so too is a discussion that any therapy is wrong for all of them. Even if benefits were once overstated and risks belittled, intellectual dishonesty pushing in one direction doesn’t justify it pushing back in the other. Not when patients are squeezed in the middle. So while I can sometimes be militant and perhaps even intransigent, please pardon my passion, and for the sake of people, who are suffering, let’s attempt to build a bridge. Personally, the entire issue has been quite daunting for me in my practice as well as trying to balance that while combating some otherwise respected adversaries and supporting other ethical and competent pain practitioners. Let’s stipulate that we agree that prescription opioids are a Godsend to some, they can be the end of the world for others.
Imagine each day walking into your child’s bedroom knowing you’ll never see your precious son or daughter again because of sudden death from an opioid overdose. It’s heart wrenching so say the least, but not really a sudden death- it’s more of a slow death that includes anxiety, depression, humiliation, panic, and devastation for the victim and the family. The days, weeks, months, or years leading up to it will undoubtedly annihilate any family. The victim of addiction finds him or herself out of control, unable to function, and unable to work or lead any type of productive life.
Now imagine each day awakening next to your spouse, riddled with chronic pain unresponsive to any medication but opioids such as morphine or oxycodone. Heart wrenching to the family? Of course – it’s also a slow death that includes anxiety, depression, humiliation, panic, and devastation for the victim and the family. The days, weeks, months, or years leading up to it will undoubtedly annihilate any family. The victim of persistent unrelenting pain finds him or herself out of control, unable to function, and unable to work or lead any type of productive life.
People, WHAT ARE WE DOING? After almost two years of news reports, professional meetings, media blitzes, Big Pharma bashing, Tweets, and more, from with professionals including ethicists to psychologists, medical doctors, pharmacists, pain specialists, nurse practitioners, physician assistants, podiatrists, other various backgrounds, researches, and families that have lost their heart and soul to the death of their loved ones, we are no further ahead today than we were two years ago when PROP sent a petition to the FDA requesting prodigious changes to the allowable indications for opioids. Just days following, PROMPT countered with objections citing flaws in the basis for the request.
Smart practitioners, researchers, and writers from every corner of the United States (and Canada) have continued to banter around the various pros and cons of chronic opioid therapy all of whom have yet to produce a shred of indisputable evidence to support either position. WE NEED THAT EVIDENCE!
So here we remain two years later spending more energy fighting than trying to correct the problem together. We have two camps of zealots; those protecting the interest of families stricken by addition, overdose and death and families stricken by unrelenting persistent pain that virtually ruins their life to the point of begging for death.
We have reached a turning point where we must work in concert to attack both problems together. There are too many smart clinicians and families to spend more wasteful hours fighting. With this blog, I am calling on all victims and professionals to comment. Here we have over 100 comments from various pain patients telling us how horrible their life has been because of their persistent pain issues. We need also to hear from the families of those that have lost loved ones to overdose and tell how their mental anguish is just as, or more painful. We are a community – WE ALL HURT! We therefore must rise up together and understand each other’s issues to develop solutions instead of preserving barriers with PROP and PROMPT followers on each side of the pond.
Automobile insurers offer incentives for drivers to obtain discounts if they take “defensive driving”. Considering the risks of opioid therapy; perhaps “opioid drivers” (prescribers) should be offered incentives by insurers and state licensing agencies to obtain much needed education; perhaps pain patients should be required to attend risk opioid risk seminars (at the expense of managed care) to understand the world of addition; perhaps families of addicts need to hear from people who have had positive life-changing events from taking scheduled opioids. This should not be a punishment for either group of people – but instead it should be used to create a respectful understanding of each other’s world for the greater good of community, to allow opioid access where it belongs, and to prevent it from getting into hands where it doesn’t belong. Who will pay for this? I believe it would be a bargain for government, health insurance companies, and even Big Pharma. And I think a carrot approach must replace what heretofore have been only sticks.
Please let this blog post be the beginning of a community consisting of patients requiring opioids and those loathing opioids. With this information, perhaps we can promulgate an incentive for the professional pain and addiction practitioners together with families, to work with various government agencies, insurance industry, and Big Pharma to create solutions, study long term outcomes, and treat addiction as a disease with proper medical coverage without a requirement to be completely downtrodden and homeless.
LETS’ START WINNING SOME BATTLES BEFORE WE LOSE THE WAR. WE MUST COME TOGETHER AND EXPERIENCE EACH OTHERS PAIN WITHOUT THROWING DAGGERS.
EVERYBODY, PLEASE TELL YOUR STORY AND SHARE YOUR OPINIONS!