Within the last few years, the full scale of the addition to prescription pain killers has burst into public consciousness and it is being referred to as an epidemic. Anna Lembke, a psychiatrist focused on addiction care and author of the book Drug Dealer, MD, agrees that “the commonly cited causes of the epidemic — doctors hoping to treat previously untreated pain conditions, pain patients demanding better treatments, and big pharma pushing opioids on the market — contributed to the vast overprescription of opioids. That let the pills flow not just to patients’ hands but to their family, their friends, and the black market.”
But in the above interview, Lembke argues that there are even more deep-rooted causes for the problem that get far less attention but need to be addressed.
One of the secrets of medicine — secret even to doctors — is that you can’t just stop opioids or quickly go down and the [patient] will be fine. You can’t do that. They’ll go through terrible, excruciating withdrawal.
I say it’s absolutely true that if you were to get opioids for your pain, it would be like a magical cure for about a month or maybe two.
But after a while, there’s a very high likelihood that they would stop working. And then you would have two problems: You would have your pain, and you would be dependent on this drug and experience painful withdrawal if you try to get off [opioids].
What I think is really important to remind people is that if opioids worked long-term, I would have no problem with patients taking them. The fundamental issue is that they stop working and then you have an additional problem.
She says that while part of the problem is that doctors feel pressured to make patients feel better and do so quickly and opiods can do the trick, another facet is that people are not accepting the limits of their bodies as they get older and think that medication can be used to avoid any lifestyle changes.
So, for example, this is a clinical scenario that happens to me all the time: I have a patient that I’m prescribing an opioid. Then they come in and tell me that they ran out three days early. And I tell them, “You can’t do that. You have to take it as prescribed.” And they tell me, “Well, I was doing yard work, and I had to cut down all these trees, I was chopping wood, and my pain was horrible. So I had to take more.”
And then I have to find a way to say to the patient, that’s not okay. You can’t use the pill to compensate for what your body can’t do anymore.
If you take additional opioids, you can’t hear the signals from your body about what you shouldn’t be doing, and then maybe you’re going to do some long-term damage above what’s already been done.
But even more importantly, you can’t use the pills to extend your limits. You have to accept that there’s some things you just won’t be able to do anymore.
People are very resistant to that idea. I think that speaks to some of the core hope for at least Americans that they should really be able to keep doing what they were doing in their 20s, and that somehow a doctor should be able to fix them and make that happen, instead of accepting that maybe that’s something they just can’t do anymore.
I can imagine that it would be hard for a doctor to deny a patient’s request for relief for genuine pain and essentially tell them to suck it up and learn to live with it. In the current state of medicine in the US where people have been led to think that medication can solve so many problems and doctors are essentially competing with each other, if one refuses a patient’s request to increase the supply, she may lose that patient to another doctor who may not be able to resist the patient’s pleas for immediate pain relief. And if they can’t get a doctor to prescribe for them, as I wrote about the other prescription drug epidemic for Adderall, savvy people still find it quite easy in the US to get prescription drugs that are legal but addictive.
As an older man myself, I know how tempting it is to deny that one’s body is not what it used to be and as one ages to try to hold back the tide, to think that if one could still do the things one could do while younger, then one must still be young. But I am also very averse to taking medications (even over-the-counter ones like aspirin) and so I let pain and tiredness serve as the signals that my body is sending me that I am pushing myself too far and need to slow things down.
Of course, it perhaps helps that I am a lazy person and don’t need an excuse to take things easy.