American Pain

From my earliest memories, I have had leg aches. They come on fairly suddenly for no apparent reason. It wasn’t until my 20’s when I figured out they related to the weather and changes in barometric pressure. I know, it sounds like folk-magic. But it’s true . As I was growing up, my parents would wrap my knees in stretch bandages and rub my legs with witch hazel. One thing they never did was offer me a pill for my pain. Never. In the pre-1980’s world, pain was part of life and mostly bearable.

My how things have changed. America­­­–with 5% of the world’s population–went from consuming less than 5% of the world’s prescription opioids in the 1960’s to now consuming some of the highest percentages of prescription opioids such as oxycodone, morphine, fentanyl, etc.

In 2015, John Temple,  an investigative journalist and journalism professor, wrote American Pain. It was one of three key books released that year in response to our opioid epidemic, the other two being Dreamland and The Big Fix. The title is taken from the “king” of the Florida pill mills, American Pain, a mega-clinic expressly created to serve addicts posing as patients. From a fortress-like former bank building with security guards, American Pain’s five doctors distributed massive quantities of oxycodone to hundreds of customers a day, mostly traffickers and those addicted, who came by the van load. Former strippers operated the pharmacy, counting out pills and stashing cash in garbage bags. Under their lab coats, the doctors carried guns. Continue reading “American Pain”

Medication Assisted Treatment – Part 1

Medication Assisted Treatment, or MAT, is finally gaining acceptance as a response to drug addiction in the US––it is a cultural shift from the view that addiction is a “moral failure.” The Hazelden Betty Ford Foundation, one of the top drug treatment providers in the country, used to subscribe almost exclusively to the abstinence-only model, based on an interpretation of the 12 steps of Alcoholics Anonymous and Narcotics Anonymous popularized in American addiction treatment in the past several decades. But in 2012, they announced they would begin providing MAT. There are four opioid substitutes that are used for MAT in opioid addiction: methadone, buprenorphine, naloxone, and naltrexone. More on these in the next blog.

November 6, 2013, the New York Times did an extensive article discussing the development, use, and risks of opioid substitutes, in particular bupreorphine and the combination drug, Suboxone. The author explaining that “While addiction is considered a chronic, relapsing disease, experts believe that replacing illegal drugs with legal ones, needles with pills, or more dangerous opioids with safer ones reduces the harm to addicts and to society. Addicts develop a tolerance to its euphoric effects and describe themselves as normalized by it, their cravings satisfied. It also diminishes the effects of other opioids but, studies have shown, does not entirely block them, even at the highest recommended doses.”

In a Frontline report in 2016, one of the doctors who specializes in addiction medicine related that doctors are limited by the DEA to treat only 100 patients per year with Suboxone. The thought behind this law is that they don’t want it to be abused––and it can be abused, as a commodity sold on the street to ward of withdrawals or for those who cannot afford the cost of a doctor and the medication. Our family faced the dilemma of the high costs for the doctors visits and the Suboxone because they were not covered by our son’s health insurance. We made the decision for him to not use this option, all hoping that a sober living house and meetings would help him succeed in his desire for sobriety. He was dead from a heroin overdose 7 months later.

The physician on Frontline pointed out the contradiction––the contradiction that has frustrated me and my husband for years––that there is still no limit on how many oxycodone or other opioid prescriptions physicians can write—the very abuse of which is documented to be fueling the opiate epidemic and creating the need for Suboxone. I personally experienced this absurd mentality towards opiates when my oral surgeon sent me home with 60 Vicodin after a root canal––60. I used two. He is the same oral surgeon who did JL’s wisdom teeth extraction and gave him multiple prescriptions for Percocet two weeks before and two weeks after the surgery––which fueled his relapse on heroin and ultimately, his death. He should have his license revoked.

As of a 2017 report by SAMHSA (Substance Abuse and Mental Health Services Administration), physicians who have prescribed buprenorphine/Suboxone to 100 patients for at least one year can now apply to increase their patient limits to 275 under new federal regulations. It is good to see movement in the right direction and I hope there will be more progress soon, especially in terms of making medication options a covered public health care benefit available to addicts who want to get their lives back.