prescription pain medicine

Unwelcome Reminders & Another Anniversary

(Translation into most languages at tab to the right)

“We were trying, all of us, so hard, and he just wanted to live.” (1)

Ursula Rauh said this about her brother, Tommy, after his death from a fentanyl overdose and a dozen stints in rehab in ten years. He became addicted to Oxy’s at 23 after being prescribed an unlimited amount for tendinitis and a year later, another prescription for wisdom teeth extraction. Sam Quinones retells the family story in The Least of Us: True Tales of America and Hope in the Times of Fentanyl and Meth. “The tragedy wasn’t just the death of her brother; it was all the time, effort, love, and pain that the family traversed, the hoping and living for the smallest encouragement.” (1)

When my husband, John, and I returned from Australia in May, we decided that we needed to address the decades of files we had saved and ‘stuff’ we had accumulated and ‘stuffed’ away in closets. We have shredded and recycled dozens of boxes of documents, cleared out half the books in our library, and now I have moved on to scanning and sorting thousands of photos. While I was pulling bins of photos and albums out of closets, I came upon a few more file bins. I sighed out loud to John, “Oh boy…more of JL’s file’s I’d forgotten about.”

Looking Back to See the Future

(Translation into most languages is available to the right.)

When I am doing research for an upcoming blog post, I can get lost. There is so much information now on drug addiction and the opioid epidemic that I suddenly look at the clock and realize I’ve been wandering virtually around the world and becoming more discouraged with each new article or report: Scotland has more drug overdose deaths per capita than any European country (1); Fentanyl is flooding California with overdose deaths skyrocketing (2); the use of over-the-counter codeine (an opiate) cough medicine among eighth graders in the US has increased (3); and, Australia now has the eighth-highest per-capita opioid consumption in the world (4).

Peter’s Story: Alcohol The Gateway Drug

(Thirty-fifth in a series of topical blogs based on chapter by chapter excerpts from Opiate Nation. Translation into most languages is available to the right.)

This week’s Story of Hope is from a friend of JL’s, Peter (not his real name). Here are some excerpts from his story in Opiate Nation (5 min read):

My name is Peter and I’m an alcoholic and addict. This is how I introduce myself at the AA meetings I attend several times every week, as I have done for over 10 years. I am from a fairly affluent family, raised with high moral standards, and attended the best schools. So how is it that I became an alcoholic by the time I was a senior in high school and an opioid addict and dealer by the time I was 20?

The first time I used alcohol was in my junior year in high school. I was new to the school and I felt like I didn’t get the playbook for how to be a part of the group. I had been raised with strong values against using drugs and alcohol – but I wanted to fit in with the popular kids.

I tried a capful of vodka—that was it. I hated the way it tasted. The next day I was sick—not so much from the alcohol, but with guilt. This would be a consistent theme in my drinking and using: I always felt guilt and the consequences of doing something soul-crushing and bending the moral line I had deep within me. Once that barrier had been crossed, then anything was permissible. Initially I only drank on weekends at parties so that I wouldn’t be the outsider.

The Important 0.1 Percent

(Nineteenth in a series of topical blogs based on chapter by chapter excerpts from Opiate Nation. Translation into most languages is available to the right.)

DNA sequences for any human is approximately 99.9 percent identical to every other human. That means that only 0.1 percent of our genetic makeup is unique to us. Genes are functional units of DNA that make up the human genome. But don’t be fooled into thinking that 0.1 percent variation is insignificant. It is nearly 3 billion base pairs of DNA which boils down to 3 million differences that determine our physical features like hair and eye color and health risks or protection from diseases such as heart disease, diabetes – and addiction. Genes influence the numbers and types of receptors in peoples’ brains, how quickly their bodies metabolize drugs, and how well they respond to different medications.

The National Institute of Drug Abuse (NIDA) reports that family studies that include identical twins, fraternal twins, adoptees, and siblings suggest that as much as half of a person’s risk of becoming addicted to nicotine, alcohol, or other drugs depends on his or her genetic makeup. Scientists estimate that genes – including the effects environmental factors have on a person’s gene expression, called epigenetics – account for between 40 and 60 percent of a person’s risk of addiction.

Epigenetics – epi meaning “above” – is the study of functional, and sometimes inherited, changes in the regulation of gene activity and expression that are not dependent on gene sequence. This means exposures or choices people make can actually “mark” (remodel) the structure of DNA at the cell level. So epigenetic regulatory systems enable the development of different cell types (e.g., skin, liver, or nerve cells) in response to the environment. These epigenetic marks can affect health and even the expression of the traits passed to children. For example, when a person uses cocaine, it can “mark” the DNA, increasing the production of proteins common in addiction which is believed to correspond with drug-seeking behaviors.

CAN MONEY REALLY COMPENSATE ?

CNN reported this week that Mallinckrodt, a large opioid manufacturer, has reached a settlement agreement in principle worth $1.6 billion with attorneys general for 47 states and US territories. Mallinckrodt announced that the proposed deal will resolve all opioid-related claims against the company and its subsidiaries if it moves forward. Plaintiffs (states) would receive payments over an eight-year period to cover the costs of opioid-addiction treatments and other needs.

Compensation: recompense given for loss injury, or harm suffered. Are the settlements that are being levied against Purdue Pharma, Johnson & Johnson, TEVA, Mallinckrodt, McKesson Corp., Cardinal Health Inc., AmerisourceBergen Corp. really compensation for the millions of lives ruined by opioid addiction? Or for all the lives lost in the past 20 years?

America’s Love Affair with Opioids

Andrew Sullivan’s 2018 article for the NY Magazine entitled “The Poison We Pick”, wrote: “…For millennia, the Opium Poppy has salved pain, suspended grief, and seduced humans with its intimations of the divine. It was a medicine before there was such a thing as medicine. Every attempt to banish it, destroy it, or prohibit it has failed…This nation pioneered modern life. Now epic numbers of Americans are killing themselves with opioids to escape it…According to the best estimates, opioids will kill up to half a million Americans in the next decade.

“Most of the ways we come to terms with this wave of mass death…miss a deeper American story. It is a story of pain and the search for an end to it. It is a story of how the most ancient painkiller known to humanity has emerged to numb the agonies of the world’s most highly evolved liberal democracy. Continue reading “America’s Love Affair with Opioids”

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”

Our Children’s First Opioid Exposure: The Dentist

Dentists are the leading prescribers of opioids for U.S. teens and the largest increase in dental prescriptions from 2010 to 2015 occurred in 11- to 18-year-olds, according to a study published in the Journal of the American Dental Association…For many young patients, this is going to be their first experience with opioids. “The fact that we’re still prescribing opioids when we’ve demonstrated that non steroidal’s are as affective most of the time is a little disturbing,” said Dr. Paul Moore, co-author of the study. (03-27-18, Az Daily Star)

If these statistics are delivering a disturbing jolt to you, as they did to me, read on. The American Dental Association recently published an analysis of five studies in their Journal evidencing that non steroidal anti-inflammatory (NSAID) drugs work just as well – or better – for most dental pain (such as tooth extractions, root canals, implants) as opioids. The ADA announced a new policy that essentially tells dentists to eliminate opioids from their arsenal, if at all possible, while it is also pushing for mandatory education for dentists that encourages using other painkillers. Finally.

Many of us remember having teeth extracted before braces as young teens and also our wisdom teeth when we were young adults. We were sent home with a few pain pills that contained codeine. When I had a root canal a few years ago, the dentist sent me home with a prescription for a huge supply of Vicodin. What on earth was he doing? This same oral surgeon gave our son a 10-day supply of Percocet until his appointment to get his wisdom teeth extracted – and then another 10-day supply (with a refill) after the surgery. Over twenty days of Percocet? Our son then returned to heroin and within two weeks died of an overdose. JL had been clean and sober for 6 months until that first Percocet….

What role did we, as parents, play in this tragedy? JL didn’t want to tell the dentist that he was a recovering opioid addict and we, reluctantly, agreed. He knew, and we should have known, that this was drug-seeking behavior. He was 25 so we had no authority to deny him medication. But we did have leverage – we were paying for the surgery – we could have very easily stood our ground and insisted that he not have opiates before or after. But we would have had to be willing to let our son experience pain, which we had been trying to help our children avoid since birth. (see my blog Pain, Feb 19, 2018)

Parents of children and young adults do play an important role in the prevention of exposure to opioids – and all addictive substances. We are not powerless and regardless of angering our kids, our love for them and our commitment as their parents and guardians needs to be embraced and encouraged. I hope these insights into one of the earliest and easiest avenues of a negative life-altering experience will help others avoid the mistakes so many of us made over a decade ago.

Note shared by a friend:

Thanks to Opiate Nation for not only bringing to our attention the issue of addiction in this country but also for providing an understanding approach to those of us who suffer from addiction or from its disastrous spin-off. I have to live, as they say, a day at a time dealing with the history of addiction in my family of and of the irretrievable loss of my beloved son as a result of it.

While my son abjured the use of pain killers following oral surgery when he was in his teens, a subsequent year-long hospitalization as the result of an accident in a mine of necessity introduced him to the world of opiates. He left the hospital addicted to prescription medications. an addiction from which he never recovered. He ultimately took his own life. Parents are often accused of being the culprit in this vicious cycle. If indeed we were, it was from our own ignorance that we did not intercede. We simply didn’t see the danger. Bless the writers of this incredibly informative blog for understanding the pain that each of us with addiction in our family suffers daily. We still enjoy life, but not as much, and we still laugh, but not as robustly. Our lives have been irrevocably diminished. Having a sympathetic ear through this blog brings surcease from our ongoing anguish.