An Overview – Part 1 of 6

By R Carter

When facing the unknown, good men honor virtue, embracing destinies as yet unrevealed.

R Carter

How it was, how it is.

In 2010 I attended the first public educational seminar sponsored by the State of Oklahoma on what was being called the Opiate Epidemic. That word caught my attention as an epidemic is usually associated with a bacterial or viral outbreak.

Addiction hardly qualifies as something contagious, referring to it as a crisis is far more appropriate. You may ask, why mince words? For one, medicine and healthcare are science-based and like all science-based subjects, precise terminology is extremely important at conveying ideas and meanings to avoid mistakes and misunderstandings. This is why all subjects based on science have a unique taxonomy, making it possible to convey complex ideas with as few words as possible.

Second, because words matter as indicated by this mistake, addiction or even the abuse of opiates is not something you can catch from another person unwillingly like a disease. Words convey an impression, an image, which gets stuck in our heads and forms an opinion for us, whether we’re conscious of that or not. So close your eyes and think only of the opiate crisis, paying attention to the images that come to mind, do that for 30 seconds then come back here.

If you’re like most the images which came to mind are of those living in rundown conditions, taking pills, smoking or injecting drugs while in a stupor, possibly doing something illegal to support their actions. We have these images because that’s what we’ve been conditioned to see, either through the media or by personal experience. While such images are true in some cases, far more often than not, the individuals are no different than you and I, average people with families and jobs who have fallen into a trap.

But the manner in which addiction and abuse are portrayed in the media, from government agencies down through individual commentary, has played a significant role in presenting these concerns as a threat to everyone, when this is in fact, not the case. And for those who must take opioids because of a medical condition or previous injury, they have assigned to them, by proxy, the same fears, and biases as those who are drug abusers or street addicts.

For this reason, you will see commentary on this sight which often describes this phenomenon as opioid hysteria, an exaggerated fear beyond the known facts. But in reality, these are real people like anyone else, who didn’t plan or intend on becoming addicted, or for developing an illness or injury where the only treatment was to take pain medication. All have been pushed this direction by something, discovering what that something is and how to address it is what makes the question for the use of opioids, a very difficult issue to contend with. So much so that we here those who don’t have these problems tell others to simply suck it up and endure a little pain.

How the Business of Healthcare Reflects the Bias of Individuals

The purpose of this first series of posts is not to discover how those individuals lost their way or explore the treatment alternatives to opioids, but to discover how those who are faced with a medical condition that requires opiates, can avoid losing their way in a world where everyone around them has been conditioned to think they are a threat to others.

The world is now hell-bent on preventing us from becoming addicted to opioids even when the evidence shows that only around 0.76% of people who use medical opioids become addicted to them. This is lower than the addiction rate to alcohol which is around 6.6% or 100x higher than opioids. People who ignore such facts do so because they are blind to they’re own denial and bias. They go to extremes because its what’s good for them, it fits into their overall ideology and in doing so, they don’t care if you live or die as long as they get what they want. In some cases, they are incapable of acknowledging anything else because it’s not about your needs, it’s about theirs. They’re so consumed by irrational fear and angst; they’re blind to how it is projected onto others, whose only fault is that they have a medical problem where opiates are sometimes the only treatment.

Words matter and in a world where making it more dramatic sells, blowing things out of proportion is part and parcel with gaining recognition for your cause. Telling others what to be afraid of and who’s to blame is the easy sell because it’s easier to lock them up, put them in treatment centers or deny them access to medical care than it is to admit we don’t understand how to respond to a substance which both has value as a medicine but can also be abused.

It’s for these reasons government and healthcare try to rely on empirical data. Data which does not lend itself to personal perspectives, agendas or politics, yet in the absence of good data, personal perspectives, agendas, and politics prevail, a point I hope to bring home when we get to the topic of discussing the lack of substantial medical research into treating chronic pain with opiates.

Changing Times, Old Fears and Bias Return

Eight years ago I had the intention of doing a deep dive into the opiate crisis, to educate myself on what our state governments were saying was an epidemic. Breaking through the rhetoric of the times, fact-checking the data and discovering for myself what was going on and how we got here. Along the way, my personal experiences at trying to access a healthcare system increasingly fearful of government regulation; began reshaping attitudes and beliefs I had held for decades. Healthcare was changing, and with regards to prescribing opiates, those changes were rapidly appearing like barriers to accessing medical care for millions of people. And while I fully supported efforts to close loopholes in healthcare which had contributed to this crisis, I was very concerned that in a rush to judgment, the government would create a new class of disenfranchised people.

While capable of enacting guidelines that would close loopholes which led to the crisis and simultaneously protecting rights of prescribers and patients, the government instead acted in self-interest only. More concerned about eliminating the cost of opiate-related deaths than they were about implementing policies that also protected those who had a legitimate medical need for such medications. The government kicked that group to the curb by implementing guidelines that literally pit the prescriber against the patient, then walked away, turning a blind eye and ear to those they had sworn to represent and protect.

Looking back to 1980, what used to be a mix of private and public institutions, schools, universities and hospitals, individual providers and small group practices who collectively worked together for the benefit of patients, an industry committed to scientific advancement and cures was now something where these values appeared only skin deep, silently hiding behind new priorities of profitability and deniability. 

The industry I began my career in forty years ago has been replaced by a rigidly for-profit enterprise, one where cost cuts and shareholder earnings often take priority over the welfare of individuals. Such goals were both contributing to the problem and simultaneously turning a blind eye to the collateral damage they created. While the majority of healthcare workers cared deeply about their patients, the system had changed and to work within that system, concessions were required. Concessions that trickled down to patients as access barriers, ethical and civil rights violations, exploitation via insurance fraud and unnecessary procedures designed to protect providers from liability concerns.

The Have Nots vs  the Haves

As I continued my research I was alarmed at how government entities were turning a blind eye to these issues. If the issue didn’t directly serve government interests at halting deaths from illegal opiates, the government was taking no action. Protecting citizens from those concerns which directly impacted patients, appeared to as issues the government simply had no interest in.

I don’t oppose government efforts to prevent deaths from illegal opiate abuse, but I believe it’s important to point out that the steps taken to date, have created new challenges which government is failing to address. In short, the government stopped short and has not gone far enough. As of 2018 data collected by the state of Ohio shows a clear trend of declining prescription-related opiate deaths, so why is there no discussion around correcting the collateral damage these efforts have made for providers and patients?

Healthcare is still considered a right by most, but those who oppose this view are most often, those who can afford healthcare. There are still laws that support that perspective and how the government is responding to this crisis is sending a clear message that it’s a privilege, reserved for those who can afford to pay for it. In Ohio, if you’re not employed full time with employer-sponsored health insurance, you can’t get some types of medical care for treating chronic pain conditions because it’s illegal to pay with cash. The healthcare industry and government have changed, their positions on this subject now lend itself to something more akin to a privilege, creating opportunity and improved access for those economically empowered over those who are less so. Today you can’t get past a receptionist without an insurance card and in many states; you can’t pay with cash. What I have found on the government regulatory front has changed my views of a government for the people and by the people, to something that looked suspiciously like a group of elitists who too often use their positions to support elitist views over the welfare of citizens to whom they are sworn to serve.