An Overview – Part 1 of 6

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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 crisis is a 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 in science have their own 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. One they didn’t believe was possible. They are real people who did not grow up wanting to be addicted.

The purpose of this series of posts is not to discover how those individuals lost their way but to discover how those who are faced with a medical condition which requires opiates can avoid losing their way in a world where everyone around them has been conditioned to think and believe the worst. A world that is hell bent on preventing us from becoming addicted even when there is ample evidence suggesting that such an event is extremely impossible and improbable. People who think like this are not interested in what’s good for you, they go to these extremes because its what’s good for them and in doing so, they don’t really care if you live or die as long as they get what they want. In some cases their bias and prejudice has become so extreme they see only the worst, they are incapable of imagining anything else because its not about your needs, its about theirs. They’re so consumed by fear and angst; they’re blind to how that fear and angst 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 is 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 something which is both a blessing and a curse at the same time.

It is for these reasons that 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.

Eight years ago I had the intent of doing a deep dive into the opiate crisis, to educate myself on what our state governments were saying was an epidemic. Breaking through rhetoric of the times, fact checking the data and discovering for myself what was really going on and on 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 loop holes in healthcare which had contributed to this crisis, I was very concerned that in a rush to judgement, government would create a new class of disenfranchised patients. While capable of enacting guidelines which closed loopholes which led to the crisis and simultaneously protecting rights of prescribers and patients, Governments instead acted in self-interest only. More concerned about eliminating the cost of opiate related deaths than they were about implementing policies which also protected those who had a legitimate medical conditions which required opiates as a treatment, Government kicked that group to the curb by implementing guidelines which literally pit prescriber against patient then walked away, turning a blind eye and ear to those citizens 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 started out 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 which 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.

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, government was taking no action. Protecting citizens from those concerns which directly impacted patients, appeared to be issues 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, 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 and there are still laws which support that perspective, but the manner in which 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 lends 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.