Death maybe a Doorway to a Pain Free Existence

By R Carter.

The title of this post is a quote from a pain patient who spoke these words as we talked this last week. Force tapered to zero medication from a previous dosage of 75 MME just over two years ago. They had been a chronic pain patient taking opioids for twelve years prior to that and like so many other stories, the physician forced this outcome to protect themselves from a perceived threat from the DEA. All attempts at finding another provider have met with a denial of care.

This person was laid off from their job following the forced taper because they could not keep up with the physical demands, and again the same happened on the next job. In subsequent attempts to find employment, they requested an accommodation under the American with Disability Act of simply having a desk position related to their field of experience. Having six years of college education, a Master Degree and at least thirty years of experience, they are an expert in their field by all accounts. But once such a request for an accommodation was made, even though details were never given for why the request was made, no job offer was forth coming.

Forced to apply for social security at least ten years before the eligibility age of 67, the individual is living on reduced benefits because of making such a request. Needing a minimum of $2,200 a month to make the house, auto, utility, food, insurance and medical payments, this person collects less than half of that, the remaining coming from a limited savings plan that should not have been tapped until they had reached the age of retirement. Those savings are running out, and like a ticking time bomb, this individual’s hope is also running out, for when the money’s gone, death may be their only escape.

On a request to remain anonymous, they relate how on more than one occasion, friends and acquaintances have shortsightedly suggested an early retirement. As if they have some secret stash of cash out there that will solve all problems. But like so many others, the demands of raising a family of five leave little room with saving for retirement. At least until children are well into their teens or out on their own. Like many average American families, the real savings for retirement don’t begin until after the children are grown and on their own. During the years when you’re at your peak earning potential.

It’s a story I have heard repeated, in one way or another, more than a hundred times over the last four years. And yet when I listen to most physicians, they profess to know nothing about such stories. That’s an explanation to difficult to believe. I heard the same thing repeated last week on the Dr. Drew Podcast as he expressed surprise that any patient with a legitimate chronic pain problem would have trouble getting pain medication. His preoccupation with Buprenorphine (Suboxone) as a leading candidate for pain management again exposes his lack of knowledge and understanding about what is going on medically in chronic pain management. That’s not necessarily a criticism so please don’t construe it as one. It would be like me knowing the finer details of managing diabetes. None-the-less, its poor form to criticize those who are pain specialist for how they manage pain, which he did several times throughout the program.

There were at least 50 million Americans who were chronic pain patients; taking opioids prior to 2012. I can now estimate this with reasonable accuracy having obtained access to the DEA pill database, which by the way only includes Hydrocodone and Oxycodone. There are still numerous other medications used for treating pain such as, Morphine, plus its extended release version, extend release preparations of Oxycodone, Fentanyl patches, Buprenorphine, as well as less potent medications such as Tramadol, none of which were included in the DEA pill data. If these medications had been included, I would estimate the number of people in the US taking opioids for chronic pain management to be more like 75 to 100 Million Americans, which is close to 25% of our population.

Such a large block of people should be a jaw dropping, eye opening kick in the pants if you’re a politician ignoring your constituents who are asking you. “What is your position on treating chronic pain patients who have a legitimate medical need?”

Still, with such numbers and knowing how quickly these medications in the wrong hands can lead to addictive behavior, I think the claim of 70,000 deaths up through 2017 speaks highly of how well the healthcare community has manage and practiced pain management. This is a truth that is slowly having some light shown on it. Massachusetts was first when it released data that showed, out of all overdose deaths which had occurred in their state, only 17% were caused by prescription pain medication, by itself and nothing else.The remaining 83% overdosed on Heroin and or Fentanyl. See Josh Bloom’s post from the American Council on Science and Health.

For reasons I don’t think we will ever understand, be it fear, conservative extremism or a deliberate plot to undermine the healthcare profession and get into the deep pockets of pharmaceutical companies, the facts will come out. When they do I expect to see the actual contribution of prescribed opioids to overdose deaths to be something similar to that of Massachusetts. That means the so called prescription opioid problem is in fact an illegal opioid problem. It wasn’t brought on by over prescribing, but by the clever entrepreneurship of a black market gone unchecked to some degree by Federal Law Enforcement, which on some level has thrown in the towel claiming, “We can’t arrest our way out of this”. Such an excuse is received as well as an addict who claims some else made them do it.

But until then, stories like that of my friend above will continue to occur and those with similar stories will leave us having chosen a solution that anyone else would consider an impossible choice to make. At least unless they are forced into it by a government acting on conclusions where the dots can’t be connected. Instead they will have drawn false conclusion for alternative reasons. To them, may the blood be on their hands. Let those who go on to a better place, find justice with a higher moral authority for all eternity.