Written By: Daniel J.  Fardella

Roughly two decades ago a medical protocol called the “5th Vital Sign” – that of determining the level of pain a patient is experiencing – was introduced to the medical community.  The response to this was the implementation of “pain management” through the daily use of narcotics to “restore the patient’s functionality”.  Top physicians known as “luminaries” insisted that patients who received opiates could “get their life back” by using narcotics as prescribed.  So powerful was this movement (financed by pharmaceutical companies that made painkillers) that medical schools included “pain management” courses within their official curriculum.  It was suggested too that those in chronic pain treated by narcotics were rarely susceptible to addiction.  Further, the administration of opiates would be safe enough to have no effect on major organs, and could be used safely for a long time.  It was stated that patients would not be euphoric, and abuse would be rare.   In short, for many years MD’s had been encouraged by big pharma to use narcotics to treat chronic pain without consequence of addiction, organ damage or major side effects and that doing so would restore quality of life – period.    The result was a huge increase in prescriptions such as Oxycodone, Hydrocodone, Morphine, Hydromorphone, Fentanyl and many other opiate based drugs, a best-seller being Oxycontin, a time released form of Oxycodone.

One might get the impression that the cause of our pervasive “opiate epidemic” is due to reckless, selfish acts performed by the medical community that resulted in the creation of patients who became addicted to prescription (Schedule II controlled) drugs because of an overzealous pain management campaign.  Some patients turned to heroin when their doctors ‘cut them off’ as the trend became unfashionable.  This abandonment could be viewed as a crime that drove desperate patients to the streets, but many believe that this is only part, albeit a significant part, of why we face an epidemic.  It is my belief that the increase in these drugs reflect changes in our society that have contributed to a mass depression, the result of a distortion of basic values and emotional change that can only be explained as a form of hopelessness relieved temporarily by the activation of dopamine, norepinephrine, endorphins and chemicals in our body that should appear naturally, not on demand by using ancient drugs such as opiates.  Once this happened, our depression, anxiety and inherent discomfort with an increasingly imperfect world was inadvertently suppressed by the drug that ultimately would change one’s brain.  It was the drug that was supposed to give one their life back rather than take it away and imprison it.  The life of not only the patient, but society itself and the misery that we used to regard as an affront to our intestinal fortitude.  We were shown a way to make it disappear, at least for a while.  And teenagers, doing what they have always done since the beginning of time, heard the call and believed the promise of something teens crave – something dangerous.

American culture has always lacked the concept of “moderation” and insofar as the opiate crisis we have gone from an excess in prescribing of strong narcotics to the virtual prohibition of same, denying many legitimate patients the access to such medicines as if the ‘old lady with cancer’ would be one less ‘junkie’.   This is as counterproductive as the prohibition of alcohol, which we know created a lucrative market for gangsters.  In the same way, today’s reversal of pain management to a policy of holding back on necessary medications for pain has created a cartel of drug dealers and a market for heroin that is huge, due to the desperation that our society has created by overprescribing and then under prescribing, leaving the patient to face their worst nightmare – forced withdrawal from prescribed narcotics.  In many cases, especially that of young abusers, the answer is in cheap, powerful, yet tainted forms of street drugs as a substitute to the safer prescription drugs.  Hence, another facet of the opiate epidemic is the drastic increase in the use of illicit drugs that are often IV administered.   In short, the get-your-life-back effort led to the proliferation of prescription drugs which were eventually noticed by young people and abused by them, and as they were ‘cut off’ by their doctors the market for illicit drugs became much larger.  Overdoses became more common.  Addictions became more unmanageable and severe, and the epidemic became more real.  One who is ‘dependent’ fears a painful withdrawal syndrome.  One who is ‘addicted’ fears the absence of the drug in it’s etirety.  A society that values wealth above all has a shortage of paths to that wealth, leaving  frustrated souls who turn to escape, of which opiates are an unhealthy answer – and the King of escape drugs is heroin.  We have created, through the internet, television, and all forms of media, an irresistible source of envy when average people are continually pounded with things they want but cannot have, until they hide behind drugs.  Then it doesn’t matter anymore.  Then, they live for one thing only:  the next fix.

The story is commonplace. An innocent and necessary introduction to pain medicine after an accident or surgery takes on a life of it’s own.   The person feels emotionally comfortable, physically without pain and in many cases their inhibitions vanish.  They feel more normal than they’ve ever felt before.  All of the things that created anxiety are now gone.  They are able to better focus.  To most people who have never experienced this kind of infamous awakening, it is not the vision of what opiates do.  Nevertheless, a person with this kind of reaction to opiates is an ideal candidate for addiction, or at the very least, dependence.   It takes roughly two to three weeks of daily use to become “physically dependent” (not addicted) to such a drug.  At this point, suddenly stopping the drug creates severe discomfort in the form of “withdrawal”.  An addict by definition is one who willingly and repetitiously engages in a quest to get high, whereas a person who is dependent has a need for a substance either to reduce pain or to avoid withdrawal.  Persons who are dependent usually become that way with no intention on abusing a substance. They typically follow doctors orders without exceeding dosage or experimentation of any kind, yet they become “dependent” through repetition of use as the drug replaces the body’s natural chemicals (eg endorphins, dopamine) to a point where one faces “withdrawal illness” as a consequence of stopping.  Conversely, an “addict” is one who from the start attempts to exploit the “fun” aspects of a substance by taking it for the very purpose of getting high and nothing else.  Addicts therefore are more likely to become reckless in their consumption, often facing the potential of overdosing.   There is more of a psychological component in the addict than in the dependent patient, and recovery for the addict is therefore more complex and difficult from an emotional standpoint.  Can dependence become addiction?  The answer is yes and no.  If an individual depends on a substance long enough it becomes part of their daily life.   Addicts seek the highest high they can achieve whereas those who are dependent are ok with ‘just enough’ to get by without facing illness and humiliation.  The dependent user such as those on pain pills for an injury are ideal candidates for well structured detoxification if that kind of program were available.  Unfortunately, we as a society have made it difficult for a person to find help that is compassionate and affordable.

The type of person who relies on a drug is one who has an emptiness crying out to be comforted.  The opiate user lacks – and seeks – peace, safety and tranquility while the cocaine user lacks and seeks energy, focus and confidence.   In the end, it is the emotional profile of the person who is taking these drugs that makes all the difference.  In addiction, it is a profile of need for the drug, more psychological than physical.   This need is based on the profile of the person at the time they are taking the medication.  With that said, let us view today’s “opiate epidemic” with the knowledge that there is no such thing as a pill with a mind of it’s own, only a person who seeks relief from emotional stress.

    By 2016 the number of opiate related deaths by legal prescription exceed that of heroin and cocaine combined.  Most of these deaths were due to the misuse and or mixing of pain medications with alcohol or other drugs (called ‘poly-pharma’) or taking more than was prescribed.  Some were intentional suicides.  The solution, after studying this issue extensively, is one of providing psychological care and physical detoxification in manner that is painless and compassionate.  Jail for addicts is foolish and counterproductive.  The essence of true recovery lies in the replacement of drugs as a crutch by providing a sense of purpose to the victim’s life, a restoration of love and faith providing a reason to live other than for the purpose of using drugs.