More than 42,000 people died of opioid overdoses in the United States in 2016—9,000 more than in 2015. That’s the largest yearly increase in recorded history. And given the unwavering incline in annual opioid-overdose deaths since 1999, even more people might have died in 2017. It is clear this crisis needs to be addressed; but how warrants serious thought. The current approach has severely hurt a population that’s been overlooked during this crisis: people with chronic pain.
Perhaps the most prominent narrative about the crisis indiscriminately points to all prescription-opioid use as the driving cause of addictions, overdoses, and fatalities. The media (and, recently, the president) have magnified this idea with bold and overly simplistic claims suggesting a direct and inevitable link between opioid prescriptions and addictions—even heroin use. But this narrative is flawed, as illustrated by the most recent data from the Substance Abuse and Mental Health Services Administration. Of the nearly 92 million people who used prescription opioids in 2016, fewer than 1.8 million (less than 2%) developed or maintained a prescription-opioid use disorder. And only 641,000 people who misused prescription opioids used heroin, meaning that less than 1% of prescription-opioid users—including those who obtained them illegally or otherwise misused them—used heroin in 2016. Furthermore, prescription-opioid misuse is largely confounded with other drug and alcohol use, which is inextricably linked to the high overdose count. Ultimately, the opioid crisis is more complex than often suggested.
This is not to say that overprescribing should not be addressed. In fact, limiting opioid prescriptions for patients with acute pain is important to limit the supply of unused opioids. Excess pills can be sold to or taken by individuals without prescriptions, who constituted nearly two-thirds of people who misused opioids in 2016. For people with chronic pain, however, a steady prescription may well be necessary. So, an overbroad attempt to limit opioid supply would be deeply problematic for this population.
Ideally, any doctor-patient relationship should result in a safe and individually appropriate opioid prescription for a patient who needs one. Unfortunately, much of the nationwide response stems from fear of a direct correlation between opioid prescriptions and addictions, regardless of any individual’s legitimate needs. This emotional and uninformed response has yielded severe consequences for people who use opioids to manage chronic pain.
One grave example took place in the summer of 2016, when Washington state officials suspended the medical license of the director of Seattle Pain Centers, stating his overprescribing had caused numerous overdoses. All eight clinics of Seattle Pain Centers were shut down entirely—with little thought given to the more than 8,000 prescription-opioid patients who were abruptly forced to obtain their prescriptions elsewhere. Though holding physicians accountable is important, punishing patients for their physician’s actions is cruel. In fact, at least one of these Seattle patients with chronic pain took his own life when he couldn’t get his medication elsewhere.
Beyond cracking down on doctors’ activities, taxing opioid manufacturers is an increasingly popular idea under consideration in several states. New York is the first to adopt this approach by creating the $100 million “Opioid Stewardship Fund.” Despite a prohibition against passing the costs of this assessment on to the consumer, this program and similar taxes may well raise insurance and medical costs. Willingness to overlook the potential burden on consumers of medication they need to live shows a willingness to treat the opioid epidemic as a black-and-white issue.
Furthermore, limits imposed by the largest insurers make pain management even less accessible for low-income people with chronic pain. Medicaid set limits in Colorado last fall and Medicare is imposing limits expected to take effect nationwide in January. Even if someone manages to find a physician willing to prescribe them the medication they need to control their chronic pain, their health coverage may preclude them from receiving a sufficient dosage. Not only is classism present in health care policies; it also manifests itself in the personal treatment and stigma people with chronic pain face. Many find themselves treated disparagingly because they use prescription opioids. The fear spread in response to the opioid crisis has encouraged inflexibly treating all opioid use as a problem to be eradicated. To people with chronic pain, the message here is clear: Their ability to exist without overwhelming, unmanageable pain—their very livelihood—is unimportant.
And these are not isolated incidents, but a direct reflection of the everyday struggles of people with chronic pain nationwide. Increasingly restrictive limits on pharmacies’ opioid supplies and physicians’ growing reluctance to prescribe opioids for chronic pain have left many unable to manage their untenable pain. This is not only cruel; this is dangerous. The consensus of many clinical experts does not recommend sharply tapering chronic-pain patients’ opioid intake as a primary response even to concerning behaviors. Yet this sharp tapering (and even complete halting) is now happening as a sudden, arbitrary response to a crisis for which people with chronic pain are not responsible.
For people with chronic pain, effective pain management is what enables daily life. It is synonymous with the capacity to work, get from place to place, and enjoy time with family and friends. It allows someone to get out of bed and focus on anything other than unbearable pain. And many people with chronic pain have found opioids to be their only successful option for pain management. Though evidence-based practices to otherwise manage chronic pain are growing, they are still in development, and their success varies wildly among individuals. The rapid push toward these options as an inflexible replacement of prescription opioids only complicates and stigmatizes chronic-pain patients’ lives.
Let’s work to end this stigma. People with chronic pain have been left out of discussions about the opioid crisis for too long. Let’s change that—and work toward their space to live unashamedly with access to their most basic needs.