Now I Get It

Last week I was at a conference for medical education, and one of the main topics was the opioid crisis. I admit I never really understood what the crisis was. Doctors over-prescribing is what I thought. Or inappropriately prescribing. For example, there is very little evidence that opioids help people with chronic pain; actually no evidence and to the contrary, chronic pain is a contraindication to prescribing an opioid. However, I know there are people with chronic pain out there desperate to try anything. Obviously addiction is the big thing. The real crisis, however, is that doctors are prescribing without a plan for getting their patients off opioids. That’s when you hear about people getting drugs illegally or switching to heroin. That’s when you hear about people losing their lives in every way possible. So a prescription without a plan. That’s the crisis. Yes, doctors have to prescribe responsibly, but they also have to have training in understanding and recognizing addiction, about implicit bias for prescribing, and what conditions will actually benefit from a prescription.

As a chronic pain patient, I’ve rejected pain medications. The side effects far outweigh any benefit I’ve had. I’ve come to terms with the knowledge that there isn’t a magic pill. Not everyone gets to that point, however. Furthermore, there are times that an opioid prescription is appropriate. My only advice is if you decide to take an opioid for even a short term condition, such as breaking a leg, ask your doctor directly what his or her plan is for taking you off opioids. They can’t be withdrawn without a plan, and if your doctor has no plan, don’t accept the prescription. As bad as chronic pain is, withdrawal from an opioid is worse. Being addicted to an opioid (which isn’t even helping your pain) is worse. You can still function with chronic pain. You can’t if you’re addicted.

The crisis is the lack of education for medical providers to take their patients off opioids. That’s the crisis. Prescriptions, yes, addiction, yes. But the real crisis is the lack of education, the lack of plans.

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