Opinion: The Overdoses -- and Underdoses -- of Managing Pain 

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In this heyday of pharmaceutical prowess, the measure of a fortunate life is a blissful ignorance of prescription drugs. People who are healthy enough to not know firsthand their statins from static, or their insulin from the insolent, are blessed indeed.

Once you need to know prescription specifics you’re in the groaning-as-you-stand, chatting-about-your-BM years. The rest of us would love to have your company, but with my $298 co-pay on a single prescription, I understand if you’d rather keep your distance.

So if you’re among the lucky population who has no pharmacist who waves to you across the store, you may not grasp why some of us pay such close attention to coroner reports of famous deaths and developments in legislation regarding what drugs are in shortage and why. Or you may take medication every day and not realize that the national news is about you.

In February and March, multiple federal agencies began unveiling their plans to address the opioid crisis in America, in which overdosing on prescribed medication, heroin and illegally produced Fentanyl has become the No. 1 cause of injury-related deaths in the United States. Aspects of these plans include limiting the length of prescriptions, using other therapies such as exercise or counseling, and trying other nonaddictive drugs to relieve pain.

All good ideas, well-considered and not given to superstar Prince in time to save his life. Prince died by overdose of prescription opioids April 21. It’s been reported that he was prescribed them for hip pain because of multiple performance-related injuries.

The problem with the well-meaning and highly nuanced Centers for Disease Control studies is that by the time they get to your doctor and pharmacist, they may lose some of their subtlety and become ham-handed. Almost immediately after studies were published, I encouraged a friend to seek medical attention for a shoulder injury she’d suffered with for nearly a year. She was kicked out of the office for drug seeking because she told them that the Tylenol they recommended wasn’t working. Another woman I know was kicked out of a pharmacy for trying to fill her prescription from her doctor for a narcotic. Both of these cases involved small prescriptions — not the big-gun narcotics. And the witch hunting begins.

When the Food and Drug Administration and CDC began releasing their plans this year, some doctors grinned and quoted that Americans needed to get ready to experience more pain. What they meant was that we’ll be getting fewer opioids. The reason opioids are so beloved to prescribe is that they’re the Super Store of painkillers. You need to knock out surgery pain? No problem. Burn pain? They can do that. Lungs hurt? They can do that, too.

But the flip side is that they knock out all kinds of other things, because like a Super Store there’s no personal service. So while they stop the pain they’re also stopping your bowels from moving, and possibly slowing down your essential life functions such as heart rate, breathing and keeping your body warm. That’s how people die from overdose.

As a counselor for those who have lost a loved one to suicide, I know how you can lose a person to underdose, too. Undertreating people for pain isn’t an option. Untreated pain is a killer. It is agony and torture. We don’t want the overdose deaths to continue, but I have seen the underdose deaths. No one should have to suffer that way. And, as you can imagine, that suffering will be as equal across race, class and gender lines in this new war on drugs exactly as it was in the last war on drugs.

Then there’s why we should selfishly watch lethal injection developments. Lethal injection was considered by some to be a humane alternative to other death penalties in this country, including hanging, firing squad and the electric chair. The ethical problem with all of these methods is the involvement of others in the apparatus of killing. Punishing killing by killing is a messy circle in the justice system. Lethal injection implicates the person holding the needle — the American Medical Association does not allow doctors to do it — and, in the eyes of a growing number of pharmaceutical companies, the maker of the drugs. European companies who make these drugs and oppose the death penalty pull the drugs out of the United States to keep them from being used contrary to their wishes.

The problem here is that the drugs have other uses and there’s now a shortage. The states and penal systems think they’re clever to jump over to veterinary drugs. The pharmaceutical companies then make those also hard to come by. Well, guess what? Those drugs were being used. And guess who by? Not just vets, but also the very researchers who were looking into curing the diseases and addictions plaguing humans. Researchers and vets adjust and use other drugs during the shortage, but every time states make another leap across the death penalty chessboard by using drugs meant to save lives to end lives via capital punishment, repercussions are felt across the health care board.

National overdose deaths are horrifying in their epidemic stages. The death penalty is a serious ethical question of a society. But often those big-picture concepts are too scary to think about on a day-to-day basis. As I finish writing this, however, there will be two pills I have to take — benign and nonaddictive, luckily. Maybe you have some. There’s a story there. S

Alane Miles is an ordained minister, freelance teacher, writer, and grief and bereavement counselor.

Opinions expressed on the Back Page are those of the writer and not necessarily those of Style Weekly.



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