Sore Loser: Deborah Paul On Opioid Dependency

Why the crisis is personal.

The media has made us acutely aware that we are smack-dab in the midst of our country’s deadliest drug epidemic. In 2015, 22,598 Americans died from prescription opioid overdoses, according to Kaiser Family Foundation data.
The individual stories of the national panic are myriad and gruesome. Young people in Ohio dry out in jail, having no other options. You see the suffering on their contorted faces, the way their bodies are curled in the fetal position on prison bunks. Babies are born to addicted mothers, already addicted themselves: the gravest of injustices. Visits to emergency rooms due to non-fatal overdoses have soared, The Indianapolis Star reports, also revealing that we lead Ohio, which has been labeled the epicenter of the problem. Pharmacies are being robbed, and two nurses in a Florida nursing home were arrested after allegedly stealing opiates from elderly patients in obvious need themselves.
I worry about this problem because if I’m not careful, I could become a victim myself. In many ways, I already am.
I suffer from severe scoliosis. On an average day, my pain rates between eight and 10. When I was young, the doctors told my parents the spinal curvature was merely cosmetic, but they were wrong.
When I overdo it, such as standing too long or walking too much, the pain spikes. In those times, you will find me in my most comfortable chair, a heating pad behind me. In fact, I own four heating pads so I do not need to totter from room to room in search of relief.
I am not looking for pity. For the most part, I am grateful for my life. I am still ambulatory, and my brain works fine. Only once in the past two years did I wind up in the ER, unable to manage the excruciating pain on my own.
Which brings us to opioids and why the crisis is personal. After spending years relying on less powerful drugs, physical therapy, exercise, and regular visits to the orthopedist, I sought the help of a pain specialist. A sign in his lobby warns patients against bringing a gun onto the premises, which gave me immediate pause. How desperate are these patients, and what would it take to become just like them?
After a brief look at my X-ray, the physician called my condition dire and suggested an opioid. “I’m scared,” I responded. “What if I become addicted?” He did not mention my age, but I could see the actuarial tables mentally scrolling as he considered the potential outcome. If I became addicted, it wouldn’t last long.
Desperate, I agreed to start on a small dose of Oxycontin. Ten milligrams twice a day isn’t much, but it’s something. The drug doesn’t eliminate the pain—that’s asking too much—but it takes the edge off. I expressed my fear of addiction to my internist, who doubted I was the type to knock over a CVS at midnight, and said I shouldn’t suffer needlessly. I am now “dependent,” in his words, a little less frightening than “addicted.”
But here’s the hard part. I need the stuff—not to feel euphoria, believe me, I don’t—but to ease the pain of a very real condition. I don’t ask for a higher dose, doctor-shop, or break the law. But the rules for obtaining the drugs even for us legitimate “users” are making the process nearly impossible. You must hand the pharmacist a printed prescription for a one-month supply. This sounds easy enough unless you are in Florida, where we spend the winter and where the drug epidemic is rampant. The drugstore does not stock the medicine, so you must alert the pharmacist five days in advance. That pharmacist is very busy; sometimes he remembers, sometimes he does not. Often, when you return, he tells you the company no longer makes the generic version, which is all your insurance allows. He doesn’t care if you are out of pills and becoming shaky and nauseated and it is a Sunday and you are not allowed to call your doctor at home because the person on the other end might not be your doctor at all, but someone the likes of Don Hector on Better Call Saul. Sometimes the pharmacy has only enough pills for half a prescription, which requires you to take what you can get and forfeit the remainder. Sometimes you frequent four Walgreens stores in one afternoon, and not one has the drug. By then, you are not only in your usual pain, you are ill to boot.
And before you even begin the dance with the drugstore, you must obtain the prescription in the first place. The doctor’s office must either mail you the prescription or you must show your ID and sign for it in person. But before that, you must call the “prescription refill line,” wherein a recorded message tells you it will take seven to 10 business days for a return call, or email a form to the office. You are advised that if you communicate repeatedly, this will only lengthen your delay.
When I read about the crisis, I wonder why my plight goes unreported. In order to patrol the abusers, the system punishes the innocent along with the guilty. We are all victims, if not of poor health, then of drug companies looking for a profit, doctors who overprescribe, and crimes committed in back-alley deals.
My frustration has peaked along with my pain, and there is no solution for either in sight.
Editor emerita Deborah Paul’s personal reflections on culture, society, and family have graced the pages of IM since 1981.