Thank goodness that pain remedies aren’t mentioned in the U.S. Constitution.
Otherwise we might have an NRA-style slogan like “Prescription drugs don’t kill people” and no legal basis to pursue opioid pill abuse.
But so far that rationale hasn’t come up as Gov. Ducey and the Legislature moved forward last week with bills rationing Oxycodone and other painkillers in 5- and 14-day doses. The aim is a noble one: Reduce as much as possible the intake of pain pills for anything other than a short-term, clinically diagnosed condition. If that creates an inconvenience for patients with chronic pain, who then must rely on weekly prescription refills, so be it. At least they are forced to maintain more frequent contact with a physician rather than attempting to self-medicate on 30- and 60-day supplies. And the new limits might also be a spur to seek out alternative, non-addictive pain treatments that are common in other countries.
Arizona, however, is not the first state to crack down on prescription painkillers – opioid abuse and overdoses have occurred at far higher rates in some East Coast and Midwest communities, and the legislative responses have been similar to the Ducey plan. The danger with drying up the supply of one kind of addictive substance is that, absent intensive treatment, it creates a market for substitutes. And in this case, heroin and fentanyl can be even more deadly if contaminated or overused.
Yes, nonmedical use of prescription opioids peaked in 2012, according to the National Survey on Drug Use and Health, and total opioid use was lower in 2014 than 2012. Yet the number of opioid-related overdose deaths continues to rise, and the majority nationwide are now from heroin, often laced with fentanyl.
The Ducey plan does include $10 million statewide for more addiction treatment, and that’s on top of the $45 billion approved over the next 10 years by Congress. But several experts have said the federal figure is about four times too small, given the need for sustained treatment with substitute medications, needle exchanges, expanded access to the overdose antidote naloxone, and other forms of harm reduction. And a Blue Cross study found that while diagnosed opioid-abuse disorders quintupled between 2011 and 2016, medical treatment grew by only 65 percent in the same period.
For those who say such treatment only enables addiction and dependency, albeit in a controlled way, consider it as a cost savings. Studies in a variety of journals have found that treating opioid addicts with methadone and buprenorphine results in reduced health care spending of up to $225 per patient per month. Combine those medicines with intensive patient counseling, education and even psychotherapy, and the relapse rate is even lower.
Finally, treatment of opioid addicts is a way to reconnect them to society rather than arrest and imprison them for illegal drug possession – and addiction is nothing if not a symptom of disconnection. That may be hard to quantify or put into legislation. But ultimately the problem of pain is not just just a medical one. How a society supports those in pain and deals with the consequences of opioid misuse and abuse is a test of its flexibility and open-mindedness in the face of dysfunctional behavior. Yes, addicts have to want to participate in their cure. But it’s up to the rest of us to reinforce that motivation.