Seldom Mentioned Downside Of Painkiller Epidemic: Patients Don’t Feel Better

When I signed on board Hospice Inc., in New Haven, Connecticut, in 1975 as a bright 25-year-old who wanted to do some good in this world, the challenge put to me by Florence Wald, a former dean of the Yale School of Nursing who had organized the young organization to build the very first inpatient hospice in the United States (which she succeeded in doing five years later in neighboring Branford), was that we had a mission to reshape public attitudes toward the control of pain in America.

Florence Wald’s experience in the U.S. healthcare establishment was that physicians here were much less willing to use powerful painkillers like morphine in treating the terminally ill than their British or European counterparts because of a misplaced fear of addiction. “Terminal cancer patients don’t get addicted to painkillers,” Florence told me flatly, “nor do they experience euphoria from the use of painkillers. This is a perception that is just dead wrong, and we need to change it. We can treat pain more effectively, and we have a duty to do so.”

In the third of a century since then, the burgeoning hospice movement in America has brought comfort and freedom from pain to millions of Americans facing terminal disease, and eased the predicament of their families, who often suffer as much if not more than their dying relatives. Public attitudes toward painkillers have also evolved dramatically, including the views held by America’s physicians, who have become more willing to condone powerful opioids when they are needed to control pain.

But there may have been a downside to this change in perception and prescription.

Barry Meier is a reporter for The New York Times who has written extensively and eloquently on problems associated with prescription painkillers, a little-discussed epidemic that began about twenty-five years after I concluded my two-year stint with hospice. In June, Meier published an ebook with the “Kindle Single” program at Amazon called A World of Hurt: Fixing Pain Medicine’s Biggest Mistake which explores this chapter of the American prescription painkiller story, which is simply this: There is a growing body of evidence that these pain-numbing drugs, along with causing an epidemic of abuse, are often quite ineffective in treating long-term pain. They may actually be harming patients.

Barry Meier’s first book, Pain Killer: A ‘Wonder’ Drug’s Trail of Addiction and Death, focused on a better-known story about painkillers, namely the pandemic of abuse that occurred surrounding the powerful drug OxyContin, especially by teenagers seeking a new high.

Barry Meier was interviewed by his paper on June 23, 2013, and elaborated on what he was trying to do with his eloquent writings on painkillers, why doctors and patients resist giving them up, and some of the side effects of these drugs.

“A decade ago, drug companies and medical experts launched a ‘War on Pain’ that promoted the widespread use of powerful narcotic painkillers for common conditions such as back pain,” Meier told the Times. “Specialists claimed that a ‘bright line’ separated the drugs’ benefits for patients from their dangers when abused on the street by young people and others.”

Today, Meier says, many of those same experts who once endorsed painkilling drugs have had a change of heart. They have reached the revised conclusion that the opioid boom “ranks among medicine’s biggest mistakes.” They cite recent studies that tie long-term use of these drugs, particularly at high doses, to addiction, dependence, reduced sexual drive, lethargy and other problems. Based on stories of researchers, patients and others, A World of Hurt highlights how treating pain differently can benefit both pain patients and the public’s health. “The promise that high-powered drugs could provide a cure-all, the key to winning the ‘War on Pain,’ was an empty one,” Meier asserts.

Meier’s critics will argue that the compelling anecdotes and stories he puts forward, along with references to various studies, don’t make a case strong enough to deprive patients who suffer from pain from the medications that allow them to manage it. No one claims pain control is perfect, and the jury is probably not in yet when it comes to assessing the level of abuse or misuse. More work will need to be done. But I see the pendulum swinging the other way today than I saw it moving in 1975.

What is the answer? Perhaps a better scientific understanding of the brain mechanisms of pain will help us uncover new medications that act differently than opioids? Meier will surely find fertile ground for continued writing on this subject for many more years. In the meantime, he has made a significant contribution to public understanding of pain and pain control, and his new ebook is a marvel of clarity and concise writing. I heartily recommend it.

Want to Feel Better? Be a Five-Year-Old

When was the last time you played like a five-year-old?

If it was when you actually were five years old, then this is an emergency. Go get a box of crayons, stat!

I have the luxury of enjoying the company of a five-year-old regularly. My niece, Emmy, is currently teaching me about living joyfully. She’s reminding me of all the things I forgot from my five-year-old days, and I have to say, I think these are really the essentials a person needs in life.

Here’s a summary:

1) Play hard, then sleep hard. Preferably with your dog snuggled next to you.

2) Eat what you love, even if it is mostly cheese with a side of cheese.

3) Be amazed at yourself and proud of your accomplishments, even seemingly small ones.

4) Cry when you need to cry.

5) Be enthusiastically interested in whatever you’re doing now, until it’s time to switch gears.

6) When it’s time to switch gears, switch.

Things I’ve done recently with my niece include dancing the hokey pokey, eating spaghetti, seeing the movie Tangled (sooooo awesome!), playing at the park, coloring, and shopping. Each of these adventures has been at least as useful as an hour of therapy. Kid fun is infectious, and it reminds me that play for play’s sake, whether I’m playing with writing chapters in my book or coloring in a princess coloring book, is possibly the most important thing I can do with my time.

Want to create more energy in your life? Want to feel better? Want to have a better relationship with your body?

Play.

I asked Emmy today how she has so much energy. She mulled it over for a minute. “I think,” she said, “kids just like to do stuff, and so they just keep doing it.”

That about sums it up. Do what you love. Play at it, don’t work at it. Love what you do. Love you. Life – all you really need to live it to its fullest potential is everything you knew when you were five.