Commentary: Attitudes about opioids contribute to their abuse

By S. Guinn

In regard to Sharon Sayler’s article in the April 13 Herald, “Opioid abuse an issue for elderly,” I would like to make a few comments and observations. I will start by stating that, due to long-standing chronic medical issues, as well as recurring acute pain issues, I have been on various forms of opioid pain medications daily for a very, very long time.

As for being elderly, I do not like to think that going on 64 years of age qualifies me in that regard — I will leave that to the reader. However, I can categorically state that I am not an “opioid abuser.” I can make this statement based on the responses of my pain management specialist over the years when I again bring up the possibility of alternative therapies, only to be told there are really no alternatives available. And also the fact that the UW Medicine Center for Pain Relief will not even make an appointment for me to be evaluated, based on their review of my medical circumstances. Their response is that they, too, would have nothing else to offer me.

The fact is that opiates are unique in their chemical synergy with the human body because we have “receptor sites” to which the opiate molecules are a perfect match. This makes opiates extremely effective and safe pain management tools, but — this is the important point — when prescribed and used responsibly.

So, how is it then that so many people are getting into trouble when prescribed these medications? I think part of the answer lies in how we perceive them and discuss their use. A key misperception is revealed in the first sentence of Ms. Salyer’s article, “It’s a myth that abuse of opioid painkillers is just a problem among young people.” To say that something “kills” something else is to imply that it destroys it completely.

Opiates certainly can reduce pain — but a large enough dose to “kill” pain is completely inappropriate and, in fact, dangerous in anything but a hospital setting. When patients are prescribed opiates for home use to control pain, they must understand and acknowledge that they will not be “pain free.” Realistically, the very best result they can expect would be a 25 percent to 30 percent decrease in the severity of the pain they experience. If they expect the pain to be reduced to zero, and take more medication to try and attain this, serious problems of the type we now increasingly see are the result.

The problem is compounded by the constant characterization (and therefore the expectation) of the result of opiate use as being a “high.” In fact, when using the proper dose of opiates for functional pain moderation, there is no “high” involved.

One sure sign that too much medication has been taken for daily use would be this sensation. Clearly, this is what true abusers are seeking. My main concern in any discussion of this issue is that we must clearly differentiate at all times between those using opiates for legitimate medical purposes and those who use them recreationally. We cannot allow the misuse of a valuable medical tool by a minority of people to be leveraged as an excuse to deny those with legitimate needs a medicine that will mitigate their suffering.

I do not pretend to have any absolute answers to the problems we face as the result of opiate abuse. But I think great improvements can be made in the medical setting by simply making certain patients prescribed opiates have a clear and accurate understanding of their proper use.

It is certainly a fact that people respond to drugs in different ways. Some have what is termed a psychological “addictive personality” and those individuals need to be identified and given appropriate treatment as soon as their circumstance becomes known. Individuals who become “addicted,” from whatever cause, should be afforded “treatment on demand” as part of a comprehensive mental health program. Those whose bodies have become physically dependent must be treated with the appropriate medical circumstances should their need for pain mitigation change over time.

My final thoughts relate to how opiates result in negative social consequences. Property and violent crimes occur as the result of those with untreated addictions seeking virtually unlimited amounts of money to afford what in reality is an extremely inexpensive drug to produce.

Opiates, when pure and whose strengths are known, can be used safely in most circumstances. Epidemiological data consistently demonstrate that people “grow out of” what are addictive habits all the time, if that addiction is allowed to run its course. Ironically, interrupting addictions with treatment frequently only serves to prolong the process and, in fact, enormously endangers the “addict” as they relapse and attempt to resume use where they left off when their bodies are no longer able to tolerate the drugs at the dosages formerly used. Not knowing exactly what they have obtained “on the street,” is another factor that has resulted in countless overdose deaths.

Drug use, under any circumstances, is a medical issue. To primarily address it in any other way is pure folly.

S. Guinn lives in Snohomish County.