The Grand Illusion
Roughly two years ago, I wrote about a friend who committed suicide because the medical profession denied him the opioids he had been taking for years, despite the fact that he had managed his pain successfully at the same levels for years without increases in dosage.
While this is not a personal problem for me, I’ve seen this problem increase among people I know, and from what I’ve observed and from the statistics, the problem has continued unabated, and there are scores of articles in both medical journals and government publications, as well as a number of studies, that show, among other things, that reduction or elimination of opioid pain medication dramatically increases suicide rates among those with chronic pain.
There have been successful lawsuits against doctors and medical providers for failing to provide adequate pain relief to patients who then committed suicide. Another study of more than 100,000 veterans on pain management medications showed that among those who had their dosage reduced or eliminated, the suicide rate increased 50%.
While the rate of opioid overdose deaths has also increased, almost all of the increased overdose deaths were the result of using illegal opioids, which makes perfect sense. When people suffering acute chronic pain are denied relief, many of them will look for any way possible to dull that pain. That’s also why alcohol use/abuse goes up among chronic pain sufferers who turn to suicide, although most of the medical literature has it backward, often claiming that excessive alcohol use contributes to suicides among those with severe chronic pain. No, people in pain are more likely to turn to alcohol to reduce or dull pain.
Yet the crusade against opioids and overdoses continues, partly because no one is really addressing the root cause – and that’s pain.
Is anyone out there really looking hard for a non-addictive, inexpensive, and effective painkiller able to eliminate or reduce severe chronic pain?
Probably not, at least not until they can charge at least $1,000 a pill for it.
I’ve been taking codeine (2x10mg tablets or 20mg doses at a time) in moderation for a number of years for recurring back and neck pain.
Until a few years ago I was able to purchase it over the counter at the pharmacy and then after being pressured by doctors the Australian government changed the rules so that I required a prescription to purchase it.
Sometimes I go 4-6 months without needing a prescription and other times 1-3 months and it feels like a fight every time to get a prescription.
When I used to be able to purchase it over the counter I had a “safety net” of being able to have some pain relief on hand when it was needed. Now if my pain flares up I have to make my way to the doctor to get a prescription and then make my way to the pharmacy all whilst in pain that it is at times quite severe.
Where I live even before a prescription was required to get codeine based pain medication there were already some pretty tight controls in place. In my state I had to provide my details and identification when I purchased codeine. That information was recorded and shared statewide between pharamcies. I could only purchase one box of 20 10mg tablets per fortnight regardless of which pharmacy I went to.
My pain is not chronic and when it flares up usually bearable to a degree. When I do take codeine for the pain I usually put up with it during the day and only take a dose of codeine before bed so that I can get a good nights sleep.
For myself the growing crackdown on opioids has mostly been inconvenient and somewhat frustrating. The way things are now I wouldn’t want to be in the shoes of people with far more serious and/or chronic pain.
I was so open and honest with my pharmacist. I said I had a check list I would use when deciding to take a pill. This often resulted in my not needing that 4th tramadol. I created a small surplus which REALLy came in handy if there was a snowstorm, any disruption in my transportation, a new injury..it just plain WORKED and I held a job and everything. Cutting out that one stupid pill has taken basically everything from me in a slow agonizing way. My pharmacist chuckled and said “Don’t use that word ‘stockpile’.” I was like, “Why..it’s what it is called right?” He said “Yes, but that doesn’t sound good.” shortly after this, things changed..I started to find out that all that honesty/transparency with doctors and professionals worked against me. All of a sudden the doctor figured, well, if you say you at times can make it with just three per day, let’s keep it at 3 per day. I’m sure doing so somehow helped keep the government off my doctor’s back. I guess I am happy to help with that. it gives me something to put into my suicide note if the time ever comes.
Big pharma still has programs looking at drugs for pain. These efforts wax and wane as the science changes. Keep in mind that drug discovery is a high failure rate process (when I started in the industry it was common knowledge that the ‘success rate’ for small molecule drugs was less than 1 in 10,000 investigated. For many, many decades most big pharma companies would be able to bring to market only 1 new drug per year).
Cancer is still a very large focus for most drug companies given the prevalence, impact on those afflicted, and yes, the market return.
As for pain, the more recent efforts from pharma companies have been targeted at migraine and quite a few new products have hit the market as a result of those efforts.
As for general pain, I know that Eli Lilly lists 3 drugs on their website that are under clinical development at this time for pain.
So, yes, new drugs targeting this all too common human affliction are still being actively investigated. And yes too, new drugs command an extraordinarily high price – especially in the US market.
I’m glad to hear about the research, but remain skeptical about big pharma’s pricing models — and their rationalizations to support that pricing, especially after the way they’ve effectively bankrupted many of those who need insulin and other drugs.
The problem is that for decades in the US, drug manufacturers encouraged doctors to push stronger and stronger drugs onto people who didn’t need them in order to reap eyewatering profits.
The broken nature of the US healthcare system meant for many people, this was the only economical means to treat their pain, and the addictive nature was heavily downplayed. Now they’re addicted and the reduction of the drug brings both withdrawal symptoms *and* the return of the pain. It’s a guaranteed trigger for a rapid downward spiral, and one which used to be ignored as a poor person’s problem but is now endemic in middle America’s housewives.
Internationally it gets weirder – a combination of importing US drug law attitudes into the West means possession of any of a class of drug is treated as possession of the most serious examples, so codeine is becoming as restricted as morphine now, while doctors readily prescribe oxycodone and fentanyl. That crosses with the huge demand for illicit drugs, meaning anything that could be a precursor is restricted as well, so vast swathes of ordinary people are restricted in what they can easily obtain without paying a doctor to prescribe it. Meanwhile the organised criminal elements just order the precursors direct from China and smuggle them in – raiding pharmacies is for the poor and desperate now.
I read the first couple of lines and that’s all i can do right now..I needed to know if I was the only one. For over a decade I was allowed 4 tramadol a day, it was changed for some reason to 3. I’ve not been able to make that work at all and my life has been falling apart ever since. I cannot seem to make my doctors understand.
ugh i’m so sleep deprived and pain is making me screw up left and right. I really believe this reduced dosage in my pain medication has directly resulted in some serious mistakes in my life including a car accident. My pain is too “loud”. The dosage I had for years quieted my pain so that I could concentrate and do tasks. Now, after a car accident, i have added more pain and I feel so devastated. I am trying to find out just how many suicides occur do to pain plain and simple. If you have ever experienced something called akathisia it’s so hard to describe. There’s a wiki..a poet or something describes it well. i’m in so much pain i can barely seek help to get through it
You say 2 years ago you wrote about a person suffering this problem with doctor reducing dosage..You don’t include where we can read this story..Can you help us to find it and read it.
That blog was https://www.lemodesittjr.com/2017/12/08/another-statistic/