We've all seen the news stories. They're often labeled things like Oxycontin abuse: the invisible epidemic. No matter what name the story is filed under, they all share a common theme. The theme is that there's an "invisible epidemic" out there of otherwise healthy people using prescription pain medications to get high. I fail to understand how they can call this an "invisible epidemic", doctors know about it. Everyone and their mother has seen umpteen "news" stories on the issue. Please follow me below the fold as I explain what the real invisible epidemic, an epidemic that is a direct result of so much attention paid to the very visible abuse "epidemic", really is.
Anyone who knows much about the history of drug over prescription and abuse has seen the same thing happen with other medications, to one degree or another. A good example is methamphetamines/amphetamines. When we think about methamphetamines today we think of toothless junkies in unwashed clothes who obtain them from dealers on the corner, for the most part, this wouldn't be much off. However, and really it was only a few decades ago, the most common user of amphetamines were soldiers and house wives with a legal prescription from their doctor. The prescriptions were written for various reasons, ranging from weight loss and to fatigue from being the first one awake, the last one to sleep and with so much to do in between. Those with ADD are among the most prescribed stimulants today. Hell, JFK received regular injections of amphetamines.
So, what happened? The war on (some)drugs, media hype and more appropriate medications for the ailments that amphetamines were being prescribed for all contributed. However, for the most part, it was media hype and the Wo(s)D. The prescription of stimulants became more regulated, doctors became afraid to prescribe them and people felt ashamed to ask for or be put on them.
Well, it has happened again. This time with the only really effective pain medications, opiates. However, this time it is much, and I do stress the word much, worse. Stimulants were never a good means of weight loss. I should know. At 16 I went from 180lbs to around 130 in a couple of months, thanks to meth. The problem is that I put all of it back on, and them some, shortly after I quit using it. Even having ADD and living without the aid of stimulants isn't that bad. The condition does abate some with age so now, aided with copious amounts of caffeine, I can function at work and life in general. Pain, on the other hand, can be just as debilitating as losing the use of your legs. Severe pain even more so.
Let me tell you a story to show you how it works.
I have been wanting to write this for a long time. The refusal of doctors to prescribe or the under prescription of narcotics has become a serious issue these days. There are a few examples from friends I could have used to illustrate my point. The wall I was running into was that I didn't feel it was right to lay their lives out in the open for everyone to see. Well, sadly, now I can use my own life, or lack there of, to show how this has become a problem.
This all started two months ago. I'm being conservative with time here as it is hard to pin down exactly how long ago this started. Not being able to work and taking my sleep where I can combined with time stretching out forever while my head screams, days run together to the point that sometimes I think it is Monday when really it is Friday. So, anyway, no less than two months. Probably closer to two and a half. It all started with a head ache. Like anyone who gets a head ache I took some OTC pain reliever and went about my day expecting it to go away. Well, it didn't. Instead of going away it got worse and suddenly I found myself running to the bathroom to empty my guts. Still, I wasn't worried. A bad head ache and an upset stomach, hardly something to freak out about. Little did I know that this was the begining of what has seemed to feel like the end of my life.
Not only did the pain in my head, combined sometimes with nausea and vomiting, not go away, it started getting worse. About once every day or two I would get a "head ache" that felt like spiked plates were pressing against my head, trying to force my brain through my forehead. I had no idea why this was happening. I have no history of head aches, personal or any family that I know of. I thought everything was figured out when a broken tooth abscessed and started hurting like hell. It fit, tooth was causing the head aches. The bacteria had an easy escape so, rather than building up pressure in my gums, it was leaking into my stomach and causing the stomach problems. I did a walk in visit to where my wife sees her doctor and scheduled a dental appointment to have the tooth taken care of. The doctor prescribed 5mg hydrocodones 1 every 4-6 hours and antibiotics and instructed me to do what I had already done, make an appointment to see the dentist. He gave me what he said was enough for a week, which was the earliest I could get a dental appointment.
Well, the "week" worth of pain medication lasted about half that. The worst part was that it fell on a weekend when I ran out so our doctor's office was closed. After hitting every clinic on the way, and being told my insurance either wasn't taken or wouldn't cover it, I ended up in the ER. After three hours it became apparent I had been labeled a drug seeker because no one seemed to give a crap how much pain I was in or willing to allow me any means of relief. The noise of the waiting room was killing my head and, when my wife asked if we could wait in a hallway that was near the ER, the guy at the desk replied that "we could do whatever we wanted but I'm not going to go looking for you". I waited 3 hours and never was seen. I couldn't take it any more and ended up going to the store and buying a 1/5th. Drank the whole bottle over a few hours hoping to pass out. It helped with the pain but I remained awake. Drunker than s**t but awake, and still in pain and what has now been diagnosed as a migraine flared up. I was lying on the floor, holding my head while crying and screaming that I wanted to die. My wife took me to the second ER we have here. I lucked out this time. They got me right in to a nice dark room, well away from where they were putting any other patients and the nurses station to ensure I had as much quiet as possible, and gave me an ice pack. The doctor made my wife promise to keep them away from me until I had eaten and sobered up a little and prescribed me Oxycodone, 10mg 1 every 4 hours, to get me through the 3 more days I had until my appointment and commented that he couldn't believe the previous doctor had prescribed such a weak dosage with my condition. Well, that's what my wife tells me. To tell you the truth I don't remember much of anything after about half the 1/5th. Though, from what my wife has related to me of the incident, I'm thankful that I don't.
I wish I could say that my problems ended after the tooth extraction and antibiotics, because they didn't. After the pain medication I was given ran out, the constant head aches and daily migraines came back, both were absent the entire duration of the time I was on opiates, even when I had to take another pill because my tooth was hurting. At this point I'm totally freaked. Like I said, no history of head aches for me and no known family history. So what's a guy to think. First thing that popped into my head is brain cancer. So, I go back as a walk in to the doctor's office and see a nurse practitioner. I explain what has happened up to this point. How it all started with a head ache that wouldn't go away, how OTC medications didn't phase it and how the only time I hadn't hurt was when I had been on medication while waiting to see the dentist. All of this history of head ache and the original prescription was at that facility, there for, all in their charts. She was very nice and said she'd have a head CT ordered but only a doctor could prescribe narcotics and she would have to see him about it. When she came back she said the doctor agreed with the head CT but said that the head aches were probably just "rebound head aches" from the narcotics, even though they started first. Not only didn't they give me anything for the pain, I was told I wasn't even allowed to take any OTC medications. The only thing I could do is lay in a dark room with an ice pack and suffer through it as even OTC pain relievers would keep causing rebound head aches.
Had a follow up appointment after the CT two weeks later. CT was clean, no cancer but still no change in my pain, even though I had complied with the doctor's order to not take any pain relievers. I was diagnosed with migraines. At this point I was thinking "Great, they'll finally give me something to stop the pain." Wrong, I was given a prescription for something that is supposed to prevent the migraines and told to come back in two weeks.
Two weeks was yesterday. The preventative medication hasn't been a complete failure. The constant pain is slightly less and it has helped a little with the duration and intensity of the migraines. The problem is that my head still hurts most of the day, the migraines still come every day and they still hurt like all hell. I told this to the doctor (real doctor this time as it was an appointment vs walk in). He concured with the diagnoses of migraines and said the constant head ache was probably a tension head ache.
So, did I receive a prescription to ease my pain. Yes and no. Yes, I was prescribed something for when the pain flares up. No, it doesn't work for s**t. Rather than prescribing me even a mild opiate, he prescribed me Fioricet. Fioricet is a barbiturate combined with acetaminophen and caffeine. My experience with it yesterday has led me to believe it has only two useful purposes. At about 4X the prescribed dose I passed out in a puddle of drool. Useful because a quick shower resolved the icky saliva off myself and, by the time I came to, the migraine had passed. As for the second use, I'd prefer not to talk about it. Suffice it to say that, as the painful days go by feeling like a useless child, I think about it to much as it is. I think stating that Marilyn Monroe died of a barbiturate overdose, the respiratory depressant effects on par, if not worse than, opiates.
The real thing that felt like a kick in the nuts is that, in researching the new medication (Always research your medications, doctors make mistakes too), I found out that the same drug is available with codeine! Had I been prescribed that it would have had a much better chance of being effective against my pain.
So, you may be asking yourself, why, if the same medication was available with a mild opiate, didn't my doctor prescribe that? Easy one to answer, due to the war on (some)drugs and all the media hype around the "invisible" epidemic, doctors are reluctant to prescribe opiates, even when needed. In fact, the ER that is part of the same network as my doctor, has a big sign on their ER stating that under no condition will they give anything stronger hydrocodone. Unfortunately, due to my insurer, I have no choice in which doctors I see. Any doctor that takes my insurance will be part of the same network that treats everyone like drugs seekers, another nice effect due to all the media hype about America's "invisible epidemic", doctor's offices and ERs treat everyone in pain like a junkie and the onus is on the patient to jump through all sorts of hoops while they suffer and to prove that they're not.
I can understand how a doctor would be concerned about addiction and all that, I've experienced that life and it is a horrible one. The problem is I have no life right now. I sure as hell can't leave the house during the day, more than a few minutes of my eyes being exposed to sunlight is guaranteed to leave me lying on the floor crying and trying not to think about that bottle of pills that could end my pain, for good. Even at night I'm fearful to go anywhere. At least at home, with the aid of an ice pack and a quiet dark room, the intense pain only, laughs at the word only, lasts a few hours. Absent those comforts it stretches on until I can find myself in a quiet and dark room for an hour or two. I sure as hell can't knock myself out with the Fioricet at work or other public places. Which reminds me, I haven't been able to work this whole time and my doctor's signed the forms saying I have to return to work on Thursday.
I don't know what needs to be done about prescription drug abuse, or that anything can or should be done about it. Before people were taking Oxycontins to get hey they were taking heroin, all the pills did was replace what was already there. In my view that's a good thing. At least with the prescription pills just what is in them and how much of it is a known, reducing the risk of an overdose or a death from something nasty that was used to cut the drug. I remember living in the bay area when there was an outbreak of flesh eating bacteria tainting the heroin, at least people wouldn't have had to worry about crap like that if they were doing pain pills instead. What I do know is that is is cruel to make people who are in pain suffer in order to guard against the possibility that they may just be trying to get high.
UPDATE
I'd also like to point a couple more things out. First of all, age and sexual discrimination are rampant when it comes to treating pain here. My wife's mother had a friend in her mid thirties, same city as me, that was prescribed oxycodone due to knee pain from being overweight. Also, I spoke with my manager the other day. He was questioning me on why I had not returned to work yet because one of my female co-workers, maybe a year or so age difference, started having issues with head aches and migraines after I had to quit coming in. She returned to work two weeks later with a purse full of pill bottles. Among them are 1000mg naproxins, that she keeps with her, and the 10mg oxycodones she keeps locked in his desk while at work.
I just don't get what is going through my doctor's head. At this point I've spent hundreds of dollars on co-pays and prescriptions, over a grand on an ER visit and missed tons of work. If I just wanted to get high it would be a hell of a lot easier, not to mention cost effective, to fail one UA for opiates along with a few notes from friends stating I've been adicted to opiates for a year to get me into the methadone clinic, which is something I'm considering.