The debate over abuse of prescription painkillers has reached a fever pitch in this country, pitting doctors and their patients against well-intentioned social crusaders who see a problem and want to fix it. The narrative drumbeat of the alarmists is: If you use prescription painkillers, you could get addicted and start using heroin — or die.
And you might.
Indeed, the statistics regarding abuse of prescription opioids such as Vicodin, Oxycontin, oxycodone, morphine, and fentanyl are grim:
- More than 18,000 people die from prescription drug overdoses every year
- Prescription overdose deaths among women increased more than 400 percent from 1999 to 2010, and 237 percent for men
- Four out of five new heroin users started out misusing opioids
- Drug overdose is now the leading cause of accidental death in the U.S.
It’s a shame, to be sure. And a problem. And something needs to be done.
The Other Side
But there’s another side to this.
The people you rarely hear about are ones like me — people who suffer from chronic pain and use opioids periodically, carefully, strategically — to help manage their pain. The truth is, my life is immeasurably better than it might otherwise be simply because I have a bottle of doctor-approved pills at my disposal.
The only free alternative is meditation — but I challenge anyone to meditate their way out of a back full of crushed and flaming nerves.
Opioids are only part of my pain-management arsenal, but I’m glad I have them. I could live without them, but frankly I wouldn’t want to, especially if I don’t have to.
According to the National Academy of Medicine, more than 100 million people in American suffer from chronic pain, or almost 40 percent of the population. That’s an astonishing number, and it covers all kinds of pain — back, neck, joint, head, you name it.
The key word is “chronic,” which is defined as pain that lasts more than 12 weeks. Twelve is an arbitrary number, of course. If whatever is causing you pain doesn’t go away in 12 weeks, there is a high likelihood that it will stretch into months and years, and perhaps — as in my case — for the rest of your life.
What people who have never experienced chronic, persistent, relentless pain don’t realize is how it impacts, and largely takes over, one’s life.
Chronic means the pain is always there. It’s like a toothache that never stops, except that over time the pain radiates through every cell in your body. It may come and go, recede and attack, and you may learn to live with it (indeed you must), but it never goes away, at least not on its own.
Living with chronic pain day in and day out means managing every moment of your life around it; learning to move in ways that don’t exacerbate it; being hyper-aware of your physical limitations and staying within them; anticipating situations that will cause you pain and avoiding them and disappointing a lot of people who want and expect you to behave like a “normal” person — i.e., a person without pain.
Furthermore, chronic pain saps your energy, drains your spirit, darkens your mood and makes pretty much everything in life that much less pleasant. It takes a lot of the fun out of living and tends to focus the mind on one elusive goal — reducing and, if possible, eliminating the pain.
Sometimes, opioids are the only escape.
I can only report on my own experience, of course, but I know I’m not alone.
I also never expected any of this to happen.
An Early Introduction
As a young man, my body rarely betrayed me. I was an athlete. I played competitive tennis; hiked, biked, and ran; worked out; ate “right” and didn’t drink or smoke. My problems started in my mid-30s, when I was diagnosed with testicular cancer.
Unfortunately, the cancer had traveled all the way up my spine to my sternum, so it was necessary to irradiate my entire spine every day for several weeks. Radiation desiccated the spongy tissue between the discs in my back, eventually crushing the nerves to the point where I couldn’t walk. I spent more than a year on crutches, then finally had surgery to alleviate the pressure.
The surgery worked. I could even play tennis again, for a while. A few years later, the cancer came back, and I had to go through six months of a rather brutal chemotherapy regimen. Chemo does nasty things to the nervous system. In my case, it reactivated my previous back pain, further crushing the nerves in my lower spine. It also afflicted me with some serious peripheral neuropathy, which is basically your nerves going haywire and shooting stinging darts of pain down your arms and legs into your hands and feet.
For many years, I could not walk for more than a block or two, or stand in one place for more than 10 seconds, without feeling like someone had jabbed me in the back with a red-hot javelin. A second back surgery — spinal fusion this time — helped, but not as much as I had hoped.
I share all of this not to gain your pity, but to explain the source of my pain, and why it is sometime necessary to kill it with a carefully prescribed dose of opiates. Also, to emphasize that despite everything that has happened to me, I am a tremendous success story.
I am 55 now, and in the best overall physical shape of my life. These days, I can walk more than a mile with my dogs, I play golf regularly, I can do household chores like cooking, cleaning, laundry and shopping and I can have friends over for a barbecue — all things I couldn’t do 10 years ago. The pain is always there, like a waiting demon, but I’ve beaten it into submission, at least for the time being.
And opiates helped make it possible.
My road to recovery was by no means easy. It took more than a decade, during which time I experienced countless bouts of excruciating pain, along with the nagging day-to-day nuisance of chronic pain — pain that persists to this day, albeit at a much more tolerable level.
To combat my body’s betrayal, I studied its strengths and weaknesses, consulted fitness experts, developed elaborate workout routines to strengthen the “core” around my spine, worked hard to balance my muscle structure and develop a lean, flexible frame.
I modified my diet, altered my posture, meditated and basically dedicated a large portion of my waking life to regaining what most people take for granted — the ability to take a walk, go to a restaurant, attend a party or just move around the house without wincing.
Through it all, however, I had to manage my pain — which, for all chronic-pain sufferers, is an elaborate series of routines and rituals without which they could not make it through the day.
Routine is important, because it allows you to live within your comfort zone. Break the routine and you introduce all sorts of variables that you might not be able to control. The walk from your parking space to the restaurant might be too long, forcing you to spend the entire meal in quiet agony. The item you’re looking for at Target might turn out to be on other side of the store, beyond your mobility zone. It could be one of a thousand things, but if you can stick to your routine, you know how much pain to expect, and can plan for it.
What I call “rituals” are routines too, but they’re more important. Rituals are the things you must do every day in order to cope. Medication is part of that. I only resort to opioids (Vicodin, in my case) when everything else fails.
For me, “everything” starts with three or four ibuprofen or Aleve (I alternate them) in the morning, along with some stretching. I also take a drug, Neurontin, which reduced the peripheral neuropathy to a tolerable tingle in my hands and feet. In the afternoon, I take three or four more ibuprofen and hope it’s enough to get me through the day. If by the end of the day my back is throbbing, I hit it with some Ben-Gay and an ice pack. Sometimes, floating in a pool or taking a Jacuzzi helps. If none of that works, I reach for the Vicodin.
Part of the reason I lean on the Vicodin is that if I tell my doctor I’m taking more than six or eight Aleve a day, he gets a worried look on his face because he knows what it’s doing to my kidneys. I don’t want to develop a resistance to Vicodin, though, so I usually break one in half and hope it does the job. Usually it does; if not, I take the other half. Rarely, if ever, do I take two at once.
A ‘Vacation’ Through Vicodin
The thing is, chronic-pain sufferers still have to work and live like everyone else; it’s just a lot harder.
Living with chronic pain is like waking up with half a tank of gas when everyone else has a full one — but you still have to travel just as far. For me, the occasional Vicodin vacation offers a brief respite from the pain and a chance to refuel, so I have the strength and will to get up and do it all over again the next day. Knowing it’s available to me if I need it also offers a measure of psychological security. No matter how bad the pain gets, there is some reassurance in knowing that I have the power to stop it.
But the fact is, I choose to live in a certain amount of pain. I could take Vicodin every day and have almost no pain, but I can’t function that way, and don’t want to.
These days, weeks can go by without me needing a Vicodin, largely because I know what my limits are and I have organized my life to avoid exceeding them. But I have a supply, just in case.
From the Outside
It’s interesting to live in chronic pain and watch people who don’t have it discuss how chronic-pain sufferers should and shouldn’t manage their suffering. Nowadays, because of the opioid epidemic, there are people who, if they had their way, would restrict them ridiculously or ban them altogether. Others talk about how patients should consider alternatives for managing chronic pain, typically massage, acupuncture, chiropractic care, biofeedback, yoga and meditation.
Personally, I think this is a great idea. I don’t like taking pills, and don’t particularly like the way Vicodin makes me feel. I would love to incorporate massage, acupuncture and a chiropractor into my pain-management routine. Unfortunately, I can’t afford it, and I can’t afford the kind of insurance that would pay for it. Yoga/Pilates classes aren’t free, either. In fact, the only free alternative on that list is meditation — but I challenge anyone to meditate their way out of a back full of crushed and flaming nerves.
Then there’s medical marijuana, which may soon may be available in Minnesota to chronic-pain sufferers like me. I might be willing to try it, but again, the price is too high. Besides, if I wanted pot, it’s not hard to get, and it’s a lot cheaper on the street.
But even if it worked, I couldn’t afford to sit around stoned all day, either. I’m a writer; I need my brain. (For the record, I have tried Cannabidiol (CBD), the legal hemp-oil extract, which supposedly contains the pain-fighting cannabinoids in marijuana without the THC high, but it didn’t work and I felt bad the whole next day.)
The fact is, opioids are the cheapest, best option available for treating chronic pain. The other advantage they have over other “options” for pain management is that they really, truly work. Reliably. Every time. And until researchers come up with an affordable drug that works just as well and doesn’t cloud your head, I’ll keep taking them.
The Real Questions
What stuns me about the public hysteria over opioid abuse is the questions that aren’t being asked. For instance, what does it say about a society when more than a third of its citizens are in a state of persistent, debilitating pain? What is it about American life that causes so many of its citizens to retreat into a narcotic haze, to say nothing of its appetite for alcohol, antidepressants, and other chemical escapes?
Why are so many of our young people anesthetizing themselves with heroin and other drugs rather than enjoying the vitality of their youth? And for those who succumb to addiction, what hole in their lives are they trying to fill that the capitalist, success-at-all-costs merry-go-round of the American Dream cannot?
These are difficult questions. It’s much simpler for people like me. For us, it’s all about the pain. I wouldn’t take Vicodin if living didn’t occasionally hurt so much. But I’m glad I have it, and until a better, cheaper solution to the agonies of the human body comes along, I’m going to keep taking it — but only when I need to, when everything else fails.