Much has already been written about the origins of the current opioid epidemic, but I liked the way this long piece in The Guardian looked at how key groups within the healthcare professions managed to thoroughly underestimate the dangers associated with opioid prescribing– which were well known, and have been for a very long time.

I did want to add an observation of my own, as to why so many physicians were ready and eager to expand the use of opioids in their own practices. It’s because they were already prescribing them to patients for a variety of problems not normally associated with pain.

Example:  Sleep. An estimated 40 million Americans suffer from chronic (persistent) sleep disorders. Another 20 million experience periodic sleep disruption. It’s one of the most frequent complaints that physicians hear. There are many sleep aids available, of course, both prescription and OTC. But most are effective for a relatively short period, after which they lose effectiveness and our sleep problems return. It’s frustrating, for both patient and physician.

Which has led some to resort to that old standby, the opioid.

A few years ago a friend called me to say his physician had placed him on a regimen of low-dose codeine for his insomnia. My friend was in his 60’s, now in longterm recovery following a frightening decade of addiction to cocaine, alcohol, and benzos. He reminded the physician of this history, but the doctor argued vigorously in favor of turning to opioids based on his own experience with other older patients. At any given time, he claimed, there were half a dozen seniors in his practice who took low-dose opioid medication at bedtime for sleep. He insisted there were no cases of addiction and only rarely did someone ask for an increase in dose. In his view, this experience outweighed the risks.

My friend had been clean and sober for almost twenty years, the physician noted, so whatever habit patterns and psychological problems had led to his earlier problems had obviously healed. Now the problem wasn’t drug abuse, it was sleeplessness. So why not try opioids, and if problems do develop, the patient can let the doctor know and they’ll simply stop the prescription.

I’ve run into this line of reasoning before. Here are several important flaws:

The doctor assumes that someone in stable recovery from serious drug addiction is no longer vulnerable to future problems of that sort. There’s plenty of clinical evidence to contradict that notion.

He goes on to attribute addictions to bad habits and psychological distress. That’s straight out of the 19th Century. A more modern view is of addictions as complex disorders based in genetics and neurophysiological adaptation.

He compares my friend’s case with other seniors based on age group, rather than with other people in recovery. To me, this is like comparing a refrigerator with a TV simply because both plug into the wall socket.

It’s these outdated attitudes that enable the healthcare professional to ignore important information provided by the patient.

Worse yet, he maintains that if problems did emerge, it would be a simple matter of stopping the prescription. Oh, would things were that easy. It’s based on the misconception that addiction is really just abuse, and controllable through an effort of sheer willpower.

I don’t have a solution to this, other than to warn the person in recovery to seek out a physician or other practitioner with expertise in addiction treatment and consult them as needed when issues of medication use pop up– as they inevitably will.


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