Kafer: Opioid epidemic narrative omits role of personal responsibility

Last week, Colorado joined a growing number of states, cities, and counties in suing Purdue Pharma L.P., the maker of the prescription painkiller Oxycontin on the grounds that the company intentionally misled health care providers, policymakers and the public regarding the medication’s risks.

It’s the latest chapter in the current “opioid epidemic” narrative: Greedy Big Pharma pushed addictive drugs on naive doctors who over-prescribed them to patients with chronic or post-surgery pain. Patients became addicted and, unable to feed their addiction, turned to heroin and other street drugs. Government sued the bad guys on behalf of the victims. The end. The storyline is a rerun of the past two “epidemics” when Big Food made us all obese and Big Tobacco forced us all to smoke two packs a day.

Frankly, I’m grateful to Purdue. I’ve had five orthopedic surgeries in ten years and Oxy made recovery from each possible. I didn’t lie in bed wailing in pain as I had done post-surgery in the mid-’80s when doctors were a bit stingier with prescription painkillers. Opioids made my dad’s three year battle with terminal cancer livable. Nothing else can block the searing pain of bone tumors. Also, the little white pills keep a friend of mine from losing her mind from unrelenting chronic pain from a rare disease. None of us has taken painkillers recreationally; not that being tired, out-of-it, and constipated isn’t tempting. What happens to us when lawsuits drive up the cost of painkillers or encourage doctors to not prescribe them when needed for acute or chronic pain?

The problem with the current opioid narrative is that it doesn’t take into account the millions of people who responsibly take opioids for pain management. In fact, the issue of personal responsibility doesn’t come up at all. Drug addiction is always the fault of drug companies, irresponsible doctors, despondency in the Rust Belt, cultural breakdown in Appalachia, or some other cause other than the choices of the person taking the pills. This blame game does not help addicts or those who take painkillers responsibly.

First of all, most people who take opioids for pain do not become addicts.  One survey of research found that people without a history of addiction who took prescription opioids for long-term pain relief had a very low risk of developing addiction or abuse.

They may develop dependence, but that’s not the same thing. According to the National Institute for Drug Abuse, drug dependence occurs when the body has come to rely on the presence of the drug and reacts adversely when it is withdrawn. That’s why regular coffee drinkers get a headache when they abstain. Because of severe, possibly life threatening withdrawal symptoms, people who are physically dependent on opioids need medical support to cease use. Drug addition, according to the Institute, “is a chronic disease characterized by compulsive, or uncontrollable, drug seeking and use despite harmful consequences and long-lasting changes in the brain. The changes can result in harmful behaviors by those who misuse drugs, whether prescription or illicit drugs.”

Sometimes a person who has responsibly taken opioids for chronic or acute pain becomes dependent and addicted, is denied refills, and turns to street drugs to treat pain and withdrawal symptoms.  More often than not, though, abuse leads to addiction.

A person who has been in and out of rehab, who has been resuscitated with Naloxone from near death, who has lost custody of his  neglected kids, and who continues to shoot up isn’t a hapless victim of Purdue Pharma. Pretending otherwise doesn’t help him.

Nowhere in 12-step programs for addiction recovery do they encourage blaming others. Rather, addicts are encouraged to acknowledge the power of addiction, their personal responsibility, and their need for help.

Addiction is hard to break and many wonderful people struggle with it.  We can support their recovery without blaming others, conflating their habit with responsible drug use, or resorting to expensive lawsuits that could curtail access to painkillers for those who need them.

 Krista Kafer is a weekly Denver Post columnist. Follow her on Twitter: @kristakafer

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