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'Script Wars

Some knee-jerk reactions to the opioid epidemic may do those with chronic pain more harm than good


It’s well-known that America is in the midst of an opioid epidemic. What seems to be less known is that the pendulum that crashed into the pill mills that started the epidemic is now swinging too far the other way, punishing people who are already hurting.

There is no doubt that opioids are dangerous in the wrong hands. There is no doubt that we have an issue with them, that they’re killing people and that the prescribing of these medications needs to be reviewed and managed. However, with our knee-jerk reaction to the crisis, we are inadvertently creating more problems and harming innocent people.

The current epidemic did not happen overnight. It began in the late ’90s and early 2000s, when greedy people hired greedy physicians and opened storefront pill mills, handing out highly addictive medications to hundreds of thousands of people who didn’t need them. This, of course, led to the creation of hundreds of thousands of addicts over the course of a decade. From 1999 to 2011, the number of opioid prescriptions written quadrupled. It’s no surprise that, from 1999 to 2008, the number of overdoses also quadrupled.

It wasn’t until 2011 that the government started stepping in, systematically shutting pill mills down. This was great because it took a lot of dangerous medications off the streets and out of the hands of addicts. What was not great, however, was what came after the sweep. Taking the supply away does nothing to cure addiction. Because addicts weren’t offered treatment and the medications they took were so expensive on the street, people quickly turned to a cheaper alternative: heroin. This led to a heroin overdose epidemic.

Hindsight is 20/20, but I fear that we’re not learning from our mistakes. This time it isn’t otherwise healthy addicts that we’re cutting off, though. All across the country, legitimate pain patients are being cut off from their medications; now we’re seeing a spike in overdoses of heroin and Chinese-made fentanyl. When someone is in daily, excruciating pain and the only thing that allows them to function is taken away without recourse, they often become desperate. Some have even committed suicide to escape the pain. Others have turned to the street dealers skulking in the alleys with cheap alternatives.

There is already stigma and lack of sympathy surrounding chronic pain patients. What a lot of people don’t seem to get is that the majority of those who are in pain management have tried other modes of treatment. They’ve undergone surgery, physical therapy, massage therapy, facet injections, etc. and have turned to pain medication as a last resort.

Chronic pain patients do not enjoy being on these medications. They would much rather not have to deal with the pain, stigma and anxiety. They don’t enjoy having to wonder every single month if they will be cut off or if the pharmacy will have what they need. Being a chronic pain patient is not fun; it’s a living hell. They are dependent upon a pill to function—that means they’re at the mercy of multiple factors, including the whims of people who have no idea what they’re going through.

We have a real problem with opioids, but the problem is not the patients who have been taking them and following the rules and passing drug tests for years. The problem lies with knee-jerk reactions inspired by fear and a desire to make it seem as though something is being done. It also lies with the lack of options that actual addicts have.

Addiction treatment in this country is woefully inadequate. It is difficult to navigate, expensive, confusing and often overwhelming. We have always treated addiction as a criminal issue instead of a mental health issue and this has caused us to neglect meaningful reform.

There are ways to combat this epidemic that do not punish innocent people—this is what we should focus on. We need to do more research into how marijuana assists people weaning themselves from opioids. We need to do more research into alternative methods of treatment, including those that are less expensive than what’s sold now.

Some pain management clinics require patients bring their medications to every visit to be counted to ensure they’re complying with doctor’s orders. All pain management offices can and should implement this tactic, which allows providers themselves to handle whatever issues their patient may be having. If they’re selling the drugs because they need the money, providers could offer assistance resources and stop writing prescriptions. If they’re taking too much, doctors can get them help. Instead of denying them help, the patients could be eased off or sent to therapy, and we’d have fewer people looking for drugs from street dealers.

We could create roles in government and medical offices for patient advocates. This would not only create jobs, it would also give patients who have no help or support system someone to talk to, to help guide them in the right direction. Any or all of these things would help with compliance without harming innocent people.

We have a big problem with overdoses and we need serious reform. Prescribing opioids should be done with scrutiny, caution and care. Good things are being done to fight this, but shutting down legitimate clinics and/or cutting off legitimate patients are not among them. It isn’t solving the problem; it’s just creating new clientele for street dealers.

Smith, a medical professional and writer, blogs at

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