“Don’t you ever get tired of being right?” an erstwhile friend once asked.
“No,” I should have said. “But I do get tired of other people being wrong.”
The latest issue of Psychiatric News brought that memory to mind, with an article entitled “Study on Opioid Deaths Shows Need to Offer Treatment for Chronic Pain Patients.” While the focus of the article is predictably to offer medication-assisted treatment, the statistics contained therein confirm for the first time what I’ve suspected all along.
The article notes that a full one third of patients who died from opioids filled prescriptions for benzodiazepines and opioids within one month of death. Benzodiazepines constitute a class of medications known as muscle relaxants, anti-anxiety agents, and sleep aids. They include such common medications as Xanax (alprazolam), Ativan (lorazepam), Valium (diazepam), and Klonopin (clonazepam), among others. The benzodiazepines are commonly taken along with opioids for the same problems, such as chronic pain, and like opioids, they are dangerously addictive and also depress the respiratory center. The cumulative effects can be deadly.
The article goes on to say that fully two thirds of people with fatalities filled prescriptions for both opioids and benzodiazepines within the previous twelve months. It mentions alcohol as a possible factor in the fatalities, but the study didn’t specifically look into that.
What’s wrong with this picture? The psychiatric establishment has been hot on the trail of the “opioid crisis” for some time now, but the literature has focused primarily on obtaining funding, pushing for “medication-assisted treatment,” conflating prescription opioids and heroin, and generally alarming while under-informing the public. Moreover, it has skewed the information to promote a narrow and self-serving agenda for dealing with the problems. The FDA has approved a specific protocol for treating “opioid use disorder,” and now requires special training for those who administer the approved medications, two of which are opioids themselves. This means that access to treatment has become increasingly cumbersome and expensive, and there is no real evidence the treatment works long-term. In fact, most studies on substance abuse treatment only follow patients for a year or less.
Additionally, the risk of fatal overdoses doesn’t stop with benzodiazepines mixed with opioids. The US is generally an over-medicated society, and every additional medication increases the risk of drug interactions four-fold. Not all depress the respiratory center, but common substances like alcohol do. Other medications, such as antacids, anti-hypertensives, statins, and psychiatric medications, to name a few, are cleared through the liver and kidney and affect the efficiency of these organs. While chronic pain patients may confine themselves to prescription drugs, the heroin addicts can be assigned to a different category of user, those who use intravenous routes of administration, for instance, and may mix their heroin with a variety of other illegal or dangerous drugs.
Neither the psychiatric nor the medical establishment has addressed the risk factors that may lead even the non-addict to fatal overdoses. When it comes to prescription drugs, a major risk is lack of information or a belief that the doctor wouldn’t prescribe something fatally dangerous. Fact is, many people over-take meds. If one pill doesn’t give the expected relief, another may. The euphoric or pain-relieving effects of an opioid may decrease over time, but the respiratory depressing effects don’t. And when someone is under the influence of mind-altering substances, they may forget what they have taken. Benzodiazepines are notorious for causing memory loss.
The most reliable and best known treatment for substance abuse remains the simplest and least expensive, as well as the most easily accessed, and it relies on peer support and counseling. This is Alcoholics Anonymous and its spin-off groups, such as Narcotics Anonymous and Cocaine Anonymous. AA was founded in the 1930s by two recovering alcoholics, and its emphasis on abstinence and progression through its “Twelve Step Program,” remains the gold standard of substance abuse treatment. That the programs are free and easily accessible make them attractive to the down-and-outers who have hit bottom and have few resources.
If someone is in chronic pain and is not dependent on addictive opioids or benzodiazepines, there are many options other than drugs. The medical community tends to frown on chiropractic, massage, physical therapy, or acupuncture, yet many people find relief from one or several of these approaches.
The sad truth is that the medical establishment is stymied by its limited, medication-focused approach to a situation that is more comprehensive than anyone understands. The pattern of turning to doctors and drugs to alleviate physical and emotional pain has become a national addiction in itself. The “opioid crisis” is just the tip of the iceberg.