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Initially started as a campaign by oncologists and pain specialists to correct the undertreatment of pain, with the addition of pain relief as a measure of quality healthcare. Unfortunately, this highly subjective, customer focused tool failed to account for the intrinsic psychological driving forces of substance use disorder.
As the capitation model took hold, there was a shifting of pain treatment to primary care providers, who were incentivized to wholly manage ever more complex and challenging patients. Unfortunately, they lacked the tools to non-pharmacologically treat pain or to identify diversion and abuse and were incentivized to reduce visit frequency.
Simultaneously was the introduction, in 1996, of the potent time-release oxycodone medication OxyContin, which the drug company Purdue Pharma deceptively marketed to providers. The fundamental issue was that OxyContin was marketed as a 12-hour long-acting drug with low abuse potential, but it was actually effective for only 8 hours.
The initial formulation could be easily crushed and snorted, producing a similar pharmacodynamic profile as injected heroin, all without track marks. The secondary issue was that the chronically elevated exogenous opioids downregulated the endogenous endorphin system, and patients became dependent on the exogenous compounds. They no longer felt normal without OxyContin and were quickly dose escalating to get the same clinical pain relief, reinforced by the customer-driven model of pain relief as a metric of quality healthcare.
OxyContin 80 milligrams became a magnet for opioid abusers. And with a street value of $1 a milligram, OxyContin became valuable as local currency. By 1999, the diversion of pills into the black market was well underway in Maine and rural Appalachia.
Medication was stolen from medicine chests, dealt with on the street, and sold in cash-only pill mills.
Between 1999 and 2011, the CDC documented a fourfold rise in prescription-related overdose fatalities. In 2011, the agency officially declared “prescription painkiller overdoses at epidemic levels.” On charts, the data were straightforward—casualties mounted in parallel with the rise in opioid prescribing—but the dynamics behind the trend were not.
Starting around 2010 or 2011, events converged in ways that made prescription pills less widely available. Law enforcement cracked down on pill mills, the maker of OxyContin made the pill harder to crush, physicians tightened their prescribing practices, and more states created prescription registries to help identify people who obtained prescriptions by “doctor shopping”—that is, by seeking prescriptions from multiple physicians at the same time.
The vigorous efforts to rein in prescribing, resulted in a one-third reduction in the number of opioid prescriptions nationwide between 2012 and 2017 but did not result in a reduction in overdoses, as many of those were driven by imported fentanyl.
Prescribing controls are well warranted, as too many doctors and dentists routinely over-prescribe, sometimes dispensing a month’s supply of pills when only several days’ worth, if any, were needed.
There is little question that the more drugs available in a community, the more they will be used. Whether drug companies were responsible purveyors and what the DEA and distributors knew and when they knew it is pressing supply-side questions that need to be resolved. But supply-side economics does little to the demand-side abuser who can source inexpensive illicit fentanyl.
Unfortunately, the bluntly designed pill-control policies enacted by insurers, pharmacies, and regulators damage patients with chronic pain who had been functioning well on prescription opioids.
Prescribers felt Drug Enforcement Administration agents, their state medical boards, attorneys general, and other health care agencies breathing down their necks. They reduced patients’ dosages or cut them off altogether, leaving them in misery, unable to find another physician who would treat them, and sometimes contemplating suicide.
The addictive potential of drugs is not random.
And while exposure is necessary for addiction to develop, exposure is almost never sufficient. Addiction is a dynamic process and, depending upon whether someone is suffering in a certain way under certain circumstances, a drug will either be profoundly seductive, or it won’t.
For too long we have treated clients struggling with opiate addiction and chronic pain. For these clients, their choices are often limited to continued dependence on opiate pain medications or learning to tolerate pain throughout their daily lives. For this reason, we started a pain management program that focuses on those who also struggle with addiction or those that want a more conservative approach to pain management. Clients will not find an opiate-centered practice while in our care. Our pain management program is provided by pain management physicians who understand addiction disorder and its implications for the management of chronic pain.
Our pain management program is focused on those in recovery. We provide minimal pharmaceutical interventions while focusing on conservative and effective pain relief. Patients undergo continual consultation for identifying, treating, and monitoring the root causes of pain rather than simply masking the neuromusculoskeletal effects of the injury or ailment. Addiction too often creeps up as an outcome of pain management and we intend to break this cycle.
Contact us and talk to our staff about your situation and schedule a consultation with one of our recovery-focused, pain management physicians. We accept those currently in addiction recovery programs, those who have completed addiction treatment, those who are entering treatment, and those who do not need addiction treatment but want a more conservative approach to pain management.
Whether your chronic pain originates in your back (cervical, thoracic or lumbar spine), joints (knees, hips, elbows), or if you suffer from cluster headaches or chronic migraine headaches, we offer specialized interventional procedures for immediate and sustained pain relief without opioids.
We specialize in medication assisted therapy for opiate addiction with patients who also have chronic pain syndromes. We are an outpatient facility where we can help patients through the recovery process from addiction, as well as address their pain symptoms.
Opiate addiction combined with chronic pain can affect quality of life and a person’s sense of wellbeing. We offer thorough evaluation and customized treatment plans to help patients achieve and maintain their best functional recovery from addiction, chronic pain or both.
There exists a significant overlap in patients who have both chronic pain and addiction to medication; and specialized treatment is required for both conditions.
The real issue is boredom and loneliness. Opioids are a short-term cure for boredom.
Using a customer-driven subjective tool to measure pain, in the pain patient, guarantees that some individuals will self-abuse.
Attempting to solve an economic model with a supply-side approach is unlikely to resolve a demand-side issue.
It’s not the drug that’s the problem, it’s the supply of the drug being used by the individual who believes that the use of the drug provides an immediate reward far greater than the immediate risk. It’s more a function of the cage that the animal is in, whether it’s economic, psychological, or sociologic.
