An opioid update: Some good news but the fight continues

Dr. Lisa Garmezy
Dr. Lisa Garmezy

Naloxone, the drug that reverses opioid overdoses, can be had at CVS for $89 without insurance or $50 with it. Because a physician somewhere approves its use, no prescription is needed. Given that the opioid crisis is so widespread, killing a staggering 130 people per day in the United States, some readers may want to keep it on hand for family members.

The drug is a life-saving weapon, but how goes the war? Fighting on two fronts is never easy. Opioids are anything acting on the opioid receptors in the brain to numb pain and, in some people, produce feelings of euphoria. Some are legal, some are not.

Progress Report

We may be gaining a bit of ground. The Trump administration expanded Medicaid coverage for the medications that are vital to recovery. Methadone and buprenorphine reduce cravings and block the euphoric effects of the drug, allowing people with opioid abuse disorders to function in society.

To date, however, only about twenty percent of people needing these medications have received them, in part because of stigma. Detoxing without medication actually increases the risk of an overdose, since the patient’s drug tolerance is reduced.

But let’s get back to the good news. The state of Oklahoma settled for $270 million in March in the first successful lawsuit against OxyContin makers Purdue Pharma. The Sackler family, who control the company, will pay $75 million of that. Worth $14 billion in 2015, they don’t need to cut out cable yet.

More importantly, the number of opioid prescriptions written and the amount dispensed per prescription have declined. Now pain pills often come in sets of seven, instead of the mass quantities of the past.

On the other hand, measuring progress against opioid abuse by counting the decline in prescriptions ignores the tragedy of lives ruined or lost to street drugs, perhaps putting an overly white face on the problem. Since 2013, illegally manufactured fentanyl has driven a large percentage of the spike in opioid deaths–and we don’t know when the next fentanyl might hit the streets.

Two War Fronts

To a psychologist, pain is at the root of this problem – both the physical pain dealt with by prescription and the searing emotional pain and trauma numbed by drugs of abuse. Mental health issues, such as depression, make taking either path to addiction more likely. So does a history of substance abuse in the user or a close relative.

More precisely, two distinct groups of people are at high risk for opioid abuse problems. The first is people with poor self-control, early trauma, and a record of illegal behavior. You’ve seen them on the street.

The second group may live closer to you – the people who, according to a journal published by the American Psychological Association, “have coped badly with a painful illness or injury.” Rather judgy language, that. People in this group tend to catastrophize their pain, that is, they experience it as a complete and total obstacle to living their lives as they wish. They think frequently about their pain and unrealistically expect not to have any. They may have a higher than average number of opioid receptors in the brain.

Members of this second group misuse or “misuse” pain medication, as one in four people do. I’m in the 25 percent, actually, for taking more than my doctor prescribes about once a decade. One in 20 of the 25 percent will move from prescription abuse to heroin addiction, blurring the distinctions between groups.

Police officers injured in the line of duty are at particular risk, but we’re all vulnerable. We all get hurt, we all get cancer and other serious illnesses, and we all age, developing arthritis, back problems, and other conditions that shove us rudely into the 11 percent of Americans with chronic pain.

Reason for Hope

Members of the second group often reasonably—but wrongly–assume pain always means tissue damage or injury. A 2019 Discover magazine article, “Tame the Pain,” explains that we also experience pain when the brain sends out “Protect me!” signals. Available online, it reports on an Australian researcher who almost died from a snakebite on his ankle. Months later, when a twig brushed harmlessly against the same ankle, the pain was intense. The researcher’s brain “thought” he had been bitten again.

As we learn more about pain, we can teach people how to have less of it. Catastrophizing goes down when sufferers shift their focus from hurting to personal goals for activity and learning to move safely. Pain patients are finding relief through cognitive behavioral therapy, relaxation, acupuncture, exercises such as tai chi, and safer drugs and medical interventions.

Getting enough sleep is key. An exhausted brain experiences more pain.

With improved treatments, better access to care, greater awareness of the danger, the right tools and some luck, we can lower the death toll. There were 16,849 American drug overdose deaths in 1999; 63,632 in 2016; 70,237 in 2017 and –this is a preliminary number—a slightly lower 69,100 in 2018. Legal and illegal opioids caused two thirds of these deaths. Cocaine and methamphetamine overdoses also surged in recent years. The 2017 and 2018 numbers are not hugely different—unless you or a loved one were among the 1,137 who survived.

Let’s enlist everyone in this fight. APA recently instructed psychologists that any and every client should be asked about the use of prescription medications for nonmedical reasons.

So when you go to Psychological Services – you know that it’s completely free and completely confidential, right? – say hello for me and hold my former colleagues accountable. The war is far from over, and there are potential fatalities among our own ranks.

Find out how to use naloxone or get peer support at “Learn to Cope,” www.Learn2cope.org, a website started by the mother of a son in recovery. Contact Dr. Garmezy at lgarmezy@aol.com.