Psyche Services: The ‘opioid’ problem: Too many prescriptions written for too much medicine

Lisa Garmezy

The October CIT training taught me a lot about the opioid epidemic through police eyes. I learned, for example, that the combination of Xanax, Soma and hydrocodone is prescribed so often it’s called “Houston cocktail.”

Perhaps our office can return the favor, and share information on opioids from a psychological point of view. Our perspective, after all, is growing in importance as awareness grows that medication alone can’t cure chronic pain, and that – as you are all too aware – the cure has become a disease.

The term “opioid” refers to drugs such as prescription painkillers, e.g., Vicodin, Demerol, OxyContin, and Percocet, as well as heroin.

A large part of the opioids being used illicitly – an estimated 70 percent of them – are prescribed medications. These pills cause 46 deaths a day, according to the U.S. Centers for Disease Control. Since 2009, deaths have quadrupled and the number of prescriptions have quadrupled—yet the agony continues.

Maybe this is personal for you. Police officers get injured, perhaps more than people in other walks of life. You’re not always active on the job. Then suddenly one day, catching a crook or even staying alive means you have to sprint or wrestle or endure a car crash. Bodies object to that kind of treatment.

And you’re American, and 95 percent of opioid pain meds in the world are prescribed right here in the USA. Other countries do fewer of the surgeries that are linked to chronic pain afterward. And in many counties a complaint of pain always generates a referral to counseling. That doesn’t happen here.

And the Blame Goes To . . .

Twenty years ago U. S. physicians determined that pain wasn’t being discussed enough with patients. They labelled pain a “fifth vital sign” that should always be checked, along with heart rate, respiration rate, temperature and blood pressure. Not surprisingly, bringing up the subject at every visit meant more and more prescriptions were written. Now, current president of the American Medical Association Andrew Gurman, says, “We are part of the problem.”

Too many prescriptions are written, and for too much medicine. Many patients receive 30 pills after a break or soft-tissue injury, but only use a couple of them. The rest linger in medicine cabinets waiting to be acquired by visitors. Expect fewer pills the next time you need them, and don’t be surprised if a urinalysis checks for other abused substances in your system.

On a side note, the FDA recommends immediate flushing of leftover Oxycodone, Percocet and many similar drugs instead of waiting for a drug take-back day or throwing them in the trash mixed with dirt or kitty litter. The possibility of misuse or accidental consumption by children or pets is too high.

Physicians didn’t create the current mess, of course. Aggressive marketing of prescription medication may have played a role, if it made medicine use in general seem more acceptable to the public. The government is separating patient satisfaction ratings from overall ratings of hospital quality, since hospitals concerned about poor reviews may have hesitated to deny requests for these drugs. Part of the problem is our aging and often obese population. Both conditions increase complaints of pain.

Developing Dependence

Once started, the use of prescription pain pills is hard to stop. As you know, users develop a tolerance to the medication, requiring larger amounts of the drug to get the same effects. That’s true whether the stuff is being used on the street or at home by an injured officer.

The potential for getting hooked on these medications must not be underestimated. Consider a chilling statement from Gurman, speaking at a 2014 professional conference: “If a patient is given hydrocodone for 90 days, there is a two-thirds chance that he or she will still be taking it in five years.”

We now know that aside from physical dependence, the use of pain medications makes the consumer more acutely aware of pain. A hugely undesirable side effect is that the use of opioids increases the brain’s sensitivity to pain signals.

We also know that some patients “catastrophize” pain; that is, imagine horrible scenarios far beyond the usual worries caused by illness or injury. These people might think, for example, “the pain will put me in a wheelchair,” or “I’ll never go back to work.” They have a harder time getting off pain medication. A psychologist who owns a local treatment facility told me that people who can’t calm themselves in the face of these frightening possibilities get the most medicine, boosting their risk of addiction.

A Different Path

Recent government guidelines steer doctors away from prescribing opioids except for cancer or terminal conditions. Alternatives are out there. Hypnosis appears to activate the part of the brain that is processing pain signals, successfully altering them for some people. Yoga is helpful for lower back pain. Biofeedback is recommended for fibromyalgia.

Learning more about healing helps people use less medication. There’s a new emphasis on creating realistic expectations in patients: zero pain just may not happen. Patients are encouraged to shift their focus away from the hurt and toward developing “strength, mobility, and activity tolerance,” according to an American Psychologist article.

Yup, that’s where we come in. We can help you change your focus, reduce depression or anxiety associated with your condition, and generally strengthen your coping skills.

As the CIT training rightly points out, HPD Psychological Services doesn’t treat addiction per se. You won’t find a detox room behind our closed doors. If you, a colleague, or a loved one needs help because of an alcohol or other drug addiction, however, do not hesitate to contact our division. We’ll be very willing to guide you or that person to an appropriate type of treatment and offer recommendations on facilities in the area.

Stephen Tate, our director, has had a number of calls this year from officers who fear entering a treatment facility will hurt their careers. He emphasizes, “If you are concerned about losing your job because you choose to get help, don’t be: it’s not true.” HIPAA laws will protect your privacy.”

In HPD, it’s the people who don’t seek help who are terminated. Please allow us to show you a path back to wellness and enjoying life.