When I began writing these musings on the general idiocies going on all about us I wrote something to the effect of, “well, somebody has to say something”. (see post). Too true. So. In recent weeks you may have noticed some rumblings about Oxycontin, an opioid painkiller being discontinued; the replacement drug is similar but apparently less easy to abuse (OxyNeo).
The drug manufacturer has kept the price the same. Government health plans do not appear to have been as circumspect; my understanding is that there are plans afoot to delist the new drug and make it harder for people with chronic pain to have their pain meds covered. Terrific.
Just as noxious is the addiction narrative that has taken over all discussion around this subject – with all its moralistic, judgemental overtones. I keep waiting for a nice Puritan gentleman in a stove top hat to mince up and stick a big red A on someone.
A promo for the CBC’s Fifth Estate proclaims that addiction to Oxycontin costs us all, as taxpayers, untold amounts and they’re shocked, shocked, that this has been going on for so long.
Um, exactly what nefarious something has been going on? People in pain had some access to a medication that could provide a bit of relief? People in hospital who’d had surgeries and procedures were able to survive without being in agony? How did pain become a crime – and that tiny fraction of people who take a drug for purposes other than what it was intended for turn into such objects of scorn?
So yet again, another abbreviated history lesson. About 50 years ago we began to realize that how medicine treated pain was stuck in the Dark Ages. How that happened was some physicians who realized their post-surgical pain relief was a giant joke. (And being doctors didn’t give them any special status – which must have come as a real shock). They realized what patients went through, being accused of faking or exaggerating or being drug seeking addicts when all they had was pain.
Medicine’s treatment of pain was a “cool and callous disgrace” according to one doctor writing at the time.
With time things gradually changed, a bit. There was research and Melzack and Wall’s seminal book on pain and major scientific effort (see the International Association for the Study of Pain, IASP, site for more.) We began to understand that if acute pain was well controlled the odds of it becoming chronic went down. That sometimes chronic pain happened – sometimes for no reason (hence the term ‘idiopathic’ which essentially means who-the-hell-knows) and sometimes because of underlying conditions like rheumatoid arthritis or scar tissue from a former injury. (Occasionally even as a result of iatrogenesis – caused by medical intervention, in other words. Some test or procedure gone wrong.)
Heck, we didn’t even realize until maybe 45 years ago that children felt pain. Infants. Which explains those bone chilling videos from some years ago where baby boys’ screams as they were being circumcised were simply attributed to, I don’t know. Joie de vivre?
We didn’t even concede that post surgical and post traumatic pain was worse at the start (right after the surgery) and better a few days later. Hence PCA – patient controlled analgesia – where individuals can give themselves a programmed amount of medication when they feel pain rather than waiting for the requisite number of hours to have passed before the nurse could give them a dose.
We even realized that we could give the dying a modicum of dignity and autonomy by controlling their pain. Because really, who on earth would care if a dying person got ‘addicted’ to morphine? Which they don’t but that’s another story.
Most important we began to realize that there’s nothing ennobling about pain. Pain just hurts.
Not that you’d realize it these past weeks as the moralistic jingoistic nonsense carries on in the media with the Oxycontin issue. Nope, the real issue is addiction. Tsk tsk.
Lost in all this is any sophisticated thinking or mature discussion as we forget the complexities of pain; how physical pain is exacerbated by stress and fatigue and hunger and other conditions. So that phrase we bandy about: ‘most common in northern communities’ might actually have its basis in what actually goes on in those northern communities.
First Nations reserves without gobs of mineral reserves and cash where individuals live socio-economic conditions most of the rest of Canada would find unacceptable. After all, if your community and your culture are not valued; if your hopes are few and your living environment horrid – perhaps addiction might be the natural result. So Sherlock, perhaps addiction is the symptom, not the underlying “disease” (if we wanted to reduce our argument to mere medical parametres).
For a lot of people opioids (oxycontin, morphine, methadone, codeine or the synthetic variants like demerol and fentanyl) – especially in conjunction with other techniques like exercise, self hypnosis, pacing oneself and other such things – allow people with chronic pain to function. Unfortunately, pain clinics that give people that broader perspective and help them learn not to rely solely on drugs have slowly been disbanded over the years (we prefer spending money on high tech toys) so now more people rely solely on medication to help them cope with pain.
I had thought, erroneously as it turns out, that we had matured somewhat when it came to our attitudes towards pain; that we understood that pain is the one condition that unites us all – wherever we live, whoever we are. But I suppose all that thinking was giving us a headache, and without any Oxycontin on hand ….
(to be continued)