Opioid Addiction-Not a Moral Failing But a Brain Injury

Some of my clients are dependent upon opioid pain medication.  I represent the families of persons who have died due to opioid overdose.  It is estimated that as many as 2 million people in this country are addicted to opioid pain medication.

Deaths due to overdose from prescription pain medication have quadrupled over the past 17 years.  Enough pain medication prescriptions were written in the past year to allow every person in the United States to have a bottle of pills.

 In Pennsylvania last year, 3,383 residents died from overdoses. Eighty-one percent (81%) of these deaths involved heroin, fentanyl, prescription opioids or some combination. Twenty years ago the medical community was under treating pain but, unfortunately, the pendulum has swung and we have a problem of over-treatment with opioids now.

In order to solve this problem, there are steps that can be taken and the first is by those people who love the person  who is believed addicted to opioids.

Vivek Murthy, the Surgeon General of the United States, has said that we need to stop seeing addiction as a moral failing and start treating it as the chronic illness that it is.  Dr. Sarah Wakefield, Medical Director of the Substance Abuse Disorder Initiative at the Massachusetts General Hospital, believes opiates rewrite the reward circuitry of the brain and permanently change the way people perceive satisfaction.  “Once the brain in changed by addiction, that mechanism of choice is damaged.  It’s almost like a stroke in that part of the brain” she is quoted as saying in a recent Time Magazine article.  

In fashioning treatment for addiction, it is important to understand that there is a difference between dependence and addiction.  Addiction is defined in the psychiatric manual as “severe disruption of daily activities as the craving for the next high takes prevalence over all else”.  Whereas physical dependence simply means that the body becomes reliant upon a medication, like it would to a medication to treat any medical disorder like blood pressure. 

Once addiction is destigmatized, and considered the disease process that it is, there are medications that can be prescribed to help wean them of the addiction, such as suboxone and methadone.  These drugs have been shown to help addicted persons maintain a job, avoid relapses and reduce the need to continue using the opioids.  

Suboxone and methadone  are controversial medicines because they create a physical dependence.  But they are valuable tools in the fight against addiction to opiates. Only a physician certified may prescribe Suboxone.  The certificates, issued by the US Drug Enforcement Agency, requires 8 hours of training on both medical and legal issues including how the drug works to blunt the narcotic effect of opiates and which patients it is safe for.  There are 32,000 doctors in the US certified to administer the drug.

There are alternatives to opiate pain medications to treat pain.  There are non- addictive topical creams that can be prescribed.  These creams are made by emulsifying various combinations of pain killing medications that are absorbed into the blood stream through the skin.  But these processes are new and expensive and often not reimbursed by health insurance, and vigorously fought against by workers compensation and auto insurance carriers. 

Other forms of pain reduction include physical therapy, acupuncture, chiropractic care, meditation, yoga, and exercise.  It is at times difficult for these methods to enter into our system of health care which is dominated by a pharmaceutical industry which suggests a pill as the best method to address a problem and a health insurance system that limits reimbursement.

 I am amazed, for example, that a health insurance carrier will limit physical therapy sessions to a certain number per year, but will pay the much higher cost of opioid pain medications for years and years.  Vivek Murthy is of the opinion that we must work to ensure that alternatives to pain management, other than prescription pain medication, is covered by insurance.

The Pennsylvania Legislature has recently sent to Governor Wolfe several bills to help combat the scourge of opioid addiction. These include measures to :

• Prevent emergency physicians from prescribing more than 1 week of opioids and from writing refills
• To prevent physicians from prescribing more than a week’s worth of opioids to minors and before doing so to assess whether they were being treated for substance abuse and get permission from a parent or guardian
• To force doctors to check a database of patient drug histories every time they prescribe an opioid.

These measures may help prevent addiction.

However if you know someone already addicted to pain medication the first step is to recognize the addiction as an injury to the brain, and not a moral failing.