The kid says

IT HURTS

your first reaction

WHERE?Don’t worry, I’ll kiss and make it better

How does this natural parental reaction to pain lead to what we now recognize as, the ‘OPIOID CRISIS?’

There is no simple answer.  

We should recognize that our instincts are to comfort our loved ones and if possible, reduce their experience of pain.

A kiss may work for a graze but not for a fracture or a hip replacement.

Loving care will not relieve the pain of a terminal illness.

Opiates (opioids) are not cures. They are pain relievers. They are drugs either derived from or designed to mimic the effect(s) that opium has on the human brain.

Opioids work by interacting with neurotransmitters in the brain and blocking the (pain) signals that they are sending. This enables opioids to serve as powerful pain killers.

BUT, the relief from pain may release the feelings of intense pleasure, which lead to addiction.

Opioid addiction (largely the ‘pleasure’ effect) is one of the most serious problems faced by America today.

HOW HAS THE PROBLEM BECOME A CRISIS?

WHO’S TO BLAME FOR OPIOID EPIDEMIC?

As always, the easy answer is WE ALL ARE!  Opioids seem to offer something for everyone.

  • You, me – traumatic/chronic pain relief
  • The Surgeon – a stable operating environment
  • Physicians – options to prescribe for chronic and palliative care
  • Manufacturers/suppliers – a revenue stream from opium/opioid products

In traumatic situations, in the ER, the surgery, opioids offer pain relief for the patient and a controlled operating environment for the surgeon. Win-Win.

In post-operative recovery, the controlled use of opioids can reduce pain to manageable levels.

For chronic (long-term) pain relief e.g. joint pains, backache etc. opioids in low dosages, and taken only when necessary (and as prescribed) can be extremely effective in masking pain.

But that is all they do.  They MASK PAIN. They do NOT cure. Extending a prescription or increasing the dosage will provide no further medical benefit but may very likely increase the risk of opioid dependency – the feelings of intense pleasure that are the side effect of this most addictive drug family.

In some circumstances, these side effects are acceptable risks; terminal illnesses and end of life (palliative) care are examples.

OPIOID DEPENDENCY – THE PRESCRIPTION EPIDEMIC

Most people’s introduction to opioids is the result of a major surgical operation and consequent care programs or a Doctor’s prescription for chronic pain relief.

The highly addictive nature of these pain relievers makes it easy for the human brain to crave more. [Note: Most prescription drugs are self-administered e.g. take 3x daily after meals.] It is only when a course of drugs (the prescription) ends, that many patients realize they’ve become dependent on the effects of opioids to function “normally.” [Undisciplined ‘self-administration’ often puts the pleasure effect of the drug ahead of the intended medical purpose.]  

There is considerable self-discipline required to overcome a dependence on opioids.

  • First, there may be the return of the original pain for which treatment was prescribed
  • Secondly, the absence of the ‘pleasure effect’ may be overwhelming.

This is the point at which Physicians are faced with the dilemma of either responding to the patient’s requests or of insisting that they endure the pain that comes with the withdrawal symptoms of opioids.

Patients may look for other means of getting their high.

Prescription opioids are expensive, and this creates a market (illicit) for heroin. It is often cheaper, more potent, and easier to obtain.

The evidence suggests that as many as 80% of heroin users were introduced to opioids on prescription.

WHAT LIES AHEAD?

The recent judgment against Johnson & Johnson could influence the approach taken in more than 2,000 lawsuits pending around the US, filed by states and cities.  They will be looking at the ruling by Judge Thad Balkman in which he said: “Johnson and Johnson carry responsibility for helping to fuel the state’s opioid epidemic by aggressively marketing painkillers.”

Oklahoma brought similar cases against Purdue Pharma and Teva, both of whom settled before trial.

It is an open question of how the settlement funds should be used.  $200 million of the Purdue settlement is committed to funding an Addiction Studies Centre at Oklahoma State University but the state lawmakers argue that it is for the state to decide how the funds should be used.

The first federal trial, which involves two counties in Ohio, is scheduled for October 21st in Cleveland. Other suits have been filed in West Virginia and many more state and federal cases could be tried as soon as next year.  In general, plaintiffs will argue that drugs were improperly marketed and that companies failed to stop shipments of suspicious orders.  In the Cleveland cases Judge Dan Polster is pushing the parties to settle, partly to avoid lengthy (and costly) litigation but mainly to set precedents for the thousands of cases which will inevitably follow.

HOW DOES THIS AFFECT YOU?

These cases are a legal minefield; there are dozens of defendants, raw material suppliers, manufacturers, and distributors.  There are thousands of plaintiffs, each with different interests and literally millions of Americans either directly or indirectly affected.  In theory, anyone could bring a case but it would be neither practical nor affordable.

State and local governments are already battling for the allocation/control of settlement funds.  And that is before any federal cases have come to court!

It seems likely that settlements will be focused on medical and care projects with special emphasis on substance abuse treatment and research into nonaddictive analgesics.

Health Insurance and Mental Health Services

These FAQs and answers are extracts from MentalHealth.Gov. How to Get Help

Do you have Insurance Questions about Mental Health or Addiction Services?

Help is available if you have:

  • Been denied coverage
  • Reached a limit on your plan (such as co-payments, deductibles, yearly visits, etc.)
  • Have an overly large co-pay or deductible

You may be protected by Mental Health and Substance Use Disorder Coverage. Parity laws require most health plans to apply similar rules to mental health benefits as they do for medical/surgical benefits. If you need more information about the protections that apply to you, there are Federal and State Agencies who can provide assistance.

Q. What can I do if I think I need mental health or substance use disorder services for myself or family members?

Here are three steps you can take right now:

  1. Learn more about how you, your friends, and your family can obtain health insurance coverage provided by Medicaid or CHIP or the Health Insurance Marketplaces by visiting HealthCare.gov.
  2. Find out more about how the law is expanding coverage of mental health and substance use disorder benefits and federal parity protections:
  3. Find help in your area with the Behavioral Health Treatment Services Locator or the Find a Health Center.

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