A decent HBO documentary about America’s opioid crisis raises questions perhaps you can answer and elicits observations based on my own experiences.
Last night, I finally got around to watching HBO’s Warning: This Drug May Kill You, a documentary about the opioid addiction problem America is facing. It’s a decent documentary that looks at four middle class families, all of which lost someone to prescription drug or heroin addictions (with the point being made that prescription drugs triggered the heroin addictions). After watching it, I ended up with three questions and a couple of observations:
Question 1 arose from the very first shot in the documentary, which opened with the stark words that America is facing an “unprecedented” drug crisis. I wonder if that’s true. I mean, I know it’s true in raw numbers, because our population is around 300,000,000. That’s why the Department of Health and Human Services can say “More people died from drug overdoses in 2014 than in any year on record, and the majority of drug overdose deaths (more than six out of ten) involved an opioid.”
Please don’t get me wrong. I’m not saying that there isn’t a serious problem in the U.S., one made more serious by the fact that smart phones and the internet mean that the problem plays out in front of all of us, all the time, with a never-ending series of photos and videos showing crying children stuck in cars and stores with parents and grandparents passed out from drugs. For example:
I’m just wondering if this current drug crisis really is the worst ever. My life has been peppered with “worst ever” drug crises, from the hippies with their hallucinogenic and opioid overdoses, to the coked-up 70s and 80s, the cracked-up 80s and 90s, and the current meth problem. I just wonder, as a percentage of the population, how bad this particular crisis is. After all, back in the late 19th century, opiates were over-the-counter and through-the-newspaper-ad-section drugs and were used everywhere.
Question 2 is about where fault lies. The documentary opened showing doctors hired by the drug companies smiling as they advertised that the new generation of opioids was safe and non-addictive, a myth that got busted very quickly. With that opening, it’s apparent that the documentary makers think that the fault lies with the drug company’s deep pockets. However, it’s clear from watching the families affected by addiction that the families think the fault lies with physicians handing the stuff out like candy.
I can attest to that easy access to powerful opioids. Both times that I had my knee surgeries, neither of which was particularly painful, I got sent home with a full bottle of some opiate or other (hydrocodone, maybe?). As I’ll discuss at greater length below, I was not tempted, plus Ibuprofin was more than enough for my pain.
Incidentally, I have experienced severe pain in my life and would have reached for anything available if could have had it. Immediately after a major abdominal surgery some decades ago, the nurse refused to give me any pain killers for the entirety of her double shift. And then there was having children, an experience that sees normally needle-phobic women begging for the needle.
I mention these experiences to make clear that I’m not cavalier about pain. I just think that in many situations, physicians over-prescribe. Moreover, given that it’s not 1999 anymore, it’s unforgiveable for physicians to over-prescribe.
Question 3 is my problem with the way in which the documentary implies that everyone who gets one of these prescriptions becomes an addict. The show claims that taking these meds daily for only a week can create an addiction.
What the documentary shies away from is whether all people have addictive traits. My Dad spent several months in the 1940s getting massive doses of morphine when he had an ailment the doctors thought would kill him. Their thinking, which was humane, was that if he was going to die anyway, why should he suffer?
Being one tough hombre, though, Daddy survived, at which time the doctors discharged him to my mother, after telling her that she’d forever after be married to a morphine addict. Daddy confounded them again. After leaving the hospital he never touched morphine again. In the same way, much as Daddy loved smoking, when a friend asked him to join her for moral support as she tried to quit, he stubbed out his cigarette and never touched another.
The thing is that, if the show is correct that doctors have written 250,000,000 opioid prescriptions over the years, if the stuff is really that addictive, you’d think there would be more addicts. Obviously something more is going on. I’ll touch more on that below, too.
Observation 1 is that, as the panicking video shows, we Americans go from extreme to extreme. Because of the opioid problem, medical protocols are now changing to stop writing opioid prescriptions at all, unless someone is has a terminal illness. A physician friend pointed out that this new protocol is just as bad as handing prescriptions out like candy for transitory pain. He deals with people who suffer from severe, chronic pain and are being rendered dysfunctional because of the new protocols. Leaving people to suffer is just as bad as creating addicts. As always, vast mandates from on high seldom serve anyone well.
Observation 2 ties in to something that a few of the family members interviewed for the show pointed out: Long before your family member dies, the drugs have already robbed you of that person. I know that first hand. My mother, who had very real, very chronic pain, was a prescription drug addict. Even when she was put in complete managed care to control her drug intake, she was so inured to the drugs that they had to give her doses that, had they been given to me (5 inches taller and 20 pounds heavier) would have left me near death’s door. She’d also managed before being put into a care situation to squirrel away innumerable pills that she turned to whenever she felt the managed dose was inadequate — which was often.
When Mom finally was at death’s door, and suffering a great deal from the drowning sensation that comes with congestive heart failure, her able and kind caregivers had a terrible time giving her enough morphine to ease that suffering. That tiny little lady took triple the appropriate dosage for a woman of her age and size. The care facility had to send out for a special emergency order of morphine because they didn’t have enough on hand for her.
Although my Mom held it together in many ways — she was always immaculately dressed and had the kind of cleanliness only someone with obsessive compulsive disorder can have — she still lived the life of an addict: She was constantly coming up with reasons to go to different doctors to get more prescriptions. Because her musculoskeletal degeneration was real, meaning her pain was real, and because she was a royal pain in the ass (as is true for all those with drug-seeking behaviors), she got those prescriptions.
Incidentally, while my mother’s drug use was the result of medical practices going back to the 1960s, so one could blame the doctors, one can blame her too. After all, it was she who resolutely refused to consider any alternative pain treatments as they came along.
Thus, while it was the doctors made her an addict, it was my mother who decided to stay an addict. As long as she was clean, well-groomed, and upright, she never acknowledged that she had a problem and as long as she didn’t acknowledge a problem, she never had to make an effort to change.
It’s those personality traits that all drug abusers show that are so awful for those around them. My once charming, funny mother spent her last decade as a groggy, angry, lying, manipulative, whiny addict, who fell constantly and lived for the next trip to the doctor and the drugs. And despite all the drugs, they ultimately did nothing for the pain because, while her brain sucked up the opiate feeling, her pain sensors were so used to the opioids they just sneered at them.
All of the above is why, for me, Mom “died” a good ten years before her body finally gave up. I never did reconcile myself to “drug addict Mom.”
My sister, too, is a chronic substance abuser. She’s dying by inches before my eyes. Her drug of choice gives her a sweet, mellow personality, but she’s so physically and emotionally fragile, it’s sometimes as if no one is there at all. I love her a great deal and it’s truly painful to see her voluntarily erase herself.
As it happens, I also have all the traits of an addict, which is why I’m so terrified of drugs. I’m a chocolate addict; I’m an internet addict; I’m a reading addict. When I was young, before I got bored with it, I was a TV addict — and even now I still was able to watch eleven season of Supernatural on Netflix in just three weeks. Were I to allow myself to like drugs, whether they send one up or down, I’m virtually certain that would take over and become central to my being. I can’t take that risk, so I never even try. In other words, I’m really sympathetic to the grip of addiction: been there, live with it, try to keep my addictions to things that are not too harmful.
The next observation — which I’ll call “Observation 2.5” — arises from the fact that we are not simply helpless, hapless vessels at the mercy of pharmaceutical corporations and harried doctors and emergency rooms. The reality is that, if you know you’re at risk, or even if you’re not sure, but you still live in a world saturated with messages about prescription and street drug dangers, why would you even start with drugs?
Of course, that question is a bit hypothetical. I know people start because of pain, fear, undiagnosed mental illness, depression, peer pressure and, of course, the big bad sin of “it can’t happen to me” arrogance. Still, these are all still choices. And the less driven a person is by such overwhelming problems as chronic fear or mental illness, it seems to me that, with the blame against doctors and pharmacy companies, we’re forgetting that at least some of these tragic addicts really made, on their own, genuinely bad choices.
(One more random anecdote: Apropos the mental illness that drives some people to take drugs, all of the stoners I know explain that they started drugs to self-treat their ADD or ADHD. At a certain point, that sounds more like a socially acceptable excuse rather than an actual reason.)
UPDATE: I published an update to this post with answers to the questions I asked.