They kill the pain, but they’re killing people by the thousands. Opioid pain relievers are so abundant – there are enough in circulation for every person in the country to have one.
Sometimes patients go to more than one doctor. Others order them off the internet. Whatever the means to get the pills, for some, the end result is an inescapable addiction.
For Dr. Gail Basch, it started in a medicine cabinet.
“I received my first opioid after having my wisdom teeth pulled. I had no idea the wrong road I was going down,” she said.
It’s how many opioid pill addictions begin; at home, taking a prescribed pain killer.
Dr Basch was in high school at the time. In the years that followed she was prescribed opioids for severe migraine headaches and was initially unaware of their highly addictive nature.
“It was a disaster waiting to happen,” Dr Basch said.
By her late 20s she craved the pills more frequently, using them for emotional relief as well.
“My disease progressed to the point where I was a practicing physician using multiple substances, having an unstable mood and I could no longer practice, I could no longer function.”
But when she did ask for help, some told her to keep her opioid use a secret and warned her the addiction so many struggle with, even some medical professionals, would harm her career.
“We’re no different than anybody else. 10 percent of the population has it, guess what, we do, too,” she said.
Once Dr Basch voluntarily reached out to the Illinois Professional’s Health Program and signed a five-year supervision contract and help came her way. She entered an in-patient treatment center, lived at a sober house, worked with a psychiatrist and joined a support group for recovering physicians.
“I re-entered medicine slowly and as I was ready.”
Her personal struggle now fuels her passion as a psychiatrist and addiction medicine specialist at Rush University Medical Center, not only treating patients but also teaching medical students and residents to be more thoughtful – even careful – about prescribing opioids.
“They give us a lot of resources to figure out how we can prevent these things because these are medications that are useful, necessary but it’s not something you want to hand out or prescribe because there are repercussions,” said Steven Whitt a Rush medical student.
“As prescribers,” Dr Basch said, “We must be much more diligent about asking our patients before we prescribe, prescribing smaller amounts and when we can transitioning them safely off of opiates and on to non-opiate pain relief.”
Justin Olech didn’t have a choice. He was just 13-years-old when he suffered a serious football injury, a severed pancreas.
Opioid pain killers were a constant for the then teenager. Years later, he underwent shoulder surgery then suffered a back injury. There were more pills.
“That’s what really got me hooked,” Justin said. “I went from Vicodin to Percocet to oxycontin and they just increased the dosage.”
When he tried to stop, the physical discomfort was overwhelming.
80 percent of people who take addictive painkillers do not get addicted. But there are huge numbers, like Justin, who function every day with the pills so they don’t realize they have a problem. That is, until they try to stop.
“I wasn’t able to function. Your head is out of it. You can’t be driving. You’re almost drunk to say a word because your head’s not there,” he said.
Justin asked his doctor about the horrible withdrawal symptoms.
“I asked him, ‘Why do I feel sick?’ He said, ‘You might be getting addicted to them.’”
The solution at the time was to pop more pain pills.
“You don’t get a high anymore so when you get to those stages you don’t feel what it does in the brain. You just feel back to normal.”
Living with the constant dependency took a toll on his work and family life. In December 2010, Justin sought the help of addiction expert Dr Gregory Teas, Chief Medical Officer with Amita Health Behavioral Medicine. Dr Teas prescribed medication assisted therapy.
“The combination of medicine plus psychosocial treatments, rehabilitation, individual counseling, community support groups such as AA and NA are the backbone of treatment today,” Dr Teas said.
Justin now takes buprenorphine – also commonly known as sSuboxone. It’s half opioid, half opioid blocker. And just like he once took pain pills every single day, Justin does the same with the replacement drug.
“The craving is so strong we now understand that if we don’t replace that opioid medically the brain will seek an opioid,” Dr Basch said.
“You’re not alone. There are places out there to help you. There are medications to help you,” Justin said. “The only way anybody else is going to take those steps is to realize to themselves that there is an issue.”
Justin was fortunate to find treatment – but many struggle to gain access to medication assisted therapy. That’s because there is a shortage of providers, who must be certified to distribute suboxone and methadone, the most commonly used opioid replacement drugs.
And while doctors want to rein in opioid prescriptions, they also realize the pendulum can’t swing too far the other direction. People with cancer and other terminal illnesses need pain killers.