Point of clarification: I didn’t mean to imply that people who take opioids for reasons other than physical pain are to blame for the opioid “crisis” or the overdose epidemic. Let me retrace my steps.
I recently pasted and posted my article, published in The Guardian, arguing that opiates prescribed for people in pain are wrongfully blamed for the overdose epidemic. All true. But I also stipulated that the illicit use of pharmaceutical opioids was a link in the chain to opioid addiction and, in the current fentanylized environment, to the overdose epidemic.
So what does that say about us former and still active opioid “abusers” and addicts? I have a pretty good sense that most of my readership, like me, went down the path of pilfering …e.g, stealing, buying, faking, or otherwise getting pharmaceutical opioids that weren’t prescribed for our physical pain. We found those pills any way we could, because we needed them to soothe another kind of pain.
I thought, since sharing my article with you, that you might feel I’m pointing the finger of blame at “you addicts” who’ve found a loophole in the prescription opioid cycle, who’ve found a way to acquire pharmaceuticals “illicitly.”
No way. Having had two spinal surgeries in the last seven years, I’m definitely attuned to the pain relief issue. In fact, though my back’s been in quite good shape since the surgeries (praise be to physio, Tai Chi, and a great healthcare system here in the Netherlands), I had a horrific episode a couple of years ago. I was attending a conference in Geneva (focused on addiction, somewhat ironically) and my back went into gridlock spasm. The pain was so intense that I literally couldn’t move, couldn’t walk, couldn’t sit. Loud noises came out of my mouth that I seemed unable to 
control. I had people coming up to me while I stood rigid, paralyzed, in the middle of a busy hotel lobby between session, and carry or drag me to the nearest sofa (it was a pretty plush hotel). And even sitting, I could not unspasm; my body seemed like a lighting rod that would not stop zapping. People I didn’t know — strangers — found me a wheelchair, wheeled me to the elevator, got me down to the street level and called a taxi to take me to the hospital. And the next day, at a doctor’s office near my own hotel, I was howling so bad that the doctor and his assistants dragged me out of the waiting room because I was scaring the other patients. They then lifted me into a taxi — back to the hospital again. When all I really needed was a shot of morphine or a substantial dose of oxycodone. Getting high was the furthest thing from my mind.
So why couldn’t they provide that? Even at the hospital, I had to lie on a gurney intermittently screeching in pain for over an hour before the morphine came. People passing by had pity written all over their faces. Has the opioid scare infested Europe too? Not as much as the US, but yes, seemingly, to a degree.
So physical pain is one thing, and I have immense sympathy and empathy for those who experience it regularly. (For me, thankfully, this was a rare episode).
But I’ve also experienced the other kind of pain, the overwhelming darkness that invades your thoughts and feelings to such an extent that you are paralyzed in another way. You can’t think, or feel, or communicate, because it hurts so much just to exist. Opioids can provide enormous relief 
from that kind of pain as well. But of course no doctor will prescribe opioids for your depression, unless you’re getting methadone or Suboxone because you’re a “registered” addict, whatever that happens to mean in your corner of the world. Maybe just lining up at some seedy clinic, maybe being sneered at, maybe not being able to get a job, maybe having your license revoked…hell, in the Philippines it means being lined up and shot.
When we’re in that kind of pain, and if we’re pretty sure that opioids can help relieve it, we’re trapped. We can’t get an opioid prescription for emotional relief. (Don’t get me started on “antidepressants” — SSRIs — which are so much less effective than hoped, which carry their own batch of side effects, and which require as much tapering as opioids to minimize withdrawal symptoms.) So we buy, borrow, steal, forge, or do whatever we have to do to acquire the medication that can bring us back to some semblance of normality, of peace.
I just want to clarify that I don’t see you, me, us addicts — former or “active” — as villains in this scenario. Yes, we do “divert” pain pills to deal with our (sometimes enormous) psychological vulnerabilities. But we only do that because our back is against the wall. Only because there’s no other choice.
That struggle was not the point of my article, and you (us) were not the audience I was targeting. But I am so with you, you don’t even know it. And if your diverted pharmaceuticals have led to (or replaced or complemented) heroin, which might have led to fentanyl, which might kill you, I see that as a shameful tragedy. But I don’t blame you. I blame the system that has vilified, isolated, and abandoned you. I don’t blame you. In fact, the risks you (we) face are so very grave, simply because we can’t (through normal channels) get the pharmaceuticals that can help us, we move to the front of the line of sufferers.
If I had to choose between battling emotional anguish and physical pain, I’d be hard pressed to decide which to try first.
There is no reason why either kind of pain should be left untreated in this age of pharmaceutical evolution. But I’m not going to be able to convince the head of the DEA, the governor of Maine, or Donald Trump that both kinds of pain qualify for care. I’m just starting with the most obvious.
Informed by unparalleled neuroscientific insight and written with his usual flare, Marc Lewis’s The Biology of Desire effectively refutes the medical view of addiction as a brain disease. A bracing and informative corrective to the muddle that now characterizes public and professional discourse on this topic.” —Gabor Maté, M.D., author of In The Realm of Hungry Ghosts: Close Encounters With Addiction
This is our modern approach:
Psychological approaches to chronic pain management: evidence and challenges.
Review article
Eccleston C, et al. Br J Anaesth. 2013.
Show full citation
Abstract
Psychological interventions are a mainstay of modern pain management practice and a recommended feature of a modern pain treatment service. Systematic reviews for the evidence of psychological interventions are reviewed in this article. The evidence for effectiveness is strongest for cognitive behavioural therapy with a focus on cognitive coping strategies and behavioural rehearsal. Most evidence is available for treatments of adult pain, although adolescent chronic pain treatments are also reviewed. It is clear that treatment benefit can be achieved with cognitive behavioural methods. It is possible to effect change in pain, mood, and disability, changes not achieved by chance or by exposure to any other treatment. However, the overall effect sizes of treatments for adults, across all trials, are modest. Reasons for the relatively modest treatment effects are discussed within the context of all treatments for chronic pain being disappointing when measured by the average. Suggestions for improving both trials and evidence summaries are made. Finally, consideration is given to what can be achieved by the pain specialist without access to specialist psychology resource.
PMID 23794646 [PubMed – indexed for MEDLINE]
And the URL referred to in my previous post:
http://www.cnn.com/2017/06/29/health/opioid-addiction-rates-increase-500/index.html
Maybe this is the link you intended, Guy? But probably not.
What you refer to here makes a lot of sense, but note that effect sizes appear to be weak. I have personally treated a client in psychotherapy who had been attempting psychological interventions for her chronic pain for over a decade. The overarching message she heard (whether it was intended as she heard it) was: It’s all in your head. That can be a deadly idea for people in pain. And in fact she was seriously considering suicide until her doctor starting prescribing a sufficient dose of oxycodone to control her pain. (I take it as a given that physiotherapy, stretching exercises, and either yoga, Pilates, or Tai Chi and related disciplines are crucial tools as well.)
There is no need to clarify, my friend…
I sit on an interdepartmental committee at a local hospital that is desperately and fecklessly trying to produce responsible prescribing guidelines that work for all physicians and patient populations. This is to provide medicine to those who need it, to provide treatment to those having difficulty, to reach the “addict” still struggling while they are being treated in-hospital for other medical issues. The committee can’t even decide on how to refer to these phenomena in patient records in a way that won’t expose the hospital and practitioners to legal issues, defame innocent patients, keep medicine from people who need it, or even refer to “addiction” in a way that doesn’t mire the hospital in regulation and red tape by having to register as a legitimate “treatment facility”— even though they already have an established addiction psychiatry department for this very purpose.
It’s like chasing full bore down the rabbit hole followed by a steady stream of quick drying cement.
Pointing fingers of blame, pointing fingers at etiology, at most effective treatment modalities, at obstacles, at moral failings, at social ills, etc. They all get fossilized and factionalized and miss the point. People are driven to find relief, comfort and solace for themselves and others, but also by the unhelpful need to be right in a domain where there is no right or wrong– only individual suffering.
Remember the old Bruce Lee movies and kung fu TV shows that often had examples of the buddhist parable about “the finger pointing at the moon?” At least those of us who were alive at around the time when dinosaurs were done roaming the earth? We have too many people fixated on way too many flailing fingers pointing at the moon. It’s important to have fingers to point the way but also important to remember they are not the moon. Moving away from “addiction”, whatever the f– that is, is about finding purpose, about finding one’s own truth. It’s about looking at the moon, not all the fingers. How do we help turn people’s faces toward the moon? How do we help them to find and negotiate their own truth?
What an exemplary comment, Matt. If there was a comment-of-the-year prize, you’d be in the winner’s circle. I have nothing to add — just to urge people to think about the big picture in all its complexity, in the way wrong-headedness evolves from personal to interpersonal to systemic, the way contradictions and conflicts not only add up until they reach some critical mass but also consolidate into impermeable dead-ends. Nowhere but in addiction is this tendency so clearly manifested. Matt’s comment sums it up beautifully.
Marc, urging people to think about the big picture in all its complexity, is well meaning, but there is a simplicity too.
This blog is also peppered with people mentioning that the struggle with themselves has ceased, and the addiction is no longer a desire.
Although some may say these people were never addicted in the first place,
This could be scientifically studied via MRI, brain scans, etc.
It is not an area that currently gets attention, but it may provide a breakthrough in the understanding of addiction.
I needed to add this for any readers currently struggling with addiction.
The feelings of hopelessness and destitution that perhaps you have an complex, progressive, chronic problem can undermine self-trust that may develop during the recovery phase.
Carlton
Addiction is a dead end, and how we are reacting to it as a culture is a dead end. We are going around in a deadly circle. Yes, we need to get some distance, to turn towards the light of the moon, together.
This blog is part of a movement to shift paradigms. Thank you for making it happen Marc.
Jan, from Toronto.
Opioids were never my thing. When on them for pain for a week. They really didn’t help my pain, and they made me queezy and nauseous.
I have had an opiate problem for close to 8 years now with intermittent lengths of sobriety during that time. I am close to a year clean and sober now and i can attest to the fact that opiates DO treat emotional pain and it has been hard getting sober and facing that pain and walking through it.
This was 48 minute broadcast was on Public Radio station in the US today:
Addiction Nation: Understanding America’s Opioid Crisis:
http://www.wnyc.org/story/addiction-nation-understanding-americas-opioid-crisis-rebroadcast
Carlton
I’m going to paste this here because it was so well-said, Marc:
“Addiction is not caused by drug availability. The abundant availability of alcohol doesn’t turn us all into alcoholics. No, addiction is caused by psychological (and economic) suffering, especially in childhood and adolescence (eg abuse, neglect, and other traumatic experiences), as revealed by massive correlations between adverse childhood experiences and later substance use. The US is at or near the bottom of the developed world in its record on child welfare and child poverty. No wonder there’s an addiction problem. And how easy it is to blame doctors for causing it.”
If we’re going to solve this, my sense is it will require each one of us seeing addiction for what it is, and recognizing, too, that recovery from it is entirely possible, once we each – all – address these root causes, including the pain of isolation. Most of us are far too isolated, from each other and even from ourselves.
Blaming anyone will not take us where we want to go. Individual and collective engagement could and, in many cases, does transform lives.
I completely agree with you, Joanna. Isolation is what sucks joy, safety, excitement, meaning, and a sense of okayness out of far too many people in today’s world, especially in the West and especially in the US and northwestern Europe.. Homo sapiens evolved to connect with each other in families, tribes, clans…and that’s what we did for tens of thousands of years. Trying to build a workable society on the backs of isolated individuals is an impossible task. And that’s what I see as the root cause of addiction. I’m sure Bruce Alexander would agree as well.
I used opiates for almost ten years “recreationally” as I used to say. It wasnt until I got older that I realized that my use of them wasnt for any recreation at all, and instead it was to numb intense emotional pain that stemmed from an abusive childhood. I used it to tame a rage that was like a wildfire inside me. I’m happy to say that today I’m clean and have been for several years. When I look back at my own drug abuse and those I encountered abusing the same drugs, there seemed to be many more folks using it as a form of antidepressant or emotional suppressant than were using it for pain related injuries. Just my two cents.
Thanks for chipping in. It’s a familiar story, but an intense one for everyone who goes through it. Did you know that the same brain region processes physical and emotional pain at the highest levels? A region called the anterior cingulate cortex.
For me, when I began the downward spiral into alcohol and drugs it was to bury emotions inside of me that I did not want to feel. Situations at hand that I did not have the courage. Using myself and not wanting to socially interact with anyone because it would ‘blow’ my high, or force me into situations/conversations I wanted to avoid. I had to come to the point in my life where I lost everything; family, friends, career, sanity, freedom. To understand that I needed to change my life to save myself, from myself.
http://www.addictionrehabcenters.com/withdrawal-detox/suboxone-withdrawal-detoxification/
thank you for writing this and clarifying that addiction IS A DISEASE
I have had experience with all of the products that can make people feel better. Alcohol is the worst, imho, followed by tobacco/nicotine. All of the opioids should be legal because if the stigma was gone (as it is with alcohol), the entire world would be better off. But in the early 1900’s, the Devil decided to keep Gods own medicine from the masses. And gave them all to the black market. Good job, Satan. Keep them drunk and miserable and eventually dead. But not because of opioids. Because of lack of legal and pure opioids.