I feel obliged to start where I always start – Fentanyl saved my life. There is not a doubt in my mind that I would not be on the earth were it not for the pain relief I received from that drug. By the time I moved down to lower-strength meds, I had used every patch size made, with my longest stint being a few years on the 100 microgram (the largest they manufactured at the time…which as I understood it at the time was about half the dose a terminal cancer patient would take; after all one can wear more than one patch or also use the lollipop or other forms on top of the patch. I only did that once, when after one of my surgeries I had oxycodone on top of it.)
Opiates are cheap, plentiful, highly effective, and scale like nothing else. Unlike most other pain meds, opiates will gradually give more relief the more you gradually take generally speaking. You definitely build a tolerance and need more over time, but the crucial point is that when you need to take more to get relief, taking more of it actually works. I don’t think anyone has found a point of diminishing returns for the relief opiates offer. I pray we never do.
When someone like Prince dies from an OD, that is certainly news. I have no problem with people writing about Fentanyl being serious shit and not to screw with it. It ABSOLUTELY is nothing to play with. What I can’t take is the epic dishonesty which surrounds the discussion of the “Opiate Epidemic.”
For openers – I feel obliged to repeat that Prince died in agony. He died seeking relief from vexing, soul-crushing pain. He died looking for relief. The stories indicate he used opiates for relief and was increasing the strength of the doses he took seeking more relief. I have been in that exact place many many many times. I have prayed on my knees to God in thanks that I was eventually released from that escalating agony. It broke my spirit. It took my will to live away from me. It made me not feel any particular value existed in my existence. No good in my life was worth what I was enduring to gain it. The feelings that came with having that experience were very very formative for me and I consider my life after that period to be a free-roll. I can revisit the despair and terror of those feelings very easily even now even though the worst of my experiences are now almost 15 years old.
Before I had the surgeries that ultimately restored some normalcy to my life, the only thing that held my life together happened the day that my doctor said to me “you are taking far too many pills to be good for you, I can replace all of them with one patch”. That one patch was Fentanyl. It was magical. It ended half a decade of the vicious nightmare that is called “conservative treatment” in the medical parlance (I also heard it called “fail first” a few times – it just means you will be forced to try every other solution for prolonged periods before they allow you access to opiates in strength sufficient to make a dent.)
Conservative Treatment simply means you will be allowed to suffer for month after month after month before the doctors will even consider allowing you access to opiates of any kind, let alone the heavy stuff. In my case, I had to go through months and months of misdiagnosis before even getting to a place where a doctor believed that I actually had something wrong with me. Neck and back pain are vague. PAIN is vague (try explaining to others how pain feels for you – I guarantee it won’t translate. No one has a fucking clue what other people are feeling.)
It may well be that there are doctors out there passing out opiate Rx’s like candy. I never met one. I never never never met even one. I would guess at least some of the doctors so-described are simply issuing the most effective medication for pain relief for those in many types of pain without making them suffer sufficiently first. What evil!!!
By the same token I am sure there are some doctors who will prescribe whatever you want in exchange for money. This is not a good idea. However – may I dare suggest something apparently unfathomable? ??? Allowing someone with a physical dependence on opiates to be free of the symptoms of that dependence is an act of mercy and should by no means be a crime.
Again – opiates are organically cheap and plentiful. The amount of dope needed to get an addict “right” is tiny and generally so inexpensive it would take barely an hour or two of panhandling to pay it off. The actual cost to society of providing junkies with enough opiate to stave off withdrawal is puny. The cost to society of making that “staving off” process run through the drug cartels and CIA first is very very steep – but this is the route we have chosen. I can’t say for sure what we lose as a society every time someone in chronic pain kills themselves because they are under-treated because we don’t track such things (who cares about such things after all?) Sigh.
Why does the most prosperous nation in the history of the world have so many people seeking escape from daily their daily life here? Why are so many people willing to throw their lives away for a few hours of opiate high? Will we ever ever ever talk about the demand for drugs? Why would someone with 5 vicodin given to them by the dentist throw their life away to get the next 50 or 500? Is that really the pills that are the problem there? DO TELL!
I feel like we are sobering up some about the destructive nature of the war on drugs when it comes to pot – but for any progress there we are going the wrong way on opiates. We are escalating something to a crisis not because opiates or physical dependence on opiates actually represents a crisis itself. The crisis comes from the lives destroyed by those doing what needs to be done to stave off the pain of withdrawal. By what possible rationale would a decent society allow such things to go on when the pain of withdrawal could be alleviated so cheaply and easily?
We are incapable as a nation of doing the kind of introspection needed to answer those questions honestly. I have thought about them over and over again. I have had plenty of time to do so during the endless hour after hour after hour laying in bed in pain – staring at the ceiling. Even when I eventually got enough meds to not be in so much pain, I was still in bed almost every free minute I had. These things cross your mind and in time I came to believe the right questions and correct answers weren’t so tough.
What is the moral difference between one who would inflict great suffering on a person and one who would fail to treat such suffering when they could very easily do so? I can tell you – to the person in pain – there really is no difference. At minimum, we are a society who very deliberately fails to treat those we easily could treat. We are making it less likely they will be treated – not more. What kind of a people do such things? By what possible rationale?
Fentanyl is big news these days. I will have other chances to answer that for you but I would guess most people could figure it out if they spent 5 minutes on it. No one spends 5 seconds on it let alone 5 minutes. I pray you never find yourself with the time to ponder these things like I had, nor that you find yourself with reasons to need to think about these things for personal reasons.
Few things – chronic pain being one – feel worse than realizing that your suffering is thought of by others as necessary or ok for some greater good. Sadly, as Prince’s death shows, suffering to the point of death won’t stimulate discussion on how to grant more relief, but rather be used to further justify withholding it.