Part Six: Without Opioids, a Decent Life becomes Impossible
When Jeremy came to see me in my office last year, his demeanor said it all: Rumpled jacket, pained expression, and the quiet, tremulous voice of a man who never in his entire life believed he’d wind up in a therapist’s office. “My doctor abruptly stopped prescribing me Oxy,” he told me when I asked him what was wrong, “and the pain is making me crazy.” As I looked into his eyes, and saw the depth of his emotional and physical pain, my own heart began to ache as well.
A third group impacted by the ongoing opioid crisis
In the last two blogs of this Opioid Series, you stepped into the worlds of Margo and Kate—two women whose journeys to and through addiction could not have looked more different. Through their stories, I hoped to illustrate how devastating the consequences of these drugs can be in the lives of those they affect. Addicts and their loved ones are deeply harmed by this country’s opioid epidemic—but they’re not the only ones. A third group of people, alone in their suffering, often completely invisible, fall through the cracks. In terms of media reporting on the opioid crisis they are rarely mentioned, and are frequently denied the support they desperately need. It’s time to shine the spotlight on opioid users who truly have no better alternative to alleviate their pain and live a decent life, and who have become stigmatized by doctors and the public alike for their continued use. They’re hurting too, and this blog seeks to make their pain visible, and give them a voice.
Jeremy is a thirty-something man who overcame a painful childhood in rural America to find success in Washington DC as a government worker awarded a Top Security clearance. Despite growing up in a physically and verbally abusive household, he married an incredible woman and together they shared a happy and contented family life, raising two young children. In early 2007 however, Jeremy suffered a serious back injury in a mountain-biking incident that required surgery. This debilitating injury not only introduced chronic and severe pain into his life—it also sent him into a depression (not uncommon for those whose lifestyles are rocked by a drastic, lifestyle-inhibiting change, physical or otherwise.) His doctor placed him on oxy and an antidepressant. The pain got worse and his prescription doses increased—but he never took more pills than the doctor ordered. He never gamed the system in search of pills, never asked his doctor for more, never showed any signs of developing addiction.
A climate of fear surrounding prescription painkillers
Then, the opioid crisis began to make headlines. Jeremy’s doctor became concerned by Jeremy’s continued use of the drug—so concerned, in fact, that he made the ”necessary medical decision” to wean him off his oxy prescription at an alarming rate before discontinuing the prescription altogether. Suddenly, Jeremy found himself suffering through a physical pain so severe he could barely function, and an emotional pain that felt far worse than the depression he’d encountered before.
Jeremy’s doctor felt pressured by the climate of fear surrounding prescription painkillers. And I get it. As a fellow physician, I too can understand the concern: being blamed for over-prescribing or fears of being threatened with a lawsuit can lead a doctor to err on the side of caution. However, to pull Jeremy completely off the medically necessary prescription was a mistake, yet one that doctors all around the country are making. The stigma surrounding opioid users is real—but every doctor takes an oath to “primum non nocere” (“first, do no harm”). No doctor should ever bow under the weight of societal pressure if it violates good medical practice. Jeremy is a classic case in point.
Working with Jeremy
When Jeremy came to see me, I immediately arranged for him to receive Suboxone induction and maintenance to ease his physical pain and withdrawal symptoms, but as we continued to meet regarding his depression, it became clear that his unstable moods were more of an issue than he may have originally realized. As it turned out, Jeremy was suffering from an undiagnosed bipolar depression that his oxy helped to mitigate by providing antidepressant effects. While he was on the drug, his mood would be unstable from time to time, but his depressive symptoms and cognitive functioning were better, and he was able to function at a high level. Being taken off the drug caused his pain to become so debilitating that he had increasingly unstable mood swings in addition to becoming cognitively impaired. Both of these issues were leading to problems in his professional life, which required a high level of focus and concentration, and in his personal life, where his wife and children had become frightened by his constant mood swings.
Together, Jeremy and I worked for months to find a combination of medication that would address his pain and mental health needs. We found that Namenda XR, Latuda, and Suboxone did the trick. After eighteen months of difficulty, Jeremy was finally back to his old self—but in the meantime, he had nearly lost his job and his family, all because a doctor succumbed to fear, rather than pursuing a more thoughtful approach.
The opioid epidemic will not be solved by sweeping decisions that fail to consider an individual patient’s needs
I don’t like to take a negative tone about the work of other doctors. I know that many of us are under severe pressure, and are doing the best we can. But I believe that patients like Jeremy—opioid users who are responsibly taking their meds—should not be cast aside as casualties caused by this crisis. The opioid epidemic will not be solved by sweeping decisions that fail to consider an individual patient’s needs. Taking an individualized approach is the only way to truly assess the needs of the person who is suffering. I was able to diagnose Jeremy with a bipolar disorder because of the biopsychosocial model, which allowed me a 360-degree view of his pain. Often, when it comes to physical pain and an underlying emotional illness, there’s more to consider than what first meets the eye. There’s an intimate connection between the two. By treating one while neglecting the other, patients’ lives fall through the cracks, and their deepening pain begins to overwhelm their loved ones, too.
* (Although lessons learned from the treatment of an actual patient are included in this story, the historical events and facts represented have been changed to protect his identity and confidentiality. Facts have been deliberately altered. Consequently, William is fictitious. Any resemblance to real persons, living or dead, is purely coincidental).
Don’t miss the other posts in my:
Opioid Crisis Series
Where can I get tested?
Dr. Bruce Kehr’s book, Becoming Whole: A Healing Companion to Ease Emotional Pain and Find Self-Love
Dr. Bruce Kehr’s psychiatry practice, Potomac Psychiatry
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Dr. Bruce Kehr’s Blog