Dreamland: RA & The Opiate Epidemic

Last updated: September 2020

I just finished a fascinating book about the "opioid epidemic" our country is currently embroiled in: "Dreamland: The True Tale of America's Opiate Epidemic" by Sam Quinones. Quinones, a journalist and former reporter for the L.A. Times, has meticulously researched the origins of America's addiction to opiates--from the explosion of "pill mills," and legally prescribed painkillers (the introduction of OxyContin in particular) in the 1990s, to Mexican black tar heroin that's infiltrating numerous U.S. cities today--to help others really understand why and how this problem began.

As a chronic pain patient who lives with serious pain on a daily basis, this issue affects me personally because I often need to rely on opiate painkillers for relief during RA flare-ups. During the last three years or so my RA has not been stable or well-controlled, which has basically forced me into going to a pain management clinic to help deal with the pain. The clinic requires all patients to actively participate in their multidisciplinary program: doctor check-ups, physical therapy, psychological counseling, and any other pain-related treatments (ex: trigger point injections).

My opiate prescriptions are strictly controlled and monitored through the pain clinic I go to once a month. I've also signed a pain contract, which basically lists several rules I need to abide by in order to continue going to the clinic and receiving my hydrocodone prescriptions. If I don't follow them exactly, then I'm kicked out of the program and the clinic. I almost suffered that fate once when I was prescribed cough syrup with codeine when I had the flu and I forgot to report it to my doctor. Cough syrup? Yes, even that. I can remember only a few years ago when all my rheumatologist had to do to refill my pain medication was call it in to my pharmacy. Those days are long gone; now you need to have the paper prescription in your hand and jump through a bunch of hoops and red tape to get relief.

Tougher opioid prescription guidelines

I do realize why the medical profession has become much tougher on handing out opiate prescriptions to patients lately; way too much addiction and abuse of these drugs (Vicodin, Percocet, OxyContin) has happened and continues to happen. People are dying in record numbers from overdoses.

According to Quinones, "Overdose deaths involving opiates rose from ten a day in 1999 to one every half hour by 2012. Abuse of prescription painkillers was behind 488,000 emergency room visits in 2011, almost triple the number of seven years before."

One overdose death every half hour?! Throughout the book, Quinones writes extensively about how addictive and dangerous opiate drugs are and just how widespread the addiction problem is. The statistics of use, abuse, and drug-related deaths are staggering. Especially disturbing is the prevalence of opiate users who become addicted to prescription painkiller medication and then begin abusing heroin. The more I read about these things, the more anxious and disturbed I felt.

"Dreamland" is a carefully researched and gripping, page-turner of a book, yet it's freaking me out somewhat that I could be one Vicodin pill away from shooting up heroin under a bridge. I realize how ridiculous this sounds and I know I need to calm down, but in all seriousness, this nation-wide "crisis" is frightening. It's scary how quickly people can become addicted to this powerful "morphine molecule," as Quinones calls it. Mainstream media has also jumped on the story, spreading tales about all of the people who are supposedly dropping like flies from taking some form of opiates.

According to the Centers for Disease Control and Prevention (CDC)'s website:

"Past misuse of prescription opioids is the strongest risk factor for starting heroin use – especially among people who became dependent upon or abused prescription opioids in the past year. This indicates that the transition from prescription opioid non-medical use to heroin use may be part of the progression to addiction.

  • More than nine in 10 people who used heroin also used at least one other drug.
  • Among new heroin users, approximately three out of four report having abused prescription opioids prior to using heroin."

Quinones provides similar troubling statistics in his book, so it's no wonder I'm suddenly paranoid I'm going to end up an addicted, arthritic junkie. I brought up my concerns to my integrative doctor at my last appointment, and she is someone whom I really respect and trust, so I feel some relief after our conversation. She listened carefully to my fears after reading the book and then assured me that I was not an opiate addict or abuser. She also didn't feel I was at risk for addiction based on my adherence to dosage and participation in the pain clinic. She also knows that I'm a huge worrier and helped bring me back to reality a bit.

However, even though prescription opiate pain medication is something that I currently take, off and on (more "on" lately), to help ease some of my RA pain, my goal is to completely stop taking it sometime in the near future. Long term use of opiate medication can pose threats to your health other than addiction: tolerance, physical dependence (not the same as addition!), withdrawal, breathing problems, constipation, hyperalgesia (heightened sensitivity to pain caused by opioids), depression, and others.

For more general information about opiate drugs and their side effects, check out the CDC's website: "Prescription Opioids" and a Q & A on opioids from the Mayo Clinic: "Mayo Clinic Q and A: Opioids for Treatment of Pain."

My goal, along with that of my rheumatologist and all of my specialists, is to find the right RA treatment to get my disease under control so that I don't need to rely on prescription pain relief. We're currently still waiting to see if my latest biologic, Rituxan, is going to do the job. Until then, I'm forced to cope with steroid medication (the evil prednisone) and the use of hydrocodone as-needed.

The opiate epidemic or opioid crisis or whatever you want to call it is indeed a real and major problem in this country right now. I agree that safety measures need to be taken to help prevent even more people from becoming addicted, abusing, and overdosing on these drugs. However, I do not agree with chronic pain patients, such as myself, being stigmatized and criminalized when we genuinely need pain relief. The main and complex challenge right now seems to be: How can we stop the over-prescribing and abuse of prescription opiates yet not deny the patients who truly need these drugs for relief? I hope someone figures out this balance soon, because I'm getting tired of feeling like a criminal and addict whenever I just need extra help easing my pain.

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