This pain

WHY YOUR PAIN IS NOT BEING TREATED

Hi. I'm your friendly neighborhood NP, here to talk to you about how THE WORLD IS GOING TO END  ARG ARG ARG RUN RUN RUN THE OPIOIDS ARE COMING FOR US ALL.

At least, that's apparently what this, er, let's call it "measured and thoughtful" letter from our US Surgeon General, Vivek H Murthy, is trying to tell us.  By us, I mean every practitioner with a prescription pad or, more to the point, a DEA number.  Yesterday I walked into my office and saw this little number waiting for me on my desk, enjoy. My opinions follow.  No, there will be no jumpcut. Read it.

"August 2016
Dear Colleague, I am asking for your help to solve an urgent health crisis facing America: the opioid epidemic. Everywhere I travel, I see communities devastated by opioid overdoses. I meet families too ashamed to seek treatment for addiction. And I will never forget my own patient whose opioid use disorder began with a course of morphine after a routine procedure. It is important to recognize that we arrived at this place on a path paved with good intentions. Nearly two decades ago, we were encouraged to be more aggressive about treating pain, often without enough training and support to do so safely. Tis coincided with heavy marketing of opioids to doctors. Many of us were even taught – incorrectly – that opioids are not addictive when prescribed for legitimate pain. Te results have been devastating. Since 1999, opioid overdose deaths have quadrupled and opioid prescriptions have increased markedly – almost enough for every adult in America to have a bottle of pills. Yet the amount of pain reported by Americans has not changed. Now, nearly two million people in America have a prescription opioid use disorder, contributing to increased heroin use and the spread of HIV and hepatitis C. I know solving this problem will not be easy. We often struggle to balance reducing our patients’ pain with increasing their risk of opioid addiction. But, as clinicians, we have the unique power to help end this epidemic. As cynical as times may seem, the public still looks to our profession for hope during difficult moments. Tis is one of those times. Tat is why I am asking you to pledge your commitment to turn the tide on the opioid crisis. Please take the pledge at www.TurnTeTideRx.org. Together, we will build a national movement of clinicians to do three things. First, we will educate ourselves to treat pain safely and effectively. A good place to start is the enclosed pocket card with the CDC Opioid Prescribing Guideline. Second, we will screen our patients for opioid use disorder and provide or connect them with evidence-based treatment. Third, we can shape how the rest of the country sees addiction by talking about and treating it as a chronic illness, not a moral failing. Years from now, I want us to look back and know that, in the face of a crisis that threatened our nation, it was our profession that stepped up and led the way. I know we can succeed because health care is more than an occupation to us. It is a calling rooted in empathy, science, and service to humanity. These values unite us. They remain our greatest strength.
Thank you for your leadership."


Well then.  And thank you, Vivek, Vivvy, may I call you Viv? Viv. Thank you, for alerting me to this "urgent health crisis that threatened our nation."  Naturally, as a conscientious practitioner, I wish to be up on the latest data and, hey, if prescription opiates like Norco and Vicodin are killing people in droves, quadruple the deaths since 1999 sounds super scary after all, I better take your advice and make sure I'm as educated as I can be, right? Of course right.  So, off I surf to CDC.gov, to fill up on data, omnomnom delicious data.  I mean, the last thing we'd expect is to find is that this kind of vague, inflammatory language isn't... *reads opioid overdose stats page* isn't based on actual facts that... *reads some more* facts that.... *re-reads*....
....
*re-reads again*
....
Gawddamnit, Viv.
Turns out, according to the CDC, "Changing the way deaths are analyzed seems to result in a decrease in deaths involving prescription opioids."  Huh. What does "changing the way deaths are analyzed" mean, I ponder. Turns out, this means that while deaths from opioid overdoses have indeed increased over the last several years, this means deaths related to ANY opioid, including such best selling titles as frakking heroin (which is NOT a prescribed opiate, just to be painfully clear) and bootleg Fentanyl cooked in a bathtub and cut with who knows what.   Apparently, overdoses from NON prescription sources, specifically heroin alone, accounts for most of this uptick.  Also, given that Oxycontin wasn't even INVENTED until 1996, it makes sense that the deaths from this medication have, you know, increased, since before it existed.

Viv, from the bottom of my prescription pad and from the bottom of my heart which belongs to two amazing partners who struggle with chronic pain every damn day, please go fuck yourself vigorously with a cheese grater. And do it, obvis, without pain meds.  Because years from now, I want us to look back and know that, in the face of reactionary ableist tripe, it was our profession that stepped up and looked critically at said tripe and led the way to ripping it to shreds.