A recent edition of the Journal of The American Medical Association (JAMA) described a report issued by the Centers for Disease Control, in a splendidly titled tome called the Morbidity and Mortality Weekly Report. Subtle sirens of alarm were sounded. The rate of unintentional drug-overdose deaths in the United States has risen over 600% between 1997 and 2007.
The report was not discussing heroin, meth or crack. It was warning doctors about prescribed analgesics. Drug distribution through the pharmaceutical supply chain was the equivalent of 96 mg. of morphine per person in 1997 and approximately 700 mg. per person in 2007. That’s enough for everyone in this country to take a standard five-milligram dose every four hours for three weeks.
According to the report, “Prescription drug abuse is the fastest-growing drug problem in the United States…and has been driven by a class of prescription drugs called opioid analgesics.” The numbers are astounding. “For every unintentional overdose death…nine persons are admitted for substance abuse treatment, 35 visit emergency departments, 161 report drug abuse or dependence, and 461 report non-medical uses of opioid analgesics.”
Did someone say there was a war on drugs? From the CDC’s analysis, it seems the medical industry has been exempt: “In an attempt to treat patient pain better, practitioners have greatly increased their rate of opioid prescribing over the past decade.”
Allow me to share two stories behind these statistics. One is about a patient of mine whose name has been omitted here, and the other involves my own personal experiences after a back injury.
The patient came to me with minor anxieties and some depression in large part due to unresolved grief. She was in her mid-thirties, a nurse, without major medical complications. Almost all her complaints centered on her fear of abandonment in relationships. Early on in treatment, she slipped at work (trying to move a large man from bed to a wheelchair) and injured her shoulder. After MRIs and doctor visits that lasted months, it was finally determined that she had some injured tendons. They put her on Vicodin. They refused her any other form of treatment.
That was 15 years ago. Her dosage increased dramatically over the years, as did her anxiety, her depression. Finally she was able to experience the abandonment she had so feared. Her marriage fell apart. She became so addicted to the Vicodin that the withdrawal was more frightening than the dissolution of her family.
I have seen this scenario in different forms at least a hundred times. I have made phone calls begging physicians please to reconsider their choice of medication and allow for other medical solutions: acupuncture, physical therapy, massage, homeopathy, mindfulness meditation, hypnosis. With the exception of a few truly open-minded practitioners, the answer has been a uniform “no.”
Why would anyone object to an alternative treatment if it brought relief at lower cost and without the risk of addiction and all the associated medical risks?
A few years ago, I fell (hard) and twisted my back. I was more embarrassed than in pain. “Oh, I’ll be fine,” I said. “It’s fine.”
Within the time it took for my adrenal glands to stop pumping, the pain became intolerable. I could not walk. An urgent-care facility told me it must have been a muscle sprain because there was nothing on the x-ray. I was urged (I mean this literally) to take painkillers. I said, “No, thank you.”
The doctor on staff looked at me cross-eyed and said, “What do you mean, No, thank you?”
I said, “I mean no. I don’t want them. How about some aspirin or ibuprofen or something like that?” He reluctantly gave in and wrote the prescription, telling me “You’re going to be sorry.”
The pain was not going away as quickly as I’d hoped, but I had seen what Vicodin could do and was determined to do whatever I had to do to avoid it. After putting up a fight with the insurance company that last two months, I finally went for an MRI, where they found the bulging disc that was impinging on my sciatic nerve.
I found a physical therapist who was a hands-on genius. She relieved the pain with a combination of deep tissue massage and abdominal strengthening. We also used guided meditation. She used to tell me to “imagine the butter melting” as she focused on releasing the iliopsoas, particularly psoas major, the muscle that connects the hip to the spine. As she worked, I felt miraculous and immediate joy.
I was still in pain and not as limber as I used to be, but my condition was moving in the right direction. And I was willing to work hard to get better. Then the insurance company insisted on a new doctor, who looked over my chart and said, “You’re going to need Vicodin.”
I said, “No.”
Once again, that same look: “What do you mean, No?”
I said, “I don’t want dope. The massage and exercise works. Why can’t we continue that and forget the drugs?”
“Because you’re at maximum improvement. You can get the drugs but not the therapy.”
It was my turn to look at him cross-eyed. Much to the amusement of the nurse in the room with us, I said, “Are you crazy? Who are you working for?”
“This is medical standard now.”
“What about your oath?”
I looked at him and said, “Yes, you are,” and that was that. I walked out. No therapy and no Vicodin.
I had to pay for my own physical training and take responsibility for my own recovery. It was not easy. But it was infinitely better than what I’d seen with my patients: people who had been struggling with aches and pains or broken hearts turned into addicts with broken homes, empty pockets, and symptoms so wildly erratic the patients were sometimes mistakenly diagnosed as bipolar instead of addicted. Rather than getting them off the vicodin, they were given ever-increasing doses of medication that eventually made reaching — or treating — them impossible.
This war on drugs we’re waging? Maybe it should start in the doctor’s office. It seems to be up to us patients. I don’t see the pharmaceutical companies leading the battle.
Judith Acosta is a classically trained homeopath, a licensed psychotherapist and a crisis counselor. A resident of New Paltz, she has written several books and is a regular contributor to The Huffington Post, The Journal of Emergency Medical Services and other publications. She may be reached at www.wordsaremedicine or www.thenextosama.com.