The United States is beset by the tragic problem that too many of our population uses illegal drugs and far too many are dying as a result. Many more are unable to find good employment because they can’t pass workplace drug tests. Families are torn asunder and unborn babies are damaged. A disproportionate number of those affected are under 30 years old. Added to that are the huge and growing numbers of people who are legally and illegally using marijuana and alcohol. I am intentionally omitting a discussion of marijuana’s pros and cons from this discussion because the OPIOID epidemic crisis is our primary concern.
In my opinion the problems are societal and are related to poverty, unemployment, peer pressure, youthful exploration and popular culture which depicts drug use in music, movies, television, and social media. They are NOT caused by law abiding doctors writing prescriptions or patients in pain properly taking the medications for pain management.
Heroin and Methamphetamine are not used for medical treatments in the United States. Illegally manufactured and imported Fentanyl is not used for medical treatments. These 3 are the main KILLERS of those who are voluntarily taking these drugs while seeking a “high”. Yet, we are asked to believe that physicians writing prescriptions for narcotic pain treatment are the root of the epidemic.
All patients taking opioids become physically dependent upon the medication. That is, if they abruptly stop taking it, they will have uncomfortable symptoms of withdrawal. The withdrawals are generally short lived and not unbearable but after the withdrawals stop, the pain remains.Physical dependence is NOT the same as an addiction disorder. Fewer than 6% of pain patients taking opioids, longer than 6 months for their pain, became addicted. An addiction disorder can be treated, but like those who misuse or illegally distribute prescription drugs, the prescriber needs to be vigilant to identify and address these problems. That is why everyone who uses prescription opioids needs to be screened and closely monitored.
The common belief is that most heroin/methamphetamine users first became addicted to “prescription pain killers”. This may be true but most of these users were taking medicine that was NOT prescribed for THEM but was somehow diverted into the illegal trade. Diversion occurs when patients don’t use all of their prescribed amount and their children or friends steal the left overs. More supply comes from “patients” who get prescriptions from more than one doctor or fool doctors with fraudulent claims of pain. Worse are crooked doctors who sell pills to anyone, without legitimate medical needs. Often in cahoots with these “pill mills” are crooked pharmacists who fill these illegal prescriptions. And in recent years the Internet has become the source of illegal addicting drugs.
The patient with chronic debilitating pain has become a victim of the attempts to curb the overuse/overdose opioid crisis because some of the governmental solutions are in direct conflict with most of these patients’ needs. An arbitrary limit on the number of pills and/or days that may be prescribed now exist in most States, yet many patients’ dosages exceed those limits because of years of use and the tolerance that has emerged.
Insurance companies’ policies are also counterproductive in trying to battle the “crisis”. Almost all require a patient to have tried and “failed” with a strong, schedule II drug before approving a safer, less addicting Schedule III. There are safer drug alternatives but patients’ insurance companies refuse to pay for them.
Modern approaches to pain management try to utilize therapies other than opioids. At Kroll Care, we provide psychologists who administer CBT (Cognitive Behavior Therapy) and in the near future will be offering neuro-feedback. Doctor David Peyroux offers chiropractic care. He also custom fits braces. We dispense TENS (Transcutaneous Electrical Nerve Stimulator) devices. When patients follow the Kroll Care protocol and avail themselves of these programs they will discover that they can safely decrease their opioid dosages without losing pain control.
One undeniable reality created by the reaction to the “Opioid Crisis” is that the DEA, FDA, State and Local Governments are all imposing dosage limits on prescribed opioid. These limits do not appear to consider individual needs and conditions. We are being forced to decrease many well adapted and successful medication programs because of these new rules.
We, the providers of Kroll Care, will work with every patient to help them achieve a balanced regimen which will continue to manage pain and observe the new limits.