by Dale J. Ross M.D.
Medical studies have been coming out for the last couple of years now proving that many people hurt. I find it a bit astounding that they spend good taxpayer money to prove something so simple, but they do. People live with pain. These studies, however, do not quantify the pain in a functional way, nor do they review how the person experiencing interprets and deals with this pain. They simply prove people admit to having pain at times in their life. These medical studies then make broad sweeping statements regarding untreated (pharmacologically, i.e. drug treated) pain. Pain is subjective and is dealt with in many ways. Some people have a high tolerance for pain, others admittedly do not, and still others talk about how high their pain tolerance is but really do not do well with even low levels of exposure to pain. Stressors and life events as well as nutrition and sleep also play significant parts in how you cope with pain.
Prescription pain pills are a much larger problem in American society than is understood or acknowledged. Adaptive processing is altered in just 2 weeks of continued exposure to opioids. Hyperalgesia, the increased pain response to the same stimulus, is a direct and basic expectation that will invariably occur with consistent opioid use. Another example of dysfunction: daily opiate use in men results in greater than 50% becoming clinically hypogonadic. This means that over half of all men using these drugs can no longer produce enough testosterone to have even a low functional level of the most identifiable male/masculine hormone, which then impacts every other system. Opiates cause dramatic changes in function in the body at multiple levels. Opioids, by the way are all of the medicines based off of morphine: codeine, hydrocodone, heroin, oxycodone, dilaudid, fentanyl and such. The fully synthetic mu-receptor agonists, drugs that are man-made that are found to work on these same morphine receptors: tramadol and methadone work and act just like other opioids, but are sometimes spoken of as if they are different. The main difference is that you cannot find them in a natural state, only created by man.
Hydrocodone pills just 5-8 years ago customarily had a dosage of 2.5 mg to 5 mg as a usual strength. 7.5 mg and 10 mg hydrocodone, taking one to two at a time, is becoming the new “normal.” The active compound strength has been steadily rising to try adapting to the passive control of the body system – the pumping in of drugs to take away engagement and control. Society has accepted this and in truth has been the primary driver, but physicians also have a responsibility to provide the best medical recommendation they have for each and every individual, case, and signed prescription.
A couple of years ago, hydrocodone pills had a street value of $5-10 per pill in the Inland Northwest, which is why some people would see how many they could get and then sell them. Oxycodone went for that price per milligram (mg) of active compound. I had an encounter with one patient who was very upset with the changes I was going to make to their medication regimen when they came to see me. The discussion was rather intense at times. Over several visits, more information was gathered. Eventually it was found that the patient did not have any drug in their system. A very thorough evaluation indicated that they really never used the drug. A calculation was made regarding the level of medication that they were prescribed at for the last several years, which came out to a street value of approximately $80,000 per month. That is just shy of one million dollars tax free per year. I am not surprised that they were unhappy with me, but the fact was that they did not have one medical indication supported by any examination, fact, or study to justify the treatment. Their medical record was falsified by self-reports that did not bear out when checked into and it was eventually proven they were not taking the medication. The drug went somewhere. The doctor’s responsibility includes ensuring a proper diagnosis and safety of anything they prescribe as much as in their ability to address. The patient’s responsibility is even more than this. The over-riding concern for pain should be correction of the problem. This is not always simple and may take a surgery, lifestyle and work changes, or great personal effort. Lifestyle choice regarding proper sleep, basic nutrition, altered job/work abilities, and an applied exercise/therapy approach are active changes. Other modalities may be needed, maybe even herbal or medication trials. Response to a complaint of pain should not center first and foremost on medication usage. Even further, a role for pharmacologic intervention is not a statement to equate to specific opiate prescribing. As the government study showed, we all have pain at times.
Our bodies were created to function without all of these drugs and making the decision backed up by effort to live life differently enough to maximize the health that you should have is not an easy path; until you decide that it is what you really want!
Missed the first part of this series? Read it here: Pain and Prescriptions – Part I