by For many years I have written about people who suffer from intractable pain and how their agony and its increase risk Cases of suicide and premature death have been ignored in the rush to end the overdose crisis.
I have told the story of a woman who was hoping for a cancer diagnosis because it might mean that her chronic pain, which she said felt like “pouring acid on” her skin, would be better treated. I have written about a father who was paralyzed from the waist down, in excruciating pain and in a wheelchair after a car accident, who committed suicide the day a doctor cut off his medication. I have told the story of a woman with a torturous genetic disorder who maintains a growing list of untreated pain-related suicides.
There are countless other accounts like these. Five million to eight million Americans currently rely on opioids to treat chronic pain, with thousands needing them for end-of-life pain at any given time. Despite their risks, opioids remain the best pain treatment available for many patients, and there is little evidence that addictions are prevented or treated by denying them to those who have already used them safely for years. Concern about the harm associated with indiscriminate cuts has been raised by the Centers for Disease Control and Preventionhe Food and Drug Administration and major medical organizations.
Yet doctors continue to abandon these patients as the overdose crisis worsens. Since 2012, the dosage of opioid prescriptions decreased by 60 percent, and the number of recipes has been reduced by almost half. During that time, the age-adjusted rate of opioid overdose deaths in the population has more than triplicate. And now the Anti-Drug Agency wants an additional 8 percent cut in manufacturing quotas for some opioids in 2024, even though shortage detrimental to treatment are already being reported by doctors.
Why is it so difficult to get policymakers to address this unnecessary suffering? Why do we seem to not care about people who are suffering, who are as much victims of the opioid crisis as people with addiction? Why does almost none of the money from recent settlements with opioid manufacturers (whose marketing fueled the rise in prescriptions) appear to go toward better treating those who are suffering now?
The answer lies in understanding the psychology and politics of pain and addiction and recognizing how many of us unconsciously close off our empathy for those who suffer, to protect ourselves and sustain our view of the world as fair and predictable. About 20 million Americans experience pain so severe that it is disabling. Few of us will live our lives unaffected.
The problem begins with language; There are few words to convey the severity and horror of intense pain. As Virginia Woolf noted, “English, which can express the thoughts of Hamlet and the tragedy of Lear, has no words for chill and headache…let a patient try to describe a pain in his head to a doctor.” and the language immediately fades away. dry.”
Our confusing language for pain may be due to the strange ways pain affects memory. Once the pain goes away, there is an overwhelming desire to try to prevent its return. But remembering the specific sensation is surprisingly difficult and subject to distortion.
However, perhaps the deepest reason for our refusal to care about pain is the stigma associated with it, made possible by its invisibility and subjective nature. Pain as deserved punishment is a primordial story in many religions. In the Bible, it is noted that women were condemned to the pain of labor for the sins of Eve. Hell is often characterized by endless agony.
It is not surprising that the stigma around pain is strongly associated with intolerance. Women They are more likely to be seen as exaggerating their pain. Decades of research reveal that black people are It is much more likely that your pain will not be treated properly. and be seen as a drug seeker.
The opioid crisis magnified this narrative. Patients in pain were blamed for trying to take the easy way out, allowing Big Pharma to unleash dangerous drugs on innocent white people who, as the stereotype goes, are not often affected by addiction. “We are the reason people’s children are dying on the streets, because we deign to take this medication and not endure it,” said Kate Nicholson, who has suffered from severe chronic pain and is founder and CEO of National Pain Advocacy. Center (which does not accept money from the pharmaceutical industry).
Why do we try to rationalize pain as a deserved punishment or an attack of hyperbolized acting on the part of the weak or the lazy? Daniel Goldberg, an associate professor of bioethics at the University of Colorado, said one important aspect is fear. We don’t want to believe that we can be trapped in unrelenting agony, so we look for differences in those who are grieving and point to those traits as reasons for their suffering.
Furthermore, the idea that pain can be randomly inflicted on those who do not deserve it makes a mockery of attempts to find moral order and justice in the world. It’s easier to avoid this existential dread by assuming that other people must somehow deserve your pain (or fake it to avoid work) than to face the fact that we’re all at risk. (In psychology, this is known as just world hypothesis.)
Dr. Goldberg has studied railway spine, an invisible pain condition said to affect people injured in train accidents in the 19th century. “The backbone of the railroad was seen as basically a hoax, a form of simulation” used to win lawsuits, she explained. Claims that the injury was not real were, of course, made by railroad lawyers. Some even called this condition litigation neurosis in an attempt to avoid payments.
These ways of dismissing pain are convenient not only to mitigate personal fear but also to rationalize inequality and racism; Here, both the poor and the rich, the happy and the suffering deserve what they get.
The reality, however, is that we are all just one accident or illness away from suffering severe pain. Shunning and punishing the afflicted does not change this fact nor does it help treat addiction. “The pain crisis and the opioid crisis are actually the same,” said Oluwole Jegede, assistant professor of psychiatry at Yale School of Medicine. “We can’t address one without addressing the other.”
Medical opioids are useful for some types of physical pain; Opioid addiction is primarily driven by emotional pain. Cutting off medical supplies makes both problems worse because it does not alleviate either type and can drive the most desperate to take illicit drugs, which are much more dangerous.
Instead, we must accept and empathetically inhabit the idea that all of us are just one accident, one genetic problem, one illness away from joining them in their suffering. If only for selfish reasons, we should strive to treat pain humanely and effectively because, yes, it could happen to us. And it probably will be that way someday if we live long enough.
Maia Szalavitz (@mayasz) is an opinion contributor and author, most recently, of “Undoing Drugs: How Harm Reduction is Changing the Future of Drugs and Addiction.”
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