About 25 million people are in recovery from substance use disorder (SUD), while approximately 100 million people live in chronic pain. With our nation fixated on the estimated 60,000 opioid-related overdose deaths in 2016, you might expect the interests of both groups to be in conflict. Consider two anecdotes.
Paul is living with chronic pain from a car accident nine years ago. His physician abruptly cut his opioid dosage even though he’d been stable. In his legislative testimony, he said, “While I understand [some] are happy to abuse medications, I’m not one of them … I’m well below my previous medication [amount] but far above my tolerable level of pain. My quality of life is suffering greatly.” Countless people echo his concerns in comments from a STAT News column.
My friend Chris received high-dose opioids from his physician for a back injury, turned to the streets when they ran out and eventually transitioned to heroin. Authorities from the CDC and FDA assert that if doctors prescribed more carefully, Chris might have avoided a 10-year addiction. Problematically, he’d misused substances before opioids and had other complicating factors at play. His childhood trauma led to unresolved emotional pain, fueling his love of opioids and subsequent addiction. Nonetheless, opioids nearly ruined him.
Sadly, neither vulnerable group is cared for all that well. Starting in September 2016, discussions among people with pain, people in recovery, clinicians, and mentors – and events that followed – at the University of New England began to show how both groups could collaborate to influence the changes we need. Here are some similarities we discovered and several proposed solutions.
1. Personalized care. Chronic pain and SUD are misunderstood conditions, and there’s a complex intersection between the two. We need carefully thought-out solutions when addressing them. Unfortunately, across the country, we’ve been polarizing the conversations, prioritizing certain voices over others and generating simplistic policies (like prescribing caps) that are “one size fits all” and incredibly extreme. Health care isn’t that black and white. Why are we pretending it is?
Quality-of-life improvement is the ultimate goal. Each person is working towards SAMHSA’s definition of recovery: “a process of change through which individuals improve their health and wellness, live self-directed lives and strive to reach their full potential.” Listening to the stories of people in recovery and people with pain, one will be amazed at the diversity of successful treatments. We cannot expect anyone to be successful when forced into a box. We must provide tailored care and embrace all interventions that improve quality of life.
Some people still need opioids for pain just as others need methadone for their opioid use disorder. Both medications are fatal when used incorrectly and lifesaving when used properly. Denying medications to people truly in need can also be catastrophic. We require personalized care, allowing clinicians and patients to make decisions together. And there’s no question that when using any type of medication[s], having good management and communication is key.
2. Comprehensive care. Dr. Peggy Swarbrick published a model of care, “the eight dimensions of wellness,” that examines the emotional, environmental, financial, intellectual, occupational, physical, social and spiritual aspects of life. Chronic pain and SUD can impact these dimensions in unbearable ways. Using that model as a guide, people in recovery and people with pain led small-group discussions on the nuances of these conditions in an interdisciplinary collaborative with graduate-level health profession students. We especially highlighted the importance of promoting healing using medical and societal interventions to meet patients’ multi-modal needs.
3. Love and understanding. Living with either chronic condition can be overwhelming, derailing even life’s little pleasures and pains. The stigma and discrimination we encounter in medical, human service, and other settings often make our feelings of hopelessness and isolation exponentially worse. Sometimes, sheer resilience saves our lives. Surrounded by judgment, both groups committed to listening to each other’s stories and fostering love and understanding as part of the healing process. We captured some of these emotional experiences in five narrative videos at a storytelling night, which was, indeed, our most poignant event.
4. Support and teamwork. People are now facing prejudice simply because they experience pain. While this isn’t new to the pain community, people with SUD have also endured pervasive injustices. As a person in recovery, I think to myself, do we want to treat people with pain the way society has treated us? We must not forget about you. Both groups can offer hope, support and empowerment to each other, and teamwork will strengthen our advocacy potential, too.
5. Accountability. While the nation argues about opioids, this sidelines other concerns that need immediate attention. Insurance companies frequently deny life-saving treatments for both groups, and we must hold them accountable for the harm this has caused. Additional issues of affordability, availability, accessibility, and quality of services have also created enormous barriers for millions of people trying to heal. The abysmal care and deaths in both groups have to stop. With the annual economic cost estimated at $560 to 635 billion for chronic pain and $442 billion for SUD, every taxpayer has a lot at stake. Don’t you agree we ought to think smarter and do better for everyone’s sake?
A call to action: joining hands
Instead of more shock-value talk on the latest wave of overdoses and the magnitude of the problems, we should come together with a sense of purpose and community, work across the silos of pain and SUD and generate comprehensive solutions to help us all.
Only through collaboration can we ensure that policymakers ask themselves, “Who could this policy negatively affect and how?” Only through collaboration can we establish the infrastructure to address all peoples’ needs. And only through collaboration can we begin to repair the harm that’s been caused on many sides.
Let us never forget that our country will accomplish more when we act like a caring community, look out for all marginalized groups and build a culture that empowers the voices that have been too often silenced in the past.
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