Roy Exum
Governor John Kasich has just issued an order that will limit opioid prescriptions in Ohio to seven days for adults and five days for children. In the city of Columbus, it is not a second too soon. Police claim they are seeing at least two deaths for overdoses every day. Earlier this month a 13-year-old called 911 and said he couldn’t wake up his dad – a senior airline pilot – or his mother – a toney housewife. That’s because the two in an upper-class neighborhood died of overdoses during the night.
Governor Kasich – who many of us thought would be a viable presidential candidate – says he is stopping drug addiction where it most frequently begins and, brother, I am all for it.
As one who has been forced by pain to take a lot of opioids in the last 10 years, I can tell you two of the greatest truths – they stop pain and they are so addicting it is scary. I am not scared of many things but opioids are on my top shelf.
I have written about this a lot so pardon me if I am redundant but here’s how subtle drugs like Vicodin or fentanyl patches can be. Bone infection really hurts and in 2008 my elbow began draining infection on Dec. 26 and finally quit in November of 2009. I took massive amounts of pain medicines.
At first I had strep, then staph and candida-in-my-blood joined in. I had a flaming case of MRSA (Methicillin-resistant Staphylococcus aureus), which means the best antibiotics – those in the methicillin family – lose their punch. Other infections, all memorized by my osteomyelitis, appeared. And as the different strains of infections increased, so did the pain.
There was one day when I was so sick at The Mayo Clinic I couldn’t lift my head and the Infectious Disease doctor sat down and told me the two drugs they were pouring by the bucket inside of me – Vancomycin and Daptomycin – were the last ones left in the cabinet. “If these don’t work … we (a medical word used tenderly for ‘you’) are really in trouble.”
But here’s where the devil was sleeping – I was taking all kinds of opioids the whole time to keep me comfortable. Everybody is focusing on the infection, not where the opioids were staking claim. They have one – dilaudid – that is a hydromorphone. It is so powerful it is obscene and, when the infections started to break, I quit taking the pain meds. Doctors fail to caution patients that if you don’t taper off the opioids, you will be violently ill and will do anything to shake the bear off your back.
That’s how the bear wins. Pain is real. So is addiction. Now the nation’s opioid abuse is epidemic and the aftermath is even worse. Mental pain, life-changing pain joins addiction and, because Tennessee is making great strides in confronting the monster prescription drugs have created, heroin is easily available all over the state. Heroin is cheap, $10 a poke, but an oral dose of dilaudid is about $50-$75 a pill, be it in Coolidge Park or Clio Avenue (where two were shot, one 16-year-old girl fatally, on Thursday morning).
Let me take you a step further. There are plenty of pain clinics in Chattanooga and I am assured by the true experts that only about half of them are legitimate. The others depend on “return appointments,” don’t you see? Every so often you’ll see where one of their false-front pretenders is shut down but another will pop up. With the bothersome but necessary regulations clamping down at pharmacies and doctor’s offices, pills are giving way to heroin in a way that knows no social, economic, racial, educational or geographic boundaries. The next step from heroin? Death.
The heroin merchants, to entice the market place, now add fentanyl to the heroin to give it an extra pop and urge the user to come back more often. One speck of fentanyl no larger than a snowflake will kill you dead, even if you take it in the ER with a drug awareness team watching.
Get this: our ERs know how to counter fentanyl if caught in time, but foreign manufacturers sell the drug lords these mysterious derivatives that don’t behave like the pharmaceutical grade does. A bad batch of this stuff, let’s say, gets in a shipment to Lexington, Ky., and people who’ve been using it for the past year follow the same routine they know works as they administer it to themselves. But because it is ‘bad,’ suddenly the Lexington emergency services has 42 overdoses with the next 16 hours.
This happens increasingly. Watch the news reports, you’ll see a full scale breakout at least once a week. Do you know four counties in Ohio now have “portable cadaver units” at morgues because they can’t cope with the overdose deaths.
I believe anyone who is given a prescription for opioid drugs should be given a “user’s guide” explaining that when the pills get low you need to taper off of them, lest you’ll die from withdrawal. I have often wondered how some guys in jail cope with involuntary “cold turkey.” Wow.
My pain control has been handled by two giants. Chris Young, a brilliant anesthesiologist at Erlanger, has guided my path for the last 25 years, while John Blake, Southern Pain Management in the Parkridge complex, was Chattanooga’s first board-certified pain management expert. His staff actually counts your remaining pills on return visits, but how else can abuse possibly be contained.
Trust me, there is an answer to the puzzle. Dr. Young and Dr. Blake will tell you that there are some chronic-pain sufferers who can maintain a good lifestyle on a carefully-monitored opioid regimen yet they will also tell you that two Vicodin handle pain much better than if you take four at a time. Believe this, it is a science, and I know that I need a careful hand so that I never abuse it.
Yet it is so scary that now 78 Americans die every day. If you must take opioids then trust me, you must accept help. You can do it. I know, because I have. And – now – in Ohio, others will do the same before that bear can climb on their back.
royexum@aol.com