Anatomy of an Opioid Epidemic


There is a quick, simple solution to our opioid overdose epidemic, and it was already used to end a U.S. heroin epidemic 100 years ago. It will become obvious once two major misconceptions are corrected:

1. Long-term opioid prescribing has not only been shown to not be helpful for chronic pain;1 it in fact causes it.2 It worsens pain by repeatedly causing tolerance and agonizing withdrawals (the main symptom of which is pain) to develop. The resultant suffering can only be curbed by successive, increasingly deadly dose increases. This fools users, who are unaware that they’re in unending withdrawals, into believing their pills are helpful and needed. Opioids also shut down the body’s production of endorphins.3 4 Thus, the only way chronic users can obtain any pleasure or tension relief is via pills; this adds to their desperation. All of this is analogous to how psychiatric drug use, though often helpful initially, ultimately can cause people to become chronically “mentally ill,” as Robert Whitaker showed.5 Just as there was no “mental illness” epidemic until psych meds were widely used, there was no chronic pain epidemic until long-term opioids were widely given.6 7

Until 1990, doctors rarely gave opiates due to awareness of these issues: they were prescribed either briefly for severe pain from surgery/injury, or continuously for end-stage cancer (in which overdose is often more a goal than a concern). But today’s doctors dispense ten times as much — 200 million opiate prescriptions yearly, mostly for non-terminal clients. The average days-of-supply per script is still climbing: it’s now nearly 3 weeks;8 that’s long enough to produce tolerance and pain-worsening.9 And these scripts are regularly refilled. Such profiting by creating chronic suffering only occurs in the U.S.

2. Buprenorphine, which is now integral to most opioid addiction programs, is only able to reduce opioid cravings because it’s just another opioid. Like all opioids, it’s addictive, and euphoric in new users; it’s Finland’s most abused and lethal opioid.10 It’s often combined with a tiny amount of opioid antagonist (naloxone) under the brand name Suboxone. But naloxone is poorly absorbed orally, so it doesn’t block buprenorphine’s effect. Thus, youths who’ve had a taste of opioids and are tempted to ramp up their usage but can’t find their parents’ pills or get pain doctors to directly prescribe them, have a new source: they can get endless supplies by merely claiming to be heroin addicts hoping to quit. Real heroin addicts may use it to quit heroin, or to tide themselves over until their next fix or to sell on the street to raise cash.

So buprenorphine may more often be a new way to create addicts, and a gateway/enabler of heroin abuse, than it is a treatment. This could partly explain why overdoses really took off after it came to market in 2002. Is it wise to put addiction treatment into the hands of a field that thrives by creating addiction? Isn’t that like putting a fox in charge of a henhouse?

Rather than pump yet more opioids into the system, why not drastically cut them back to pre-1990 levels, by simply resuming enforcement of the 1914 Harrison Act? This law helped end that era’s heroin epidemic, by criminalizing the prescribing of opiates to maintain addiction. It led to the jailing of some MDs who did so; this scared most other MDs from following in their footsteps. Prescribers of any opioid longer than two weeks, other than for end-of-life care, should again risk prosecution. Perhaps their sentences should be longer than for street dealers, since at least with street dealers you know what you’re getting into; with doctors, it may be the last thing you’d expect.

To fully enforce the Harrison Act now, the 2000 Drug Addiction Treatment Act must be repealed since it undermined it by exempting buprenorphine-peddling from being deemed a violation. This is crucial, since Suboxone docs dole out 30-day opioid supplies like candy. Each sees hundreds of clients for 5-minute monthly office visits in assembly-line fashion. It’s so lucrative that even high-pay specialists like anesthesiologists often do it. The recent big rise in buprenorphine scripts was half as great as the recent fall in pain pill scripts.11 And only the brief-supply pain scripts fell. So the medical field appeared to curb its opioid-dealing, while really just playing a game of whack-a-mole. Suboxone docs, in particular, are nearly 10 times as likely to have been previously sanctioned for offenses like excessive narcotic prescribing.12

Doctors recently also ramped up their drug-dealing by dispensing more stimulants for “ADHD.”13 All of this increase was in scripts for teenagers and adults; in fact, they’re now mostly given to teens/adults,14 in whom they’re euphoric and addictive. They can thus be gateway drugs not only to opioids, but also to other stimulants like cocaine or crystal meth. Maybe that’s why yearly overdoses involving these drugs doubled in the last three years: to 14,556 for cocaine; 10,721 for meth.15 No stimulant was ever shown to truly help any issue, so taking them off market is this crisis’s fix.

Show 15 footnotes

  1. Reuben, D, et al. “NIH Pathways to Prevention Workshop: the Role of Opioids in the Treatment of Chronic Pain” Ann Intern Med, Feb 17, 2015, 162,4,295-300.
  2. Hayhurst, C, Durleux, M. “Differential Opioid Tolerance and Opioid-Induced Hyperalgesia: A Clinical Reality” Anesthesiology, Feb 2016, Vol 124, 483-8.
  3. Bronstein, D, et al. ”Effects of Morphine Treatment on Pro-Opioid Melanocortin System in Rat Brains” Brain Research, 1990: 519(1-2),102-10.
  4. Zhang, G, et al. “Tolerance of Hypothalamic Beta-Endorphin Neurons to Mu-Opioid Receptor Activation after Chronic Morphine” J of Pharmacol Experimental Therapeutics, 1996, 2,77,551-8.
  5. Whitaker, R. Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America, 2010, Crown Publishers, New York.
  6. Annual Statistical Report on the Social Security Disability Insurance Program, 2012, Awards to Disabled Workers, Table 40: Distribution by Diagnostic Group 1960-2012.
  7. Freburger, PT, et al. “The Rising Prevalence of Chronic Low Back Pain” Arch Int Med, 2009, 169(3)251-8.
  8. 2018 Annual Surveillance Report of Drug-Related Risks and Outcomes, CDC, National Center for Injury Prevention and Control.
  9. Chu, LF, et al. “Opioid Tolerance and Hyperalgesia in Chronic Pain Patients after One Month of Oral Morphine Therapy: A Preliminary Prospective Study” J Pain: 2006, 7(1)43-8.
  10. Kriikku, P, et al. “High Buprenorphine-Related Mortality is Persistent in Finland” Forensic Science International, Vol 291, Oct 2018, 76-82.
  11. Quesinberry, D, Bunn, T. “KASPER Quarterly Threshold Analysis Report” Fourth Quarter 2017, Kentucky Injury Prevention and Research Center, Feb 28, 2017 (2018).
  12. Sontag, D. “Addiction Treatment Has a Dark Side” New York Times, Nov 16, 2013.
  13. Jones, C. “The Latest Prescription Trends for Controlled Prescription Drugs” U.S. Food and Drug Administration, Sep 1, 2015.
  14. Muzina, D. “Report: Turning Attention to ADHD” Express Scripts, Mar 12, 2014.
  15. ”Overdose Death Rates” National Institute on Drug Abuse, NIH, August 2015.


Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.


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  1. Pain doctors knew what they were doing, didn’t they? Circumvent the Harrison Act, done with the Drug Addiction Treatment Act, and you make a bundle. The mafioso possessed the same sort of knowledge, only in their case, illegality can up the ante. Illegal, or legal, addictive substances are profitable. Outlaw fentanyl, and the mob is back in business. Actually, you don’t even have to outlaw it. It’s so addictive that if they get their hands on it, stacks of money grow. Now that medical doctors have become major drug distributors, that’s got to give a body pause for thought.

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  2. If they send me home to suffer next time I get a toothache hopefully I can contact a drug dealer and get a few pills.

    Its scary, a few months ago more like 8 months ago I was up all night with a toothache. I would get out of bed and it would somewhat go away then I would go back to bed and before I could get to sleep it the pain was back up to a level 7- 8 and I had no other choice then to get up or feel level 9 or 10 total pain distress.

    The next morning I made a dentist appointment soon as they opened and got one for the following day. I was very very lucky that the toothache went away by itself cause I could sense in that dentist office I was suspected of being a drug seeker. Everyone is these days.

    I still have to get some dental work done, next time I am around the right people get a few roxy 30s just in case. What if I need root canal ? Tooth aches are so awful and the last thing I want is to be reduced to begging if a big one hits. Everyone should have some opiates in their survival kit.

    I had my problems with alcohol, big ones. I don’t get the opiate addiction thing. Alcohol is better, it hits the spot chills you out but at the same time you get motivated to go out stir shit up.

    All this debate on the opiate crisis is stupid anyway cause we have a working model of what to do.

    Portugal’s radical drugs policy is working. Why hasn’t the world copied it?

    Portugal, that’s old news we can’t do logic in police state USA but Check this out: Getting paid to get the naltrexone implant (kickbacks) People are starting to troll AA meetings looking for customers.

    There has been an update I will put it on this forum thread.

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    • 277 views and only 2 comments ? That’s lame, very lame. Its real easy to sign up for this website.

      I don’t get it, when I read online news I often check for a comment section before reading it and if it doesn’t have one I look for the story on a site that does.

      What fun is reading it without interaction in the comments ?

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      • The_cat:

        I’ll respond. Tens of millions of households (in America only) do have stashes of opioids lying around in case they’re needed for “survival”. That’s how millions of thrill-seeking kids got started on a path that has led to so many of them dying by the age of 24.


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        • Lawrence,
          What you are describing here is a parenting issue. Responsible parents recognize that teens’ thrill-seeking behavior is to be expected, and take appropriate measures. I agree with the_cat about stashing a few opiates for dental pain in one’s survival kit. Enough with the nanny state.

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          • You had the 1914 law for a reason. Opium and opium derivatives used to be considered legit medicine. Now we’re supposedly trying to forget why that law was put on the books in the first place. Opium is potentially deadly dope. We’ve got what is referred to as an opioid crisis now. Why? In the 2000s what happened early in the 20th century is apparently a lesson we have to learn all over again. Widening the definition of ‘opium den’ just doesn’t cut it.

            Doctors wouldn’t be becoming such unscrupulous drug distributors if they had been taught better in medical school.To re-frame the problem, basically, amphetamine and opiates are drugs, not medicine. Ditto, alcohol. You’re going to have to go a little light on the pain killers if it is not the patient you want to kill.

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          • Yes, Frank, opiates are deadly.
            And keeping them out of teens’ curious, thrill-seeking hands is their parents’ job.

            Just like parents who keep liquor in the house should be storing it in a locked cabinet, because thrill-seeking teens can binge-drink themselves to death.

            And parents who have a gun need to keep it secured in a locked gun safe, because duh. And if they fail to do this, and the kid gains access to the weapon and uses it, the parents are held responsible. Same holds true for illegal drugs. Why not prescription drugs too? Kiddies gain access, you hold their parents responsible.

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          • I hold doctors responsible. It is now doctors who are the primary suppliers of opiates, not parents. We’re talking prescription drugs. Parents are only going with the flow. Doctors should not be pushing drugs that are more deadly than they are beneficial. This goes back to what I was saying before. You already had the 1914 law, and then you fashion a way around it. That’s asking for trouble. What are they teaching them in school? What it seems they are not teaching them is that opium, and opium derivatives, or drugs that act like opium and opium derivatives, are not drugs they should be doling out like candy. We already went through this matter in the nineteenth century, and I guess, at this point, we have to relearn the lesson of the early twentieth century.

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          • Frank,
            When you are expecting, is it the obstetrician’s job to baby-proof your house?? Of course not! If the parents fail to do so, and the baby sticks a fork in a wall socket, is the doctor to blame?
            Parents control the environment of their home, and what is accessible vs. locked away. If they fail to do that, and their kid ODs on mom and dad’s prescription pills (of whatever variety), the parents have themselves to blame.

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          • True enough.

            I just think anybody who had done any thought on the subject would have thought long and hard before making opioids a drug of choice. Apparently some peoples, and peoples in important positions at that, thinking apparatus is off. Should they have lost their positions of authority over this break in their thinking devices. I would think that one wouldn’t have to think so long and hard over the subject as one might over the prescribing of these dangerous and addictive substances in the first place. As result of their faulty thinking apparatuses, we have people dead and dying that otherwise wouldn’t be dead and dying.

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        • I went to and then both worked and volunteered at a drug ad alcohol treatment center for years and I think you are more on track with the ADHD drugs being the gateway. I should have went for that in my first comment. Dexedrine is part of my story, that Rx didn’t come into my life until age 29. Long story that reckless prescriber and psychiatry wrecked me.

          Anyway by the time I got to the last treatment I had discovered ‘anti psychiatry’ became kind of an activist.

          For several years I have been asking the clients were you drugged in school ? Its not terribly difficult to bring up the subject of psych meds and ask that question to people in rehab and the majority say yes. You can do the same thing at AA, AA has become opiates/drugs anonymous especially the young peoples meetings, just start a conversation drinking drugs psych meds and using then ask did they drug you in school and the same thing, the majority say yes. Anyone can can do this survey. Keep it scientific ask the 30 and under people you will see.

          I am not buying that left over med’s in the cabinet started this, if they were that addictive there wouldn’t be left over med’s in cabinets cause one taste and the person prescribed them would finish the bottle then bug out and run to the hood to buy dope.

          Again Dexedrine is part of my story, Adderal too. When that stuff wears off your left in a place you need a drink or benzos or opiates to quell that crash into restless anxious can’t eat depression. I took that stuff as a fully grown adult and it was a rocketship ride I can’t believe they give that to children. And no I was not ‘abusing’ it. 40mg dexedrine or 60 Adderal a day is pretty standard.

          I see this whole opiate/drug epidemic as the result of the child medication generation growing up. The 2 are related. Spend your teens or entire childhood every day up and down high and crash on ADHD drugs it likely becomes the only way these people know to regulate. An opiate feels alot nicer during an ADHD drug crash cause its relieving something.

          My generation, X, we had open house keg parties, beer was our drug, pot acid and cocaine was around that’s about all that was on the menu. Heroin was only on TV news in far away yucky places. None of us were drugged in school. Me and my buddies, today we would have been. We did not pay attention.

          Now the war on fun police state America, the youth all drugged in school and into pills hiding in basements instead of together partying in public like we did. It has to suck.

          “enabler of heroin abuse”

          Oh gosh Suboxone, “subs” I know how it works. Its currency out there, complements of the insurance companies. “sell half my script to buy dope then use the rest to come off it” Whole back and forth game they play.

          “resuming enforcement of the 1914 Harrison Act?”

          There is no putting this toothpaste back in its tube, its happened already, the cartels have moved in and will fill any void created. There were no cartels like we have now in 1914. Cell phones and smugglers, 1000s of container ships with millions of containers to hide stuff in, mail, the internet dark web, tunnels from mexico under the wall… Drones over the wall…

          I don’t know, again the Portugal model is the only one shown to work.

          And this

          I don’t think its worth one person in chronic pain to suffer to save 100 who just refuse quit being dope fiends. Its like the Blackstone’s formulation.

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  3. I was recently offered an opiate derivative pumped directly into my bloodstream during prep for a colonoscopy. I refused due to being allergic to opium derivatives. The coloscopy procedure ended up painless. The pain treatment for colonoscopies is opt out rather than opt in. It costs $ 1,200. I’m confused why the default assumption is that everyone will need a pain killer for what was, at least for me, a painless procedure. Drug company influence? Hospitals padding their billing?

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    • Medical procedures freak me out and if they offer IV opiates I will take it. I got better things to do then be having anxiety attacks bugging out wile people do medical operations on me cause fake news has declared all opiate consumption is bad.

      I am getting older, I hope I stay healthy and stay out of hospitals and don’t need medical procedures but I hope this war on pain treatment goes away before my health ever fails.

      For example up to 50 percent of people with diabetes may experience nerve pain. I am not in that 50% but if I get that shit don’t F with me that some political BS says I can’t have the only pain treatment that works, opiates, but instead have to use some toxic alternatives. F off with that.

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    • Maybe because you own default assumption is that everyone else is like you and should feel no pain, or doesn’t mind remembering their colonoscopies? I can tell you, I’m not one of those people and I think you would find if you asked, that a good proportion of people are more like me.

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    • I agree madmom, you really have to wonder why they offer things like this. I’ve had two major surgeries this past year and was approached with all kinds of pain meds that I did not want nor did I need them. I have a bottle of hydrocodone that I never needed setting in my medicine cabinet. Don’t know why I’m even keeping it and need to take it down to one of those places where they collect prescription drugs that aren’t used.

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  4. “Prescribers of any opioid longer than two weeks, other than for end-of-life care, should again risk prosecution. Perhaps their sentences should be longer than for street dealers, since at least with street dealers you know what you’re getting into; with doctors, it may be the last thing you’d expect.”

    I agree, I was prescribed a “dirty opioid” under a different name (Ultram), then lied to, and told it was a “safe pain med.” Opioids are NOT “safe … meds.” The doctors, who’ve all promised to “first and foremost do no harm,” and choose to betray their patients, do deserve longer prison sentences than the street dealers.

    Especially since the doctors do go on to misdiagnose the adverse effects of the opioids, and in my case also the common withdrawal symptoms of a “safe smoking cessation med” (actual mind altering and dangerous antidepressant), as “bipolar.” Despite the fact this is a blatant misdiagnosis, even according to the DSM-IV-TR. From the DSM:

    “Note: Manic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar I Disorder.”

    This then results in multiple (14 in my case, according to medical records) attempted murders, via the medically known toxidrome, anticholinergic toxidrome.

    Today’s “bipolar” recommended drug cocktails are basically all a recipe for how to create anticholinergic toxidrome, and make people “mad as a hatter.” A toxidrome is a known way to poison a person, and poisoning a person is a form of attempted murder.

    Yes, hypocritical and unrepentant attempted murderers should be prosecuted and incarcerated, especially if they are doctors who are utilizing their medical education to harm, rather than help, their patients. But this is not happening, which is why medical harm is the number one killer of Americans today.

    And why America is experiencing it’s very own psychiatric / “medical holocaust” today.

    The doctors who attempt to murder their patients really do need to start getting arrested. But our legal system is set up to protect these unrepentant murderers and attempted murderers. Only one of my former, attempted murdering doctors (motive was to cover up prior malpractice and medical evidence of child abuse in my child’s medical records, BTW) was even investigated, let alone convicted.

    And he was convicted for Medicaid Medicare fraud, not for murder, the harm he did to me and my family, or other patients. Despite the fact he’d likely, “medically unnecessarily,” murdered many of his patients.

    Today’s opium epidemic and psych drug “holocaust” could have been prevented. But the “powers that be” set up these satanic systems on purpose, because it’s very profitable for doctors to make people sick with drugs, then “manage symptoms,” rather than “cure” diseases. So the medical community, collectively, should be ashamed of themselves.

    And I do now understand why, during my drug withdrawal induced, “super sensitivity manic psychosis”/spiritual awakening, Jesus supposedly said, “all the doctors are going to hell.” I didn’t agree with Jesus then, and still believe there are good and bad doctors.

    But now that I medically understand how today’s satanic, murderous, medical and psychiatric “system” works, I am disgusted by it. Thank you for being one of the decent doctors speaking out against it, Dr. Kelmenson.

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    • Ultram (tramadol) and Palexia (tapentadol) are called “opiates” by the doctors. They are called “non-addicting” because they don’t get you high like the oxy or vicodin.

      HOWEVER, tramadol is really an SSRI, and tapentadol is really an SNRI. They developed tapentadol because so many people were on SSRI’s that they got serotonin toxicity when they added tramadol.

      There is severe withdrawal from tramadol / tapentadol, but it is irrelevant to the weak opiate action.

      This is because they fiddle your neurotransmitters like psych drugs.

      They should be tapered carefully if used for more than 3 weeks at a time.

      And doctors, in their ignorance, still think of them as “opiates” (the “good kind,” the “nonaddicting” kind, the kind with less street value), and don’t consider checking for interactions with psych drugs.

      I had a friend go into serotonin syndrome because she was on max dose of Pristiq, and then offered tapentadol when she broke her back. She said to me, “I don’t feel so good,” and I asked her what they gave her and said “OMG quit! And call the pharmacy!” Fortunately, she had only been on them a couple of days.

      But = stupid stupid stupid.

      Sometimes I wonder, Someone Else, if Jesus is right, and all doctors are going to hell.

      Contrast with pure opiates, give me 72 hours and (apart from the addictive behaviours, which must also be broken) you can get someone off the opiates in detox.

      Not so, antidepressants (which, like Cymbalta & Lyrica, they also give for pain conditions).

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  5. I think eventually with electronic medical records it can be shown that the kids drugged in school are the ones showing up at drug rehabs. I know it but right now no one is officially tracking it.

    “”The researchers used Magnetic Resonance Spectroscopy scans to examine GABA levels in the medial prefrontal cortex of 44 male ADHD patients. They found evidence that methylphenidate use by children produced long-lasting alterations in GABA neurotransmission in this region of the brain.

    “This study focuses on one specific neurotransmitter system: the GABA system,” Solleveld explained. “We report that there are lasting changes in this neurotransmitter system when ADHD patients are treated before the age of 23 years old, i.e. during brain development.””

    The GABA system, when that gets screwy nothing feels better the a Xanax or Roxy to level off… besides maybe a drink. The anxiety part of the ADHD drug crash is a GABA system malfunction.

    I am not into the whole drug war thing but this bullshit of drugging kids in those indoctrination centers posing as schools is an atrocity. I met enough people in the rehab with drug charges and I tell them to get it on the record that they got drugged in school as child and they never learned any other way to regulate besides doing drugs.

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  6. While the actual medical details of this piece are surely beyond my pay-grade’s ability to comment, I pretty much stopped listening when the words “simple solution” floated across the page. It’s always so tempting to trot out the simple solution, especially those that promise that we can threaten and punish our way to success. But as usual, the devil’s in the details. Enforcement of any law is the key, but in the day of drowning government and government regulation in the bathtub, I wonder what exactly, such enforcement of the Harrison Act would actually look like. And if you’re going to say that the simple problem needing the simple solution is doctors’ bad prescribing of pain meds, and that the government should apply punitive measures and should jail doctors, where is the will in the doctor community to create their own methods to drum the bad docs you’re pointing a finger at, out of the profession entirely? Why should it be the government’s job to “scare doctors straight” and enforce a level of ethics that the medical profession itself won’t truly demand of its members? You mention sanctions, but apparently those have zero teeth. You guys are the smartest guys in the room, what’s the solution for that then?

    I also strongly disagree with your assertion that chronic pain was not a problem before opioids, which is just another way of saying you don’t believe in people’s reports of their own pain. God, can things get any more demoralizing than that from a patient point of view? More likely that prior to opioids being prescribed for anything but near death, people just suffered in silence, and died off as early as possible to get away from it. I assure you, chronic pain can get worse over time and become a thing from undertreatment, just as it can from overtreatment with opioids. I’m the poster-child for sucking it up until it’s too late.

    I’m glad you’re not dealing with pain, but many really do, and there’s not much out there for it at present. Downplaying the impact of chronic pain on quality of life, is standard doctor method for dealing with their own discomfort: you can’t help much, so assauge your own feelings of helplessness by being dismissive, or just flat out not believing patients to be reliable reporters of their own pain, especially if the patient is female, because you know, women. Then tell her she’s probably psychosomatic and offer to give her a script for (wait for it) antidepressants! In this I’m speaking from the experience of having a condition that is frequently first misdiagnosed as MENTAL (can you say depression/anxiety/conversion disorder?) and that many docs STILL insist is not painful: MS. So doctors holding forth on what pain is legitimate or not, tends to get my dander up.

    Somehow I’m thinking that going back to the days when the prevailing attitude was suffering is good for the soul and hyper-masculine stoicism was held up as some ideal, is not going to work anymore. I also think that pushing a solution that requires the same medical community that according to many, went to the extreme of passing out opioids like candy, to now go back to the other extreme of withholding any opioid until the patient is dying with stage IV cancer pain, is not going to work out so well either. Both of those extremes are lazy, IMO. Just like hustling everyone with a sad face or with pain, out the door with an antidepressant is lazy.

    I go on the assumption (based in experience) that most of the time that if I hold it together, the doc will assume I’m overstating my pain, but that if I’m emotional, the doc will equally dismiss me with the hysterical label. There’s really no way to win, so I don’t play. But while I personally am sucking it up, I don’t expect that will always be an option. I understand quite well why people in chronic pain might want to check out permanently, and the responses of doctors have had a large hand in that understanding.

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    • I am glad you said this. Many cases of “depression” involve chronic pain or other chronic conditions that impact quality of life, and of course, the psychiatric profession tends to ignore these completely, as they don’t fit with the “brain disorder” worldview the profession is trying to promote. Dealing with daily pain is draining and has dramatic effects on one’s view of life and the world.

      As I’ve said many times, the first error of psychiatry is to believe that the same “symptoms” are always caused by the same thing and always require the same “treatment.” This goes for chronic pain as well, in my view. What works for one person won’t work for another, and the person who is best situated to determine what the best approach is would be the patient. Rigidity in either direction leads to stupid and often dangerous results.

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    • Very well stated. As with psychiatric labels there is also lots of stigma around chronic pain. Unless a doctor, or anyone, has lived with debilitating chronic pain they should not judge someone else’s pain.
      As I try wrap my brain around the insanity that is ‘psychiatry’ the most appalling revelation is that nothing a person is going through matters. Whatever life crisis you are dealing with – it simply does not matter to a psychiatrist. That has been the most shocking thing to learn.

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      • Great point! You can try to explain to them why you ended up in their wonderful “care” and they sit there looking at their watch and being very impatient, if they even let you talk at all in the first place. But of course, they’re great experts on everyone else’s life and they know it and who are you to try to dissuade them from this fact??? How dare you tell them that you know your own body and mind better than they do!! What blasphemy!

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    • The comments are all about the psychiatrists and their failings, and no doubt that’s an issue, but I never made it to a psychiatrist, and you will see why in a sec. My aha! moment came from one of the arguably truest abusers of psychiatric meds, a GP. About 10 years ago, I started feeling like I had the flu all the time – hurt all over, you couldn’t touch me, etc. A rheum eventually did dx me with fibromyalgia. But not before I had dutifully gone to my GP to see what he could do. I was having a particularly rough day and it showed – I wasn’t actually crying, but I was worn out and hardly at my best. Out came the script pad, and he started scribbling away. I asked what he was writing and he said a name I knew was an antidepressant. I asked why he was giving me an antidepressant, and he said “Well, people in your condition are often depressed.” Only I wasn’t depressed, just bloody tired of hurting. I was pretty gobsmacked and of course I refused the script. But I remained shocked and annoyed that he went straight for trying to drug me for “depressed” in under 15 minutes. That’s not a dx, that’s a blow-off. He’d been my GP for a while at that point, and I was (and still am), a pretty squared-away person, even now with several significant health problems.

      Anyway, being the old feminist that I am, his response pissed me off so much, that I eventually found MIA, which has been exceedingly informative over the years.

      And it may seem somewhat tangential to some, (although I don’t see it as such since the topic is pain and its treatment), but I will say that I don’t read everything here, so this could have been addressed somewhere at some point and I missed it, but I’ve not seen the issue of women and the over-prescribing of psychiatric drugs, addressed. The ingrained bias in the culture against women, manifests in the medical world as the subtle blow-off, the impatience with women’s pain, and disbelief at what women report. We are the ones who more frequently show up with “medically unexplained symptoms”. The question becomes though, ARE they unexplained, or do women with difficult presentations (typically autoimmune) then get blown of as unexplainable because they’re women, or attributed to mental problems more often, also because they’re women? And does it even delay the serious research that autoimmune conditions are just now starting to get?

      All of those those medical attitudes and behaviors mentioned contribute to the delay women often experience in receiving correct diagnoses, since women suffer disproportionately from painful autoimmune conditions like RA, MS, and Lupus, conditions that often present earliest with very difficult to explain pain. And now that antidepressants are prescribed with a handy Pez dispenser, the blow off often just looks a bit different than the eyeroll of previous generations.

      For any woman here, but hopefully even some of the men reading, I can’t recommend this book on the subject of the misdiagnosis of women because they’re women, highly enough: “Doing Harm: The Truth About How Bad Medicine and Lazy Science Leave Women Dismissed, Misdiagnosed, and Sick” by Maya Dusenbery. If Robert Whittaker’s writing was one big aha moment for me, Dusenbury’s book was an even bigger one. She even outright describes what I intuited long before I read her book, and that is the terrible double-bind of presenting pain to doctors either emotionally or stoicly. It really is a no-win. We often aren’t believed on the occasions that we present with acute pain either, and for the same reasons.

      So, you can see why some of the attitudes on display in the good doctor’s piece above, are setting off my alarms. When you can say it would be better to assume that there never was an epidemic of chronic pain, essentially saying chronic pain is a problem that was only manufactured by the overprescribing of opioids (uh, no), and that it would be better for society if we went back there, where people just toughed it out, I have to seriously disagree. The probable reality is that most people just suffered in silence, men because they’re MEN! and women because they knew (still often know) instinctively that they’ll be brushed off as “hysterical” or lying.

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      • Yes! I read the book. It is a twofer for females! Pain and or DSM dx in ten minutes or less. Also the whole ignorance of the female physical experience. Has any female ever ever was asked what was or is your puberty experience and or who would actually want to disclose to some of the treating docs any way.
        Also the repression of sexuality so that gender almost becomes meaningless.
        Thanks for bringing this up. Books need to be written. And check treatment advertising! Women are the prime targets.
        And why are females in this movement more hidden than not?

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      • I would add to that the fact that womens’ burden of abuse, poverty and discrimination is much higher on the average than men, yet psychiatry continues to refuse to take such stresses seriously as causal factors, and this attitude has spread to GPs as well. The Kaiser study showed that physiological problems like IBS and fibromyalgia, lupus, and others occur more frequently in trauma victims than the general public. But we can’t seem to get together as a society and admit that oppressive circumstances are preventable and are causal factors in many of the problems we see in adults.

        Back in the 70s, feminist writers were all over this idea that women’s reactions to an oppressive society were minimized and trivialized and hidden by the psychiatric professions’ approach to diagnosis, and that real physiological issues were often also hidden through accusations of “hysteria” going back 100 years or more. But I don’t see much writing from feminists on these points lately. Am I missing something?

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        • Steve, we could both be missing something. I haven’t read much of modern feminist thought, but the little I read a few years ago seemed more concerned with internecine battles and the subject of intersectionality and how (now old, so it had a generational vibe) second-wave mostly-white feminists were so bad for not having vigorously addressed the concerns of LGBT and black women. Also, until just recently, my observation (somewhat limited it’s true) has been that younger women have been loathe to even identify as “feminist”, preferring instead to call themselves “humanist”. (In the driest, dustiest tones possible): I think the last 2 years have probably taught them the error of that position.

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      • Artanis12- thanks for your comments and the book suggestion! Your story resonates so much with me, as a woman living with undiagnosed chronic pain. I have some symptoms that are suggestive of a specific autoimmune condition, but I do not meet full diagnostic criteria, therefore they will probably never be officially diagnosed or taken seriously. I definitely agree, that sexism and the bias that women’s pain symptoms are mere “hysteria” is very real. In fact, the last rheumatologist I tried to work with told me he didn’t think anything was wrong with me because I was “tall, thin female” (?!). I wish had the nerve to say something to him then, but I did at least strike back with a few reviews exposing his sexist comments. 🙂 I also had an internist who I had been working with for several years before I had health problems who disappointed me by eventually trying to push antidepressants. Initially, she was very good about referring to other specialists and trying to get to the bottom of my symptoms, but at the end, I was getting the talk about SNRIs at a visit where I was visibly frustrated with the docs like the sexist rheumatologist. She actually wound up moving out of state after that final visit, but I would not have been motivated to go back to her even if she had stayed. I later caved and took drugs from a psychiatrist, since I was getting distressed by the lack of support I got at work and my family. Not surprisingly, that turned out to be a disaster that has taken me years to get out of.

        I am also glad to see others speak out against Lawrence’s ill-informed opinions about the legitimacy of chronic pain (that are clearly not based on any personal experience living with or professional experience treating chronic pain). FYI if you haven’t read them and don’t mind your blood pressure going up, there are two others that also do a disservice to people with chronic pain, but for whatever reason, MIA seems to think he should continue to be given his (badly informed) platform. What probably bothers me the most is that he (and some others here, unfortunately) do not see that complex chronic pain which is not taken seriously is a major route to getting psychiatrized. And thank you for bringing up the very important point that many chronic pain conditions disproportionately affect women (who are disproportionately less likely to be taken seriously) which makes the chronic pain –> psych drug gateway especially a problem for women.

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        • Surviving and Thriving – likewise, as a round, plump female, I get blamed for all my pains, because “I’m fat.” “If only you’d lose weight. . . ”
          (never mind the metabolic problems that were caused by 20 years of psych drugs. . .. )

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          • Rachel777 which is funny because – they give us the drugs that make us fat, and then blame us when we get fat. Tell us to “exercise more” when we’re drugged out of our minds, lethargic and anhedonic, and tell us to “eat better” when the drugs make us crave carbs like a Cookie Monster…..but it’s “our fault.”

            Not the fault of the doctors or the drugs.

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  7. Thanks for this Lawerence.
    This is another example of cross currents in medicine that have gone badly and how corruption and greed infiltrated the entire medical system.
    Insurance, education, and research modalities created further opps for abuse.
    The Sackler Family is worth a research effort.
    Back in the day folks with Sickle Cell Anemia and terminal cancer had true hard pain issues. It was a dilemma and people experienced terrible pain.Other conditions also had pain management nightmares.
    This happened parallel to and at almost the same time as psychisyry’s change into bio psychiatry.
    For both crisises there are alternative treatment and coping modalities. But there mostly are not funded by insurance, are scattered around and usually only work through individual trial and error and many times even if they work are too expensive to continue long term.
    Triple that level to pediatric populations.
    Good Living Through Chemistry. Right.
    My relatives and I found pain management docs a joke.
    Some found help with anti- depressants Truly.
    It’s just a gargantuan mess in capitol letters written in flashing neon colors.
    I would like to see Insurance Companies investigated as well as medical and professional schools investigated, private and profit hospitals addiction and Psychiatric programs, the entire range of owners of big Pharma and should shareholders pay a price for the deaths involved?
    The legal profession and government should be investigated as well. How many NDA’s are there floating around?
    And what other wealth strong arms with pens and legalcompandiums have negotiated silences from folks?
    Some folks do need help with pain. Some folks need help with trauma or perhaps other issues. They all and we all should have the right to have competent and humane medical and no medical treatment options.
    And the children- a real chance to live well and prosper.
    Sales reps told docs it was nonadictive, they in turn told their patients but the big lies create hell. And so many families are living in hell.

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