Karl Benzio, M.D., says the reason the U.S. is currently experiencing a disastrous epidemic of opioid abuse can be summed up in two words: Pain avoidance.
"In the 1990s, you had this proliferation of people trying to address the symptom and not so much the underlying cause of the pain the person has," he explains.
According to the federal government, in 2016, the nation mourned close to 64,000 deaths from drug overdoses. Two-thirds of those involved the misuse of opioids. Benzio, a Christian psychiatrist and member of Focus on the Family's Physicians Resource Council (PRC), fears the toll could approach 80,000 in 2018.
We wouldn't be here, Christian doctors say, if opioids weren't so effective. Americans want something for their pain—regardless of whether that pain is physical, mental or emotional.
Patients categorized as heavy prescription opioid users express greater satisfaction with medical care than non-users by 32 percent, the Annals of Family Medicine reported in January.
"We live in a psychologically compromised society that is impatient and entitled, and that feels there should be no pain in life," explains W. David Hager, M.D., also a member of the PRC. "Greater demands are placed on providers to eliminate all pain with medication."
The problem is that once they get a taste of the relief— coming easily in the form of a powerful pill, powder or shot—some patients develop a dependence that leads them down a dark path. Ironically, that path leads only to deeper struggles. For some, the exit will only come in the form of fatal overdoses as opioids shut down the body's ability to breathe.
Neither Benzio nor Hager categorically objects to the use of opioids as a form of pain relief, but both say such prescriptions must include limits. Both advocate treatment that does not rely heavily on the use of narcotic painkillers. Most importantly, both believe truly effective treatment means helping patients deal with life's pain and its root causes head-on, rather than masking it through medication.
It Started with a Letter to the Editor
Hager believes the current crisis can be traced back nearly 40 years. Medical researcher Hershel Jick and graduate student Jane Porter of Boston University Medical Center analyzed data from patients who had been hospitalized there. Close to 12,000 had received at least one dose of a narcotic medication during their stay. Of those, Jick and Porter's analysis found only four had developed a well-documented addiction.
Jick sent the findings to the New England Journal of Medicine, which published his analysis as a letter to the editor in 1980.
"Despite widespread use of narcotics drugs in hospitals, the development of addiction is rare in medical patients with no history of addiction," Jick wrote. His words would end up carrying far more weight than he ever dreamed.
Though Jick's summary of his work with Porter was only one paragraph that wasn't even subjected to peer review, it would be cited frequently over the next 20 years. In 1990, Scientific American called it "an extensive study." About a decade letter, Time proclaimed it "a landmark study." Most significantly, Purdue Pharmaceuticals, maker of the popular narcotic OxyContin, began a promotion asserting less than 1 percent of patients treated with opioids would become addicted.
Pandora's box had been opened.
Decade of Ignition
In the 1990s, pain was correlated with a greater probability of a patient having ongoing health issues. So the medical community elevated it to the position of the fifth vital sign, along with heart rate, blood pressure, body temperature and respiratory rate, Benzio explains. "The medical and pharmaceutical community, thinking that reducing pain would help long-term patient satisfaction, health and outcomes, started to prescribe more pain meds."
The '90s also saw the development of stronger and more effective opioid painkillers. As the decade drew to a close, Benzio says, "the opioid epidemic was ignited."
It took some time for most of the country to realize the metaphorical fuse had been lit, but the numbers back up Benzio's view. According to the U.S. Department of Health and Human Services (HHS), between 2000 and 2017, opioid prescriptions increased 400 percent.
Between 2000 and 2010, misuse involving non- compliance with prescription instructions or using medications prescribed for another person, doubled, says Hager.
Now, the results are playing out in heartbreaking form nationwide, impossible to ignore. Overdose deaths—116 per day, according to federal statistics—are shaking Americans of all incomes, ages and ethnicities. From the rural back roads of Kentucky and West Virginia to the steely urban sprawl of New York and Los Angeles, the epidemic is cutting a flaming path that threatens to leave no family unscathed.
The Blame Game
It's become popular to lay the blame for the epidemic squarely at the feet of the big pharmaceutical companies. This May, the Los Angeles Times reported more than 350 cities, counties and states had filed lawsuits against makers and distributors of opioid painkillers. Los Angeles's suit accuses drugmakers and distributors of deceptive marketing aimed at boosting sales, claiming the companies borrowed from the "tobacco industry's playbook."
One of the companies most frequently put under the microscope has been Purdue Pharma, maker of OxyContin. In May, The New York Times, calling Purdue "the company that planted the seeds of the opioid epidemic through its aggressive marketing of OxyContin," uncovered a disturbing report on it compiled by the U.S. Department of Justice, which found Purdue Pharma knew about and concealed significant abuse of OxyContin in the first years after the drug hit the market in 1996. The Times also reported that in 2007, the company admitted in court it misrepresented OxyContin's potential to be abused.
Purdue Pharma's response?
"Purdue Pharma accepted responsibility for the actions some of its employees took prior to 2002 in promoting OxyContin," spokesman Robert Josephson tells Citizen. "Since that time, we've led industry efforts to help address prescription opioid abuse. Suggesting activities that last occurred more than 16 years ago are responsible for today's complex and multi-faceted opioid crisis is deeply flawed. As government reports state, today's increase of fatal opioid-related overdoses is being driven by abuse of heroin and illicit fentanyl."
Josephson is citing a National Institute on Drug Abuse study updated last September that found overdose deaths from heroin and other drugs laced with fentanyl increased 600 percent between 2002 and 2015. Street dealers have increasingly been cutting their drugs with fentanyl—a particularly dangerous and relatively inexpensive substance—to boost their profit margins. In many cases, the users don't even realize they're buying fentanyl-laced products.
While there are many who believe Big Pharma is complicit in fueling the epidemic and should shoulder much of the blame, Benzio sees it differently.
"Pharmaceutical companies only make the meds," Benzio says. "Only about 6 to 8 percent of people who take an opioid will misuse or overuse it in a destructive way. It is the doctors who over-prescribe and a society that is looking for a quick fix and can't tolerate any discomfort [that's to blame]."
The Road Ahead
The epidemic may have grown somewhat quietly, but the nation's attention is riveted to it now and policymakers aren't sitting still. In 2016, Massachusetts became the first state to limit the duration for painkiller prescriptions, at seven days. Since then, more than two dozen other states have also established limits (see list, right).
At the federal level, President Donald Trump declared the opioid crisis a public health emergency in 2017, and formed a commission to fight it. Meanwhile, HHS now has a multi-pronged strategy to get the crisis under control, including getting better data through research and improving prevention, treatment, pain management and recovery services. The federal crackdown is estimated to cost $13 billion to $18 billion over the next two years.
Hager and Benzio say that's a good start. Benzio also believes that rather than automatically jumping to the quick fix of narcotics for those in pain, physicians should look at encouraging other forms of treatment.
"There are many ways to combat pain through physical therapy and fitness, relaxation, better sleep and nutrition," he says.
Both doctors, however, believe getting a significant handle on opioid abuse will only be possible once the core issues that lead people to the drugs in the first place are addressed.
"The three principle root issues are rejection, abandonment and abuse," says Hager, drawing from his past work helping people deal with alcoholism as a Celebrate Recovery facilitator. "Unless we enable [people] to identify their root issue and deal with it first, the rates of relapse are high. When they are able to deal with their root issues by offering forgiveness, making amends and seeking a personal relationship with Jesus Christ, we find that large numbers are able to enter and maintain sobriety."
That, Benzio and Hager say, is why the Church has the unique ability to make a difference in combating the opioid crisis.
"We have to convince faith-based communities to get their hands dirty, to get involved and realize that this is an issue," Benzio says, inviting laypeople to develop a working knowledge of dopamine, the brain chemical that provides the pleasure-inducing sensation many who use drugs are seeking.
"There is only one power that can sever synapses in the brain that have been stimulated by a substance to achieve [a certain] dopamine level," he says, "and that's the power of the Holy Spirit."
Just how Christians appropriate the Spirit's power to take on the opioid crisis will vary from case to case. The point, Benzio and Hager say, is that this needs to become a top-of-mind concern for the Church. Precious families and lives, each bearing the image of their Creator, hang in the balance.
For More Information:
To see detailed guidelines from the U.S. Centers for Disease Control and Prevention on prescribing opioids for chronic pain, visit https://bit.ly/2LMKm7j.