One magazine I sometimes read is More, whose content is designed to help women in midlife. This month they’ve got a long feature on how women with migraines are being deluged with painkillers.

The drugs are “transforming” the migraines from episodic to chronic daily headaches. I’d thought this was my own private anomaly. (This view is part of growing up in an alcoholic family: everything is “personal,” we don’t have anything in common with anyone else, and we Don’t Talk About It.) I’m sometimes forced to take triptans every day for weeks, and this is not good for me but I do it anyway. It’s a common problem for women.

The piece mentions a review of medical-insurance claims published in 2009 that found “almost 20 percent of the opioids prescribed in this country are dispensed to relieve the pain of migraines and headaches.”

But the source wasn’t cited. So I did a little checking and turned up the study, which appeared in the journal Pain (144:20-27). Psychiatrists at Washington University School of Medicine in St. Louis examined insurance claims for opioid painkillers, since self-reports of opioid use are pretty unreliable (we forget; we lie; etc.). They were looking at people who were “chronic” painkiller users (with more than 180 days of opioid use—which means I was a “chronic” user way back in 1999); “acute” users (less than 10 days), and non-users. Some startling results:

  • Chronic users made up only .65 percent—a tiny sector of the total population, but they used almost half of all the painkillers appearing in the claims
  • They had significantly more physical and psychiatric problems than people in the other two groups
  • Women made up more than 63 percent of the chronic users, and they used more of the medical services, especially as they got older
  • More than one-third of all the chronic users—and many more women than men—had mental health disorders.
  • Opioid abuse was twice as common among women than men, while men had twice the rate of alcohol problems.

Classic: We don’t have to drink, because we have our drugs! I can’t tell you how many women I’ve known who had this experience. I think of it as professionalizing our addictions. Being a drunk is low-class—Hurstwood crashed in the Bowery flophouse. But popping those pristine purple pills (which is the way I always remember OxyContin—like little amethysts) is moving it uptown.

And what do the drugs do for us emotionally? Do the scientists ever ask about the kinds of pain the drugs numb out?

Questions for a future interview.

The researchers are calling for pain programs to offer treatment not just for the “physical disease state” but also for the emotional problems that go with the appearance of chronic pain.

The way I hear this is, in order not just to cover up the symptoms but actually to heal, people in pain need other people to listen to us. We need community.

But healing the emotional problems is expensive. It’s a lot cheaper to give out drugs, even Prada drugs like OxyContin. Methadone and oxycodone (both of which I’ve taken; methadone is strong and cheap, I remember my shock when I bought 90 pills for five bucks) are a lot less expensive than the kind of help people might need to really heal. A study in the journal Headache (2010;50(7):1175-1193) last year found that in just six years between 1997 and 2003, U.S. methadone sales shot up by 824 percent, and oxycodone sales rose 660 percent. And this investigative story published in Salon and picked up by AlterNet the other day reported that the DEA has for the past 10 years been rubber-stamping gargantuan increases in production of opioid painkillers despite evidence of massive diversion from Florida to Maine and into the Ohio valley.

Insurers no longer want to pay for long-term treatments that involve patients talking to actual people (this story is trending in the New York Times today; there have been others talking about how psychiatrists only have time to give out drugs and can’t afford to listen to their clients).

It’s expensive to pay a real person.

From an interview with Gabor Maté that I’m going to run later on (stay tuned):

G: Do you think addicts can truly recover? You’re a proponent of harm-reduction for a certain percentage of addicts.

GM: The answer is absolutely yes. Precisely because we’re not isolated human beings. It very much depends on a supportive context. And if you talk to people who have made it, what was the one quality that was always there for them? Community.

The best solution is to build more community. Connection heals.

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