So I’ve been asked to give a series of lectures this summer about addiction and recovery to medical students who are coming from all over the country as part of a Scaife Foundation-funded program at the Institute for Research, Education and Training for Addictions (IRETA). Awesome organization, fantastic people. Great opportunity to give back.
I’m told this is one of two programs in the country that educate future doctors about addiction and recovery. The other is at Betty Ford.
The program coordinator wanted to know what I’d like to talk about. I said: 30 million Americans have a drug or alcohol addiction; only 1 in 9 people with addiction get treatment. Fifty percent of young people between the ages of 12 and 20 admit to using drugs and alcohol. Untreated addiction costs the country $450 billion in lost productivity and medical costs each year. (I personally bet it’s more if you add in nicotine addiction, which still kills almost half a million people every year.)
And lo: it’s also estimated that 76 million Americans suffer from pain.
I told her about how I got addicted to painkillers while seeking treatment for two neurological problems. How, for my work, I’d been interviewing the people who crafted the Joint Commission standards that called for assessing pain as the fifth vital sign; how I’d interviewed people like Russ Portenoy at Beth Israel and Kathy Foley at Sloan Kettering and Dave Joranson, the smart and exceedingly compassionate guy who helped found the Pain and Policy Studies Group at U. Wisconsin-Madison, the organization that calls for state policy that balances the need for substance-control with the need to treat pain. I remember the day in 2001 or 2002 that I explained my pain problems to Dave and he said, “You need to get treatment.” I wasn’t sleeping; I wasn’t able to work to the levels I wanted to work; I couldn’t concentrate because of pain all over my body, and then there were the pervasive migraines. So I went to the university pain clinic.
I told the IRETA coordinator how the neurologists and anesthesiologists there knew all about how to get me on drugs and nothing about how to get me off. How they don’t know anything at all about how to assess for risk of addiction before initiating treatment—no one ever asked me whether my father was an alcoholic; no one took my mother’s nicotine addiction seriously; no one asked how far back into my family alcoholism ran; no one explained why this might be important information and might save my life. Because no one understood.
And doctors, even pain specialists, know next to nothing about how to assess for the emergence of addiction during pain treatment. And when they catch a patient deceiving them about their drug use, rather than responding with the compassion they’d show a dying person, they respond with anger and disgust to the deceit, kicking the patient out of their practice and into a psychiatric hospital, forcing the patient to detox either in a psych ward or alone at home, dealing with both addiction and untreated pain.
And the threat of this kind of treatment makes how many patients every year reluctant to confess their problems to their practitioners? How many times did I want to tell my doctors, “Look, I have a problem here—I can’t control my drug-use, but I’m afraid if I quit the drugs, the pain will come back. Can you help me?” They wouldn’t have helped me, they would have kicked me out. Don’t let the door hit you in the ass, baby.
I told her about interviewing Russ Portenoy back in the early 2000s, how he’d told me with the conviction of certainty in his voice that the risk of becoming addicted to painkillers during treatment for chronic non-malignant pain was less than one-tenth of one-percent, and how those numbers had come from studies of opioid use in dying cancer patients, how they shouldn’t have been translated to chronic non-malignant pain patients. In my own developing addiction, my own self-deceit and my own desperation to have my pain controlled, I didn’t consider these facts carefully enough.
I remember how Dave Joranson told me that just because somebody is an addict doesn’t mean they shouldn’t receive pain treatment. That we have to figure out ways to treat both problems.
I got on a roll.
“Jeez, I wish we could have you for more than an hour per session,” the coordinator said.
“You should do a TEDMED talk,” a friend said.
I’m ready to talk to doctors. I’m ready to talk to TEDMED. I’m sick of hearing that people don’t get addicted to drugs after seeking pain treatment. It’s bullshit, and someone has to show her face and explain that, while a lot of people do become addicted by nicking drugs from their grannies’ medicine cabinets, a lot of others become addicted because they pull their backs or break their ankles or have dental surgery and are prescribed Vicodin, and they like it so much—it “works” so well for them and helps them get so much done—that they begin chewing it, and when their scripts are cut off they begin buying it on the street or stealing it from other people. Or else they turn to heroin, which is cheaper, if less reliable in quality. Or else they just suffer, they white-knuckle between hits, not knowing what the hell is wrong with them and afraid to talk to anyone about it because of the stigma. And a lot of them never go to treatment, they either stay addicted or they kick in other ways, like I did.
What would you have me say to these future doctors about addiction? Tell me in the comments, or email me.