Opiate Epidemic: Are We Creating Puppets In Pain?

By Laura C. Meyer 09/09/16

Addressing the problem of heroin and abuse of prescription medications is about addressing the pain of our daily lives, and helping people come to understand this, and how to change their lives.

woman on marionette strings.

I received an email from the National Counsel for Behavior Health with the first sentence stating: This is a day to celebrate.

The second sentence read: Today, we recognize Congress’ momentous accomplishment. CARA will increase access by including nurse practitioners and physician assistants as authorized prescribers for medications that support treatment.

I dream of the day our culture considers that more medication is not the answer, so it's hard to see this as a "momentous accomplishment"—especially since the Comprehensive Addiction and Recovery Act (CARA) is in direct response to the increase of heroin and prescription medication-related deaths.

Granted, there's more to CARA, and some of it I agree with. I, however, have been working with medication-assisted opiate treatment for seven years, and it's hard to see how CARA is leading people into their own empowerment and inner capabilities. At this time in history, with a call for strong leadership—not only in our leaders, but in ourselves—it's hard to imagine a strong nation built on people who can't leave the house without their medicine. And if you talk to the patients, it is just that: "I can't function without my medicine."

CARA feels much like the $700 billion bailout of 2008. It's hard to argue the need to fix the problem, but the housing market was a problem we created, and then we needed something to clean up the mess.

Similar to the mortgage crisis, at some point, giving more money was no longer the answer, but we kept doing it. Too many of us were asleep to the situation, and unfortunately, even in our daily lives, we usually need large amounts of pain to wake us up. Life doesn't have to be that way, and there were many people who saw the housing market dangers, but we are historically known to need really big explosions before the majority will take notice.

Working with medication-assisted patients recovering from opiate addiction for seven years has been like watching a really long episode of Ashton Kutcher's television show, Punk'd. I keep waiting for someone to come out and say "gotcha!"—but the show hasn't ended.

I keep watching medication-assisted treatment getting bottled up, and I keep waiting for structured detox and taper programs to help people put the crutches (medication) down and learn to walk fully in their lives. This is what other forms of rehabilitation do—why do we not offer this approach in opiate addiction rehabilitation?

I keep watching an increase in different pills (medications such as Zubsolv and Bunavail), and keep waiting for an increase in different skills. Not 90% pills and 10% skills—I'm waiting for the opposite.

I keep watching police task forces appease parents by going after the drug dealers, and I keep waiting for someone to see the process of supply and demand.

I've watched kids die from medication being sold to them from entrepreneurial patients getting hundreds of pills prescribed monthly from their doctor. I keep waiting for someone to implement a monitoring process for these huge amounts. Not the prescription monitoring program (PMP), but in-office accountability.

I keep watching our public school systems push out bored, docile humans with no awareness as to how to manage thoughts, emotions and stress; how to set goals, manage money, visualize a future; or to build inner character—and I keep waiting for someone to make this connection.

I keep watching people feed off the anger and fear served to them from the media, and waiting for people to realize how this feels. It's painful. Pain calls for pain relief, hence, painkillers to the rescue.

I keep watching people live out loud lives of desperation, reaching for pills, and I keep waiting for them to realize they have the power to take the initiative to live differently. And in the information age, you can just about learn how to change anything in your life without paying for it.

Let's look at the question: are we, as a whole, actually producing the opiate epidemic? Producing puppets of pain? It's much like money, in that we, the people, created money. We gave money its meaning and power, and for many of us, we have become puppets and slaves to money. We allow money to painfully control us, sometimes to a fatal end.

We are known for creating our own problems. As unintentional as they may be, there is usually a voice in the crowd (or in our own mind) that forewarns us, but we opt not to listen because then we might have to take responsibility for our choices. We are becoming a nation notorious for creating our own messes. We allow external stimuli to control us, harm us, and then find someone or something to blame so we don't have to take responsibility.

Type 2 diabetes, stress-related illnesses, a smoker who continues to smoke with lung cancer, a heart disease patient who won't lose weight, addictions (including food, sex, technology, mindsets), poor financial management, debt, divorce, anxiety, and depression—no one does this to us, we do it to ourselves. This is not about whether we had conscious access to our choices in the beginning, because I believe we do the best we can. My concern with choice is the lack of personal responsibility to choose differently when we now know. It's sometimes hard to not see that we have become a culture of not caring (about ourselves) and laziness, which adds more pain.  

Addressing the problem of heroin and the abuse of prescription medications, especially painkillers, is about addressing the pain of our daily lives, and helping people come to understand this and how to change their lives, not cover their day with more or different medication.

A patient goes to the doctor for depression due to some poor financial choices (this is a real example). She leaves with an antidepressant, and not one suggestion to consider some financial help. I call this to attention because it poses the question: who or what is responsible for actionable change? Is it our public school system for not teaching her about finances, the doctor, her parents, the pharmaceutical company, or her?

We could argue for any of them. However, she, we, the people, are the only ones with authentic self-interest to better our lives, so the answer is her.

CARA can look like the relationship between an abuser and their victim. If I hit you, you play the victim. I come back an hour later to rescue you by telling you I love you. I am, in essence, the abuser and the rescuer, and as long as you stay, you keep the relationship going.

Has our nation become an abuser? Not exactly, but the relationship looks the same. Our country offers us pain everyday, offers us a non-human quality education, and we keep taking it, forcing us to need a rescuer, which was the heroin and abused medication. But now the government comes to the rescue. We become the product of a system that offers no skills, but they are happy to give us pills to make up for it.

I understand because I would reach for pain relief too if I lived only with the 12 years of public education I received. Actually, my education was so painful, I left after nine years of it. I'd need relief too if I spent every day absorbing fear and anger from the media—if I watched hours of political monkeys slinging poo at each other; got my sole entertainment from reality shows and binge-watching; if I sought beauty in the Kardashians or Real Housewives; if I watched sports on television but never played; if I talked long enough about how much I loved hiking and fishing but never did them; if I ate boxed, microwaved food everyday; spent more time on the couch than outdoors; found my sense of importance and connection from the Internet, all the while experiencing glimpses of knowing that my life sucks. This is a painful existence, who wouldn't want to escape, "kill it," and medicate it?

But I don't need to escape this pain with heroin or medication, because I learned to cut my puppet strings, and this is what people really want. Release the pain, and you release the need to kill the pain. Attach new strings to experience authentic pleasure—strings of one's own choosing—and you change lives.

We can log out of the madness just as easily as we log in. This is not to stick our heads in the sand. It's to get out long enough to find our strength, create change in our lives, learn to master our own strings, and then we can log back in with the intention to make a difference.

As unintentional (some may argue) as it is, pain is what America is feeding us right now; it's what they (we) are selling. But we eat it, and buy it. We become puppets of our own choosing.

In order to use the word "epidemic," something has to grow rapidly. Is the epidemic really that we have reached a mass of puppets in pain? And have we done it to ourselves?

Solutions? I don't have the answers, but what I do know is what medication-assisted patients want, and no one is listening. So if CARA is going to increase prescription pads for medication-assisted treatment, I am a voice for your new patients, to empower them to insist on life skills, results, and a taper plan when they are ready. Don't stay a medicated puppet.

In regard to the bottleneck of medication-assisted treatment, I'd like to see more detox and taper programs required from the prescribing facility. Working in a methadone clinic for five years, and now two years privately, the amount of clients who enter with the intention of getting off the medication hasn't changed.

At intake, my experience has been that about 95% of patients will comment that they don't want to stay on the medication, and the other 5% will say they don't know yet. I've never had a patient answer yes. And if you ask patients on medication-assistance in December what their goals are for the New Year, nearly all of them will answer that it's to get off the medication.

I understand the current need for medication-assisted treatment—we have to treat the overwhelming number of people who need help—but without structured guidelines that actually adhere to person-centered treatment, and some accountability behind the prescription pad, it can be like a prostitute finding relief in the safety of a pimp. It's better than being on the street, but the pimp doesn't have plans for you to leave.

As much as I respect the private practice doctors I collaborate with—because they offer more than medication to their patients—I am not a supporter of long-term medication maintenance for several reasons. One, remember, the patient should have more say about their treatment than the professional—it's called person- or client-centered treatment. Our role as the professional is to help our patients gain the skills to get where they want to go, and if that goal is to get off the medicine, it's our obligation to support that, not to convince them to stay on a maintenance program. Vague requirements for maintenance programs leave too much room to question who is really benefiting, the patient or the prescriber?

Second, this is not an opiate deficiency in our brain or body that we need long-term medication for. We have a deficiency in being human, and in our ability to be aware of our thoughts, emotional drives and motivations. We are deficient in the skills needed to respond and to detach from pain.

Last, and most important to me, is the knowing that we are capable of learning and unlearning. We are powerful when we take responsibility and use our inner resources. We can choose to log out of the madness and start detaching those painful puppet strings. And knowing how much time we invested in creating a mess for ourselves, we can choose to invest our time to clean it up, not keep covering it up.

How do I know this? Because we are human. If someone is crashing and burning their car, sure we can punish them, lock them up, tell them they are sick and diseased, but at some point, it may be helpful to ask if they know how to drive. Same for being human—have we really been taught how to drive ourselves?

Laura Meyer is a mindfulness instructor at the University of Virginia's School of Medicine, and a therapist specializing in mindfulness for mental health and addiction. She advocates for approaches that empower patients' self-reliance over their own mental and physical wellbeing. Her private studio is located in Charlottesville.

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