I’m watching the Hooked on Painkillers episode of Panorama from the 2nd. I’m quite often leery of this sort of programme, as I think it can feed into the perception of people with a need for painkillers as drug-seeking, and further limit the access of people with chronic pain to longterm pain relief. People like me, really.
I’m not exactly reassured by the opening blurb, that informs me – over the dramatic synth OMG NEWS theme music – that there are people in the UK who are prescribed pain relief medications which are “in the same category as heroin.” Oh do fuck off, Declan Lawn. That’s opiate painkillers – morphine (check), codeine (check), tramadol (check), fentanyl, and oxycodone, and some others. I’ve taken opiates, as have other family members and friends. Scaremongering bullshit like that isn’t helping anyone. “I’ve got really nice boots on, I can’t possibly be [an addict], ” announces a middle-aged woman in a “nice” living room. Dear god. This is going to be awful.
8 million people with chronic pain in the UK (according to the National Pain Audit). We are introduced to a woman with spinal problems, osteoarthritis, and fibromyalgia, who takes a myriad of painkillers, and other medications. When she explains what she takes, we aren’t told what is and isn’t a painkiller – but she’s taking various antidepressants and others that aren’t primarily used for pain relief alongside painkillers.
“Once, [opioid painkillers] were reserved for cancer patients. But not any more.” Possibly because doctors have realised that chronic pain isn’t bullshit and does in fact require long-term pain relief? Lawn tells us that it is due to a culture shift, but doesn’t really explain what underlies that shift – whether there is a change in licensing, in diagnosis of chronic pain, or of how doctors are trained to deal with medicating chronic pain.
We’re a third of the way before we start to explore what the culture shift might be – after watching the lady with fibro and the middle-class addict with nice boots have described their experiences. But Martin Johnson from the Royal College of GPs only gets a few seconds to explain a little bit (he mentions the role of an ageing population, and that pain relief is a basic need), before back to Lawn starts in with the doom-mongering. Cue sad harmonicas. Cue big pharma. Cut to a few seconds of a film showing young black men on a street, leaning against a graffiti-covered wall, and a grainy news clip in which a panicked-sounding woman tells us of armed robbers in pharmacies. I’m not saying that oxycontin and other opioids aren’t addictive, and that there isn’t (wasn’t?) a thriving illegal trade – but this seems to be over-egging the pudding a little bit.
Lawn takes us to rural Kentucky, the “Ground Zero for the epidemic of prescription opioid abuse,” to talk to men in rehab, as well as a doctor whose son overdosed on oxycontin. Lawn doesn’t mention that it’s entirely possible that the two men who turned to illegal oxycontin also struggled to afford perfectly regular prescriptions, because America’s healthcare system is fucked up.
Oh good, back to Martin Johnson, who seems to be our voice of reason. He points out that while we can learn from America, the differences between the NHS and the US system are different enough (at least for now) to mean that there are also very different factors at play. Johnson seems to be leaning towards saying that there isn’t enough guidance for GPs – which is fair enough. My GP knows very little about fibromyalgia, and it’s been several years (and several house moves, and therefore several GPs) since I saw a GP who did. But we aren’t allowed to dwell on what that guidance would look like, because it’s time to find another middle-aged, respectable man to tell us about what it’s like to be in
constant pain a drug addict. His family helps him manage his pain, and his medication – he is going to a pain clinic, because he wants to take less painkillers. Like every other person in chronic pain, he seems to be balancing the need for pain relief with the risks and reality of being dependant on prescriptions. I’m dependant on my prescriptions – not just my painkillers, but on my antidepressants too.
24 minutes into the programme and Lawn mentions that the lady with fibromyalgia isn’t just getting help with her painkillers, but also with her pain management. Perhaps this is the problem – that it takes months, if not a couple of years, to get to a pain clinic, where medication is integrated with other forms of therapeutic pain relief? Maybe that’s why there’s also a problem – we don’t have any other choice but to take painkillers, because we need some relief while we sit and wait for referrals, assuming we live where there is a pain clinic, and we have a GP who can refer us. Cathy Stannard, a Consultant in Pain Medicine tells us that coming off opioid painkillers is better even if there is no alternative – that opioid painkillers are best in the short-term.
The problem being that there is nothing else to offer. Some people probably are prescribed too many painkillers, for too long, and too frequently – and some GPs probably do jump straight to heavy-duty opioids before trying some of the others. But there is frequently no alternative – and being in pain is not acceptable, both to individuals in pain, and to society at large.
We have a crappy relationship with pain, in our society. Pain is cast as very, very negative – being in pain is constructed as unsustainable, as impossible to live with. A person in pain is not a person – they’re less than human, an animal. Doctors see pain as a personal affront – just as any other symptom needs to be cured quickly; pain is suffering, and suffering must be stopped as quickly as possible. People who live with chronic pain challenge this ideological standpoint, and there is a huge temptation to shove them under the rug, treat them quickly with what should work, rather than taking the long route. That is the real problem – not the people in chronic pain, and not the people in chronic pain who are dependant on painkillers.