Yesterday morning, just as they do every day, they came. With fervor and steadfast pursuit, with both realness and with artificiality, they dive with deep hope into the abyss of painlessness. On canes and in wheelchairs, they come searching for the sedating salve — they go with presumed erudition negated by their dismay in due time. To the house of God, with walls leaking, creaking, and wreaking of the delicious opium, come they. They arrive, in glorious time, to this place for which they long. They fetishize it in hedonistic fashion. They begin to belong. They passionately kiss the walls. They sip of the nectar seeping from the walls, all the while with every drink of the golden elixir frying up each Mu receptor into nothingness and sheer unresponsiveness. The receptors are hooked like an illiterate youth on phonics.
Low and behold, here arrives addiction. The air all about smells of its putrid stench. The disgustingly unkind and generously disrespectful gift of addiction that man, in part, gave to himself, humbled himself so much to allow it to be given in pen and paper by his darling physician, his legislative representative, his relative who has the same prescription and sometimes something even more potent. And now, he and she, all of them, search desperately for the delight in escape. Yet, there is no reprieve from the suffocating grasp. He sweats. She vomits. They become weak and anxious. There is no balm for this state of being, and the end to the means is the abundant life found in the unblessed quietness of overdose.
Dearly beloved, you have a drive to be doped up. Since your pain was considered as vital as your end-organ perfusion measurements, there must always be pain that must be fully eliminated. In this respect, nothing much works. You profess allergy to ibuprofen. Acetaminophen makes your jaws shake. You still hurt. It hurts so badly. Sleep won’t come. It is so terrible. You cannot walk. You cannot talk. Even the most minimal manifestation of the pain state necessitates medicating for you. You are on a conscious trajectory with unconscious consequences.
You, America, are the patients who Desire Opiate Prescriptions Eternally.
Addiction is a state of being. It becomes your way of life and, physiologically, will overcome and overtake you. With admonition, I say to you, speak up — for your hydromorphone, oxycodone, and hydrocodone, you must consider, may do you some harm. They will do you some harm. Thus, reconsider the notion that you need them always and forever.
For we do not prescribe opiate analgesics for chronic pain.
You will not be 100% pain-free 100% of the time.
Consider that your frequent falls may be due to opioids.
Know that it is a criminal offense if you sell prescribed opiates.
Sloppy prescribing by physicians must cease.
There is no plausible explanation as to why a ninety-year-oldgGrandmother needs 180 hydrocodone tablets every month.
It’s time to taper. Set expectations for pain control and relief.
Emergency and urgent care physicians, not just primary care physicians, in every state should be required to check prescription drug monitoring program databases.
More access must be made for insurance coverage for Naloxone.
Why is pain a vital sign?
Consider prior authorizations for opiate medications for pain.
More primary care and sub-specialty physicians need to become certified to prescribe Buprenorphine analogues.
Why do Buprenorphine analogues for addiction treatment necessitate prior authorization?
We must expand addiction treatment programs to rural populations.
When opiates are demanded by the patient, the physician reserves the right to Just Say No.
Consider taking hydromorphone out of your prescribing practice.
America, all of America, has a drive to be doped up. It’s a multifactorial woe. It takes a multifactorial approach and buy-in from the patient, all physicians treating that patient, the patient’s congressional representatives, and the patient’s family.
Dear America, thou art DOPEd up. Speak truth to yourself. Realize the sting of addiction is a problem, an opiate epidemic, that impinges upon us all like a rapidly progressive metastatic lesion, laying its hold on any willing organ bed of nourishment it can find. That is the first step.
And please, America, get you some help.
Earl Stewart, Jr., is an internal medicine physician in Thomaston, Georgia, and 2016–2017 Doximity Fellow. He started and runs the only Buprenorphine Treatment Program for Opiate Addiction in Rural Upson County, Georgia. In addition to on Doximity, he blogs at esjmd.wordpress.com.
