The Opioid Epidemic: Fentanyl

Part Two of Two: Fentanyl has been a game-changer

Line of cocaine forms a human skull at the end.

In the last post, we talked about the opioid epidemic in this country and the dramatic increase in overdose deaths, over 70,000 in 2017]. A report released by the National Institute on Drug Abuse in 2017 reported that between 21 and 29% of patients prescribed opioids for chronic pain misuse them, between eight and 12% of these patients develop an opioid use disorder, an estimated 4 to 6% who misuse  prescription drugs transition to heroin and approximately 80% of the people who use heroin first misused prescription opioids. Continue reading “The Opioid Epidemic: Fentanyl”

The Opioid Epidemic: The Many Causes

Part One of Two: A look at the many causes of this epidemic

Advertisement for Morphine from the 1900's.

As you are undoubtedly aware our communities continue to struggle with an epidemic of opioid misuse and abuse. In 2016 42,000 people died of an opioid overdose. Apparently, 11.5 million people misuse prescription opioid painkillers. Almost 950,000 people used heroin and 2.1 million people suffered from opioid use disorder in the United States.

This epidemic has many causes. One contributing factor is our healthcare system’s over-reliance on narcotic pain medications to treat a large number of patients with chronic pain. Most physicians receive little training in the treatment of chronic pain. Opioids are most effective in the treatment of acute pain but in the treatment of chronic pain, pain that goes on for 3 to 6 months, opioids, in the end, may actually make the pain worse. Most individuals who develop an opioid addiction received opioids initially through a prescription from their physician.

In many communities, primary care physicians provide most of the care for chronic pain patients. They are often unaware of nonpharmaceutical interventions for chronic pain. To be fair those who provide these interventions such as psychologists, physical therapists and acupuncturists have not done enough to educate other providers or the public about the effectiveness of these interventions.

There is little evidence to support the use of long-term opioid therapy in the treatment of chronic noncancer pain. Considering the risk of harm posed by the misuse of opioid prescriptions and the lack of evidence to support opioids for chronic noncancer pain the Centers for Disease Control and Prevention recommend nonpharmaceutical treatments or non-opioid pharmaceutical treatments to be considered as the initial treatment approach for chronic pain. Non-opioid alternatives include, but are not limited to, acetaminophen, anti-inflammatory drugs, membrane stabilizers such as gabapentin, and muscle relaxants. And there are others. Recent research has indicated that these non-opioid alternatives are at least as effective as opioids for low back pain and are less associated with adverse events.

The most widely studied and effective interventions for chronic pain that are nonpharmaceutical include cognitive behavioral therapy and other interventions such as acceptance and commitment therapy, exercise, physical therapy, and interdisciplinary rehabilitation. Depending on the pain condition other therapies with evidence of efficacy include yoga,  biofeedback, acupuncture, spinal manipulation, and massage.

The American Psychological Association is encouraging its members to become better educated and trained in these nonpharmaceutical interventions and to educate other providers in the community and the public about these interventions. We will be talking more about these interventions in future posts.

This article was originally posted to Psychology Today, “In the Face of Adversity”, by Dr. Ron Breazeale, Ph.D. With his permission, we will share a series of posts on the Chronic Pain and related issues as a prologue to introducing what Maine has to offer for treatment options.

Photo pf Ron Breazeale, Ph,D.
Ron Breazeale, Ph.D.





Our Healthcare System: Partners

Part Two of Two: How to be an equal partner with your healthcare provider.

Hand interrupts a colorful set of falling dominoes.

In our last post, we talked about the problems with our present healthcare system. We discussed how it has become a for-profit enterprise with healthcare corporations hospitals and insurance companies paying large amounts of money to their CEOs and dividends to their owners. We also discussed how the pharmaceutical industry in many ways has determined the direction of our care focusing on the prescription medications some of which have created the present opioid crisis. An example of that we discussed was the treatment of chronic pain with opioids. An alternative to that is the treatment of chronic pain with nonpharmaceutical interventions such as cognitive behavioral therapy and acupuncture.

The question that remained was what can you do? As I said in the first post: a lot. Here’s a list of some things to think about that relate to the resilience skills that we have focused on in this blog.

Number one: Demand that your healthcare provider connects with you and communicates with you.

My late mother was better at this than anyone I’ve ever known. In her late 80s when the physician would talk to me or someone else who had brought her to the appointment she would immediately redirect him and remind him that she was the patient and he should be directing his questions and comments to her. If he attempted to leave the room and hand her a prescription and she wasn’t finished, she would tell him to sit down and listen because she still had questions that he had not answered. Most of the providers that dealt with my mom soon learned that the best policy was to sit down listen and respond. Remember that you are the consumer of this person’s services. You are paying them for their consultation and advice. In short, they are working for you.

Number two: Demand flexibility on the part of your providers and be flexible yourself. They should shape what they are doing with you to meet your needs, not theirs. And you need to be flexible in dealing with them. If you are not receiving what you need from a provider, talk with them. If that doesn’t work, find another provider.

Number three: Healthcare should be a partnership. You and your provider both have responsibilities in that partnership. Collaboration is important. You both are equals, but perhaps you are more equal since you are paying the bill. In some countries such as Great Britain, they are training providers to collaborate with their patients. That is something we should be doing more of in this country.

Number four: Advocate for alternative ways of obtaining medications in your state. Your state government can pass laws and regulations that allow the importation of cheaper medications. Unfortunately, the cost of pharmaceuticals can sometimes place people in a situation where they have to make a choice between paying for the medication or paying their rent. The state of Maine is considering such alternatives right now. If the federal government would use its ability to bargain with pharmaceutical companies in this country the cost of prescription medications could be the same as it is in Canada. The health service there, which is a one-payer plan, uses its numbers to obtain more favorable treatment from the pharmaceutical companies. We could use the millions covered under Medicare to do the same in this country. Ask your representatives and senators why this doesn’t happen.

Number five: Take care of yourself. Be an equal partner with your healthcare provider. Pay attention. You should be the expert on your health. You probably know more about your body than anyone else does. Medicine has certainly advanced, but don’t expect medicine to save your life. Drugs and surgery can treat many of the problems that we have and some of our parts can be replaced when they wear out. But it is far better for everyone if we prevent the healthcare problem rather than treat it. Care for yourself.

This article was originally posted to Psychology Today, “In the Face of Adversity“, by Dr. Ron Breazeale, Ph.D.  With his permission, we will share a series of posts on Chronic Pain and related issues as a prologue to introducing what Maine has to offer for treatment options.

Photo pf Ron Breazeale, Ph,D.
Ron Breazeale, Ph.D.



That Moment When Understanding Occurs but Remains Unconfirmed

Why Understanding of Police, Public Safety, and Emergency Response is Mixed

First responder sits on porch steps, head down, deep in thought.

As all past and current law enforcement and emergency personnel can attest, we have been the last face many a dying person saw before embarking on the journey that follows human life. Death by natural cause, fulfilled by someone else, or an accident, it mattered not, for in the final moments, the police officer had profound awareness that change took place and an unexplained transition occurred. We can believe in a supreme being, who many call God; or with those who maintain this is our relationship to life experience, a stage of process, a moment in infinity. The belief, or not, is a personal matter; for what follows will bring understanding as we individually reach that stage.

I have reflected for years on the elderly woman severely injured in a traffic accident, west of Gorham, Maine, who suffered a traumatic head and facial injury. I knelt on the road with her, having placed a large dressing to the side of her face, holding onto her shaking body, and talking softly to her? Her final breath followed by a stillness; a Trooper and now deceased body, awaiting the arrival of additional emergency services. I felt a presence, was it real or imagination? Was I seeking explanation, a belief, to make sense of what I just experienced? To this moment I believe it was real, an edge of understanding as she was welcomed home from the lessons of this life. It was also personal to me, for there is no certainty or proof; just her eyes that seemed to understand, asking me to do the same, in the silence of it all. Continue reading “That Moment When Understanding Occurs but Remains Unconfirmed”