The Pain Refugees: The forgotten victims of America's opioid crisis

S.J.B.

S.J.B.

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The Pain Refugees
Brian Goldstone
Harper's Magazine
April 2018

It began with a loud pop. Though Austin Sell had suffered from severe back pain since childhood, on a clear autumn morning in 2011, not long after his twenty-first birthday, the pain became something much more frightening. He was chasing his younger brother through their mother's yard in Great Falls, Montana, and his left foot landed in a crevice. His upper body buckled backward; there was a sound like "a bungee cord being snapped in two." He could tell that it was bad, a kind of bad he had not experienced before. A few hours later, having tried heat and ice and Tylenol, Sell was sobbing and incapacitated; a piercing ache in his lower spine made it impossible to walk. A trip to the emergency room resulted in several morphine injections, a CT scan showing a slight disk bulge, and the assurance that he would be feeling better within four to six weeks.

Later that night, when his wife, Kelsey, who was pregnant with their second child, brought him home from the hospital, they hoped the worst was behind them. But it was just getting started. Soon the most innocuous movements were sending a shrill, lacerating sensation from his lower back into his groin, hips, and legs. "I was beside myself," he told me. "The pain was out of control. I kept thinking, 'Isn?t there something that can be done for this?' " So he proceeded again - and then again and again and again - to the emergency room. Instead of eliciting concern or further action, however, the return visits were met with annoyed suspicion. "I'm a big black guy with tattoos," he said. "They accused me of exhibiting drug-seeking behavior." Six weeks came and went.

It was not the first time Sell's pain had provoked a skeptical response. His mother, Kathy Sell Mitchell, who raised Sell and his four siblings mostly on her own, recalls her hunched-over son confined to bed by a mysterious condition that struck randomly but persistently. It was just debilitating enough to cut short outings and playdates, but not to persuade his Medicaid-reimbursed pediatricians to take it seriously. No MRIs, no referrals to a pain clinic. He's too young, they'd say. He probably has a low pain threshold. "The doctors would sort of blow us off - and I would just let them," Mitchell said. "I wish I'd had the strength to say, 'No, you really need to look into this.' " Instead, Mitchell did what little she could: with money she didn't have, she paid for visits to a local chiropractor, gave her son ibuprofen and nightly back rubs, and drew him baths filled with Epsom salts and surrounded by small tea candles.

Now with a family of his own, Sell convinced himself that he needed to push through. The commission checks that he collected from Colonial Life and Accident Insurance Company, where he was employed as an agent, made up the bulk of the family's income. The work required him to visit clients throughout Montana; he knew that these grueling hours in his old Crown Victoria were only aggravating his condition, but he had grown up poor, believing he would never earn more than minimum wage - this job was the key to a different future. A month and a half later, though, he was forced to go on unpaid medical leave, from which he never returned.

The pain became a corrosive substance, eating away at his career and his marriage. Those closest to him were mystified. "I couldn't figure out why he was hurting so much," Mitchell told me. "I know he didn't understand it either." Sell's primary care physician was no less perplexed. He referred him to a neurologist, who in turn referred him to another specialist. Desperate, Sell pursued an exhausting ensemble of treatments. There were epidural steroid injections and medial branch blocks; there was acupuncture and yoga and guided meditation. There were physical therapists, herbal remedies, and over-the-counter medicines. Some of the treatments were excruciating and offered not even temporary relief. Others proved more effective but, not covered by his insurance, were prohibitively expensive. He shuttled from one provider to the next, confused by the contradictory guidance he was receiving, and not sure how much longer he could remain in such a state.
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Read the full story here.
 
recently had a doc tell me "quit going to western doctors to try and find a solution to soft tissue problems - we dont do that"
 
^that is a highly inaccurate statement. Many methadone clinics also accept CP patients, so there isn’t a difference. And most criminals do not have access to methadone, as it’s very rarely prescribed to incarcerated populations.

Both groups are generally treated very poorly though. But with CP patients, this kind of mistreated have been going in since the early 1900s when folks like Hoover started going after doctors that prescribe opioids.

During the 90s things got a little easier for CP patients, but that was still pretty messed up given how most doctors didn’t understand how to properly prescribe or monitor their patients, so increased access came with serious costs.
 
Going to a MMT clinic is not ideal for aboain patient...it's cruel. They can barley walk and now every single day they have to go wait in line?

They only get a dose in the morning? What if the pain is worst at night? Mmt is a sad excuse for pain treatment except for the large doses.
 
MMT clinics that treat CP will often give the patient more leeway than substance use disorder patients. I mean, it’s far from ideal, but if it’s the difference between pain meds or not, it may be worth it.

Pain patiences I met at my old clinic would be in a totally different schedule than other patients. Like spit dosing and take homes.

I’m sure lots of clinics aren’t that good, but I believe there are a lot, at least in my state, that allow for this.
 
Public opinion is like a rubber band or slingshot. It'll bounce to extremes... left to right to left. Right now opioids favor negative public opinion. It will eventually level out... The hotter the topic, the higher it bounces.
 
^That's some insight :)

What bugs me is how much bullshit it seems to cause largely on the whim of whatever the fad/hot topic of the day/decade is...

Another way to look at it is that it is going to take a tremendous amount of suffering that is yet to come before public opinion really begins to embrace something approaching a sober minded approach to drug use or opioids.

And, America has basically been in extreme when it comes to propaganda and "public opinion" since 1914 (or technically the temperance movement prior to that as well, although they didn't pick up on opioids until the end of the 19th, that becoming more popular - opiates as the demon drug - until the turn of the 20th century).
 
I really dont think opioids or any drug for that matter is a "demon drug". All drugs in my opinion can be useful. Addiction is definately a rampent problem, though. Doctors prescribe drugs under the assumption that their patients are going to use it therapeutically. So now doctors should also be police? Now there is this weird situation where doctors are evil drug dealers and addicts are all victims of "Big Pharma" ...and sure this is true in some instances but the media loves to exploit the hell out of an angle. So, how do you balance this? Should you even try to balance it? I personally feel their is too much concern and regulation as to what people consume. The whole thing makes America look like a bunch of irresponsible children who cant make decisions for themselves. I also feel drug education is severly lacking and misleading but thats another topic.

The whole "war on drugs" is epically stupid and harmful to everyone involved.
 
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I experienced a very frightening moment last year with my doctor. I had been in severe 10/10 pain for weeks, totally reliant on opiates. I knew the situation was temporary but the pain was beyond belief. Without morphine I would literally lay there in bed screaming for hours. Screaming. My neighbours would come checking on me.

The frightening moment was when my doctor said, "I think you've had enough of those." He couldn't even look me in the eye when he said it. It was like he went into his brain and did some logical calculation without even considering me as a patient. I said... are you fucking kidding me? I'll decide when I've had enough and my pain is manageable, thank you. I was on low doses to begin with but he was treating me like I just came to his office to get another fix. I was so offended. Luckily he was the non-confrontational type and as soon as I reasoned it out with him he changed his mind. But for a moment there I was really shitting myself. If he cut me off I would have literally had to find a drug dealer ASAP.

I hate that doctors are the gatekeepers of pain control and that they can hold this kind of power over us. Under United Nations medical mandates, pain relief is a human right. It's at the top of the list of what international medical conventions are supposed to recognize and treat. But now we have this political culture in North America where, as a result of the failed war on drugs, addicts are demonized and in turn this view has begun to seep into standard medical thinking.

How about instead of treating everyone like a potential addict we acknowledge their pain and suffering? Even the addicts themselves... if we provided them with regular access to what they needed they could achieve functionality and begin planning a better life going forward.
 
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Couldn't agree more, Foreiner. I think Dr's are scared of getting in legal trouble so they are making safe decisions for themselves. The governement imo shouldnt be poking their noses into anyones business. (Doctors, patients, drug addicts, anyone). We arent children, we are tax paying citizens. Whatever we want to do with our bodies is our problem. Nixon and Reagan really fucked shit up for americans and their influence spilled over to other countries.America yas a nasty habbit of trying to police everyone
 
Personally, I'd rather make sure I treat a pain patient properly and have a few addicts, drug seekers, slip through the cracks. As opposed to making sure every single drug addict is caught at the expense of any legitimate pain patients getting treated properly. Just how I feel. It may not come as a surprise that I feel the same way on legal matters. For example, I would prefer a few guilty parties slip through if it means any innocent ones don't get unfairly prosecuted. I think it's very important to treat innocent folks and legitimate pain patients with as much dignity as possible. Just my 2 cents FWIW.
 
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