The opioid epidemic as a Shakespearan tragedy


By bob roth

Managing Partner of Cypress Homecare Solutions

The opioid epidemic has been described as the worst man-made epidemic in modern medical history. The magnitude of the series of misunderstandings and missteps that led to this crisis is beyond comprehension or imagination. With hindsight being perfect vision, the Shakespearean elements and pathos of the opioid tragedy can be seen.

The element of disguise:

The addicts of the opioid crisis are not all the homeless junkies that many envision. For many years, we as a society have assumed that those who become addicted to drugs or alcohol do so out of character weakness or moral depravity. While it’s true that some became addicted from recreational use, many also became addicted taking opioids exactly as prescribed by doctors. Many seeking treatment for legitimate pain had the unintended consequence of opioid use disorder, characterized by tolerance to the opioids, withdrawal symptoms, and obsessive behaviors to fuel the supply of drugs. Once addicted, people need to keep using opioids to avoid feeling awful.

The struggle between good and evil:

In an effort to alleviate suffering, doctors started regarding pain as the fifth vital sign. While heart rate, body temperature, respiration rate, and blood pressure can all be measured, pain is subjective. Pain is a symptom. Pain is not a vital sign, nor is it a disease.

How did pain come to be known as the fifth vital sign? The concept originated in the VA hospital system in the late 1990s and became a Joint Commission standard in 2001. Pain was allegedly being under-treated. Hospitals were forced to emphasize the assessment of pain for all patients on every shift with the (mistaken) idea that all pain must be closely monitored and treated. This is based on the (mistaken) idea that pain medication is capable of rendering patients completely pain-free. This has now become an expectation of many patients who are incredulous and disappointed when that expectation is not met.

The tragic hero, possessing a tragic flaw:

Symbolically, this has to be the flawed logic sold to the doctors by pharmaceutical companies. The doctors were told that slow release opioids were safe and effective for chronic pain; they are neither. Opioids have their place in the acute setting, but for chronic pain, generally the benefits do not outweigh the risks. Using a combination of modalities such as exercise, cognitive behavioral therapy, acupuncture, massage, physical therapy, yoga and spiritual support are extremely important. Chronic pain is a complex problem which requires a complex solution. It is unrealistic to think that a pill can be the simple answer to chronic pain.

External conflict, facing the forces of evil:

Sales of prescription opioids in the U.S. nearly quadrupled from 1999 to 2014, but there has not been an overall change in the amount of pain Americans report. Policymakers wanted to stop so-called “drug abusers” but were ignoring the problem of over-prescribing. It was all focused on preventing kids from getting into grandma’s medicine chest, but no one was looking at why every grandma now had opioids in her medicine chest. Why are high school kids being prescribed 30 days’ worth of Percocet for wisdom teeth? There is a great need for public information campaigns to help people dispose of unused narcotics.

Internal conflict, personal struggle:

Many addiction specialists consider medication-assisted treatment the gold standard of addiction treatment.  It utilizes behavioral therapy as well as medications like buprenorphine and methadone that can reduce cravings and withdrawal symptoms from opioid use. Without physical cravings, the patient is able to concentrate on implementing positive changes and healthy lifestyle patterns of behavior to rejoin society.  Significant gaps between treatment need and capacity exist at the state and national levels. There is a great need to increase the number of facilities that provide this medication-assisted treatment.

Catharsis, release of emotions:

By and large, drug addiction is mistakenly not seen as an illness. There has been much damage done by the negative stereotype of addiction. Until recently, the image of a weak, morally depraved person has encouraged a punitive perspective and hindered research of this medical condition. Many hold a negative view of methadone clinics as a way of swapping one opioid for another. To withhold treatment for the very real suffering of withdrawal is inhumane. Would we withhold medication and education from a diabetic? There simply must be more compassion and acceptance. Please encourage your friends and families to understand addiction for what it is. There is no other chronic disease that carries these emotional barriers to recovery and we must help in the healing by lifting this veil of shame.

Tragic waste, unnecessary loss of life:

Arizona is one of just 10 states without a Good Samaritan Law. People who witness a drug overdose are often reluctant to seek emergency assistance for fear of prosecution of their own drug use. As a result, an individual who overdoses does not receive necessary emergency care. Through the implementation of a Good Samaritan Law, bystanders are more likely to seek emergency assistance, increasing the ability for law enforcement or first responders to administer naloxone to address an overdose.

Comic relief:

The opposite of addiction is not sobriety, it is connection. Hold your family and friends close, tell them you are with them unconditionally in this challenge. Remember the good times, laugh and vow to implement change.

It will take time, but with knowledge and compassion, we can dig out of this epidemic of hopelessness, loss of life, destruction of families, and inhumanity to those who suffer from the chronic disease of addiction.