The opioid epidemic: the origin

The patient

The patient is a forty-two-year-old male who works in the auto manufacturing arena. He takes one step to his left, he turns and lifts a seventy-five-pound piece of metal from a moving conveyor belt. He turns back and takes one step to his right to put the metal on his table. He tightens three screws, lifts the metal off the table to take one step to his right, turning, and places the metal back on the conveyor belt. He does this again and again, four times a minute, 240 times an hour, 2,880 times in his 12-hour shift. This is every day. If he doesn’t have a bad back or neck, he will get them very shortly. When he develops a chronic back or neck problem, he will need help to keep his job. This job keeps a roof over his family and food on their table.

This patient’s help is half of an opioid pain pill with a fourth of a muscle relaxer. He takes this every four hours while he works, with the pain medication rotated to a different pain med every four months. The alternatives to the opioid pain medication are not effective in the workplace. They have never been, and they never will be.

Every state has occupations that require heavy physical labor. Physical labor has been the backbone of the United States since 1776, and it will continue to be our backbone forever. Americans who perform physical labor are the true heroes of this country, but our backbone has developed problems of its own.

The origin

On July 1st, 2015, the Tennessee state government passed a law that closed 308 pain clinics in one day — pain clinics that had been certified by the Tennessee Department of Health. The law dictated that only pain specialists could operate pain clinics in the state of Tennessee. This law left only the sixty-three pain specialists practicing in the state. All sixty-three offices were at full capacity and did not accept any new patients, at least not without a two to six-month wait.

Closing the 308 clinics put 120,000 Americans — properly diagnosed with chronic pain, properly being treated with appropriate opioid pain medications — on the street with nowhere to go. All 120,000 went through opioid withdrawal, and some of them died. Opioid withdrawal lasts seven days.

That is seven days in which the patient cannot work. When the patient comes back to work, he begins to suffer, but he needs that roof and the food on the table for his family.

Until two weeks ago, when I was interviewed by a reporter from my local ABC affiliate, no one had talked about the 120,000 who are still out there. These 120,000 patients felt as if they didn’t count, and they didn’t matter. They feel forgotten as if they are deplorable. But in America, every one of us counts.

Tennessee was the third state to pass this law. Florida was the first state to adopt the law which resulted in 600 certified pain clinics closing with 240,000 patients, properly diagnosed with chronic pain and properly being treated with appropriate opioid pain medications, being left with nowhere to go for treatment. Alabama was the second state to pass the same law with 400 certified pain clinics being closed, leaving another 160,000 patients — also properly diagnosed with chronic pain and properly being treated with appropriate opioid pain meds — left in the cold. North Carolina (fourth) and Missouri (fifth) soon followed.

And they kept going, state after state, ultimately leaving six million Americans without appropriate treatment. These patients are still out there, and they are still suffering. The opioid epidemic began in 2015. It was started by the Federal (DEA) and state governments, not the doctors, not the pharmaceutical companies. One year after these laws were passed, the use of heroin skyrocketed across the United States.
No one would ever guess that our government, federal and state, would promote heroin use in its people, but they did.

Who would ever guess that our media would remain silent and ignore six million people unjustly suffering? But they do.

The why is still a mystery, but I know. Someone always benefits when the people are made to suffer. That is not America, and it never will be.

Councill Rudolph is an emergency physician.

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