In this essay, writer Anna Hamilton discusses the benefit of prescription opioids for her chronic pain amid a national epidemic.
It has become clear in recent years that the U.S. is in the midst of a serious opioid epidemic. According to the Centers for Disease Control, overdose deaths caused by prescription opioids “have quadrupled since 1999,” as have the number of overdose-related deaths caused by heroin, one form of an opioid drug, since 2010.
I have several health problems, of which chronic pain from fibromyalgia is the most persistent. Fibromyalgia is a chronic, lifelong condition that is “characterized by widespread musculoskeletal pain,” as the Mayo Clinic terms it. On its own, widespread pain doesn’t sound like a big deal; to most people who do not have physical disabilities or chronic illness, it probably sounds like something for which you would take some over-the-counter pain meds and get on with your life.
I tried that strategy for a few years. At one point, I was proud of the fact that I “didn’t have to” take opioids for my pain. As the National Institute on Drug Abuse reports, opioids are “a class of drugs that include the illegal drug heroin, synthetic opioids such as fentanyl, and pain relievers available legally by prescription, such as oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, morphine, and many others.” That means opioids can be used illegally, like in the case of heroin, or prescribed for a legitimate reason by a doctor, like in the case of oxycodone. Not taking my prescribed opioids worked…until it didn’t. A couple of years into living with fibromyalgia while still in college, I had a bad fall and ended up with a tiny yet ridiculously painful hairline fracture in my left wrist. When the doctor I saw suggested that I take hydrocodone for the pain, I balked. I can’t take those, I thought. What if I develop a substance use disorder? I’d grown up watching my dad struggle with alcoholism and did not want to subject myself to the horrors of that kind of addiction. But I needed something for my wrist and taking ibuprofen hadn’t been working.
An hour after taking the first prescribed dose of hydrocodone, I realized that my body was not in debilitating pain in addition to my wrist. My back and neck pain were still there, but it was as if someone had turned down the pain’s volume. I was amazed. My rheumatologist agreed to prescribe hydrocodone for me, provided that I followed her instructions to the letter. Since that time, my life circumstances have changed, but I currently see a pain management doctor who prescribes opioids.
When I don’t take my medications, or don’t take them on time, the fibromyalgia pain can be debilitating. It can feel like my entire body is on fire, or like I’m being crushed by one of the Ents from Lord of the Rings, or numerous other weird images that come into my head. Of course, my overall pain level depends on many factors, including the weather, if I’ve not been sleeping well, whether one of my other health problems flares up, among other things — but taking hydrocodone makes the pain easier to live with. The short version of why I take it is this: This medication allows me to actually have a life instead of being stuck at home in constant pain.
For a long time, I resisted taking hydrocodone for pain even when it was clear that I needed to do so. There are people who are in much worse pain, I reasoned, or I can tough it out without taking pain meds this time — I’ve done it before! I would wait hours and hours to take a necessary dose, and would end up in excruciating pain on the higher end of the “happy face”pain scale — about a 10 or 11 on cartoonist Allie Brosh’s “Better Pain Scale.” It seemed to me that toughing it out was something to be proud of, like my earlier dalliance with superiority in not taking prescription opioids for my pain. Chronic pain conditions can wear you down, physically, emotionally, and mentally — perhaps not surprisingly, having chronic pain has been linked to changes in the brain over time.
I currently have a much healthier relationship with the concept of appropriate pain management, but I still have complex feelings about taking opioid medication during an unprecedented epidemic where similar drugs have harmed and killed people at alarming rates. I will be the first to admit that I am physically dependent on some of my medications, including the hydrocodone; but dependency on a medication is distinct from substance use disorder in a lot of ways. To paint all people who take opioids as having substance use disorder — especially when many of those people are using those medications responsibly and for legitimate reasons — is counterproductive and factually wrong, and condemning people with substance use disorder for facing a difficult health problem is not a great approach either.
Having to depend on big pharma for a medication that has helped me tremendously, but has harmed many thousands of people, makes me queasy. So does Purdue Pharma’s role in the epidemic by way of its aggressive marketing of OxyContin as a miracle relief drug — something that harmed many of my fellow chronic pain patients. My being able to obtain hydrocodone under a doctor’s close supervision is also closely tied to my status as a white, middle-class, and cisgender woman; there are documented disparities in access to pain management, and these disparities are particularly stark between black people and white people.
Ending the U.S. opioid epidemic will likely involve tackling multiple factors that have contributed to it. A more comprehensive approach to relieving the suffering of millions of people with chronic pain should be part of ending the epidemic.