I-TEAM: Opioid addiction versus dependency

LAS VEGAS - Millions of chronic pain patients, already living in agony because of disease or injuries, now live in fear that their medicine will be taken away because they've been stigmatized as drug addicts.

News stories about opioid overdoses are pretty common, but few of those who overdose are pain patients. Ninety percent of those who die of overdoses use illicit drugs.

Pain doctors says that, when it comes to opioids, there is a big difference between addiction and dependence.

"We will see an increase in drug overdoses," said Dr. James Marx, addiction specialist - pain management.

Pain specialist Dr. Jim Marx probably didn't make any new friends on the Nevada Medical Board when he proclaimed during a board workshop that slapping new restrictions on opioid medications would cause more overdose deaths, not fewer.

News reports about the so-called opioid epidemic routinely claim that opioids kill more than 60,000 Americans per year, but it's not prescription drugs. Opioid prescriptions have dropped every year since 2011 by nearly 50 percent, but opioid deaths have gone up during the same period.

One reason is because addicts who previously, one way or another, obtained prescription meds are now taking street drugs, if someone had a plan to drive Americans to try heroin, it worked.

"What we've done is we've created a target rich environment for the illegal drug trade," Dr. Marx said. "They're probably sending legislatures Christmas cards now. This is a great thing for them."

"When we talk about opioids, do we mean prescription or illicit such as heroin? Heroin cannot be prescribed in the U.S., but it is being conflated with all the other opioids. It creates hysteria and alarm.

Steven Ziegler teaches public policy at a major university, but previously worked as a DEA agent. After decades of various wars on drugs, the streets of America are flooded with stronger, cheaper, and more powerful versions of every one of them.

Illicit fentanyl, smuggled in from China and other places, is 100 times more powerful than heroin and it is the single deadliest opioid of all -- a 540 percent increase in overdoses in one year. Policy makers mistakenly lump together all opioid deaths, whether legal or illicit, and in order to "do something" about it, they have gone after the only non-moving target -- chronic pain patients, who are paying a terrible price because of irresponsible actions by addicts.

"To arbitrarily deny prescription pain medicine to those folks who need it, to reduce dosage without regard for their individual function, is problematic. When people are experiencing pain, if they cannot get relief through their prescriber, what do you think is going to happen?" Ziegler said.

For millions of chronic pain patients, opioids are the only thing that works. The medicine allows Rick Martin to go grocery shopping for himself. It means Nicole Ball has the energy to play with her grandkids. It keeps a lupus patient from ending his excruciating pain by taking his own life.

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"We have patients that we've been seeing for 25 years that are on stable doses of medication who have not overdosed," said Dr. Marx.

But in the eyes of politicians and some regulators, opioid users are addicts who must forcibly be taken off drugs. Dr. Marx says pain patients are certainly dependent on their medications, the same way a diabetic needs insulin, but that dependence is not addiction. 

"Addiction is a psycho-social where there is adverse consequences," Dr. Marx said.

Dr. Marx says pain patients do develop a dependence on their medication, but they can take it basically forever without harm it allows them to keep their jobs, remain active, have a life. Those who've had their meds cut have suffered terribly, and many have committed suicide. Their need for medication is not addiction.

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"Dependence is not addiction," Ziegler said. "Withdrawal is not addiction. Addiction is a completely separate matter. As lot of people can be managed well on prescription therapy. For those who can be managed well, why are you trying to change their treatment?"

Nevada doctors have asked the state medical board to delay implementation of even stricter prescription guidelines because they are concerned about unintended consequences.  On Friday, at UNLV's Boyd School of Law, physicians, attorneys and policy makers will spend a full day discussing and debating opioid regulation and policies.