World of Pain

“opioid-tolerant” by gabriella travaline/Flickr

By G. Jeffrey MacDonald

No one expects to become an opioid addict — especially no one who’s conscientious about following a doctor’s orders. But the doctor’s office is precisely where most opioid addictions begin. It’s also the source of drugs in the majority of opioid overdose deaths.

Statistics from the Centers for Disease Control frame in jarring relief the scope of today’s prescription opioid epidemic. Two million Americans are addicted to prescription opioids such as OxyContin and Vicodin. Prescribed opioids killed 165,000 people in the United States from 1999 to 2014, including 14,000 in 2014 alone. Every day, more than 1,000 people are treated in emergency rooms for effects of opioids prescribed by a doctor.

Yet for those keen to prevent addiction, one CDC statistic towers above the rest. As many as one in four persons who receive an opioid prescription from a primary care physician ends up addicted. That includes teenagers who suffer routine sports injuries and receive an opioid for pain. It includes middle-aged men and women who complain of back pain and go home with a prescription. Even the elderly can find themselves addicted after a surgery that leaves them home, hurting, and holding a pill bottle.

“What we’re doing by trying to help patients by prescribing them a very strong painkiller is, in a small number of patients, we’re creating future addicts,” said Dr. Ronald Hirsch, a Chicago-area internist who grew concerned in the late 2000s when he noticed how many patients at his suburban hospital were opiate-addicted. “And it would be totally acceptable to give these patients ibuprofen,” an anti-inflammatory drug that is not an opiate and not addictive.

With risks high and prevalent across demographic groups, experts and advocates say there’s a lot congregations and clergy can do. That work involves understanding risk factors, raising awareness, and equipping people to take steps that mitigate the hazards at hand.

“They’re given it by a doctor, so it feels legitimate and sounds legitimate,” said Janine Stuchin, executive director of the Alcohol and Substance Abuse Prevention Council in Saratoga Springs, New York. “But these are highly addictive drugs, as opposed to others that you’ve been prescribed to moderate other health conditions.”

She finds these drugs are common in homes, but they’re not seen as highly dangerous or risky because they arrived by way of a doctor’s office and a local pharmacy.

“My agency frequently talks with parents and adults, and there’s way too much opioids coming into a household, coming into a young person’s life in this way,” Stuchin said.

Managing risks starts before the first visit to the doctor. While some people do not like the feeling of opioids and quickly stop taking them, others love the euphoric feeling so much that they are hooked as soon as they start, Hirsch said.

“With certain people who have something in their brains, the first time they’re exposed to an opiate is the end of it,” he said. “They’re now dependent. It turns them into a life of addiction.”

Risk is inherently high for those who have a history of substance addictions, trauma, or other types of abuse, Stuchin said. But doctors seldom ask about addiction histories before writing a script for hydrocodone, oxycodone, or another opioid. Nor are people adequately warned of the high risks when they receive their prescriptions, Hirsch said.

Clergy and lay leaders can play an important role, Stuchin said, by encouraging parishioners to examine their histories for trauma or substance additcion before surgery or other medical visits; counseling them to be cautious consumers of health care; and asking physicians about non-opioid alternatives for pain management. Pain can often be managed with alternatives, such as Ibuprofen. Hirsch said medical marijuana is safer than opiates.

Episcopal congregations are responding well. The Rev. Jeff Mello, rector at St. Paul’s Church in Brookline, Massachusetts, spoke last March at a community forum on opioids while the legislature was considering an aggressive policy program.

In May, St. James Church in Lancaster, Pennsylvania, held a Eucharist focused on addiction and recovery. A recovering addict gave a testimony during worship. Also in May, St. Gregory’s Church in Parsippany, New Jersey, hosted a free screening of The Hungry Heart, a documentary about a physician who struggles to treat a rising number of opioid addiction cases among his patients.

Such events can help raise awareness, but churches can also make a daily difference. Using bulletins, newsletters, and message boards to promote pill take-back programs in a community can have a big effect, said Jan Brown, vice president of the board of Recovery Ministries of the Episcopal Church.

Often a community will have a designated spot, such as a hospital or police station, where residents may leave the medicines they no longer use. That ensures safe disposal lest anyone — a child, a neighbor, or even an unknown addict who knocks and makes an excuse to use the bathroom — rifle through a medicine cabinet for drugs to use or sell.

“It might not be your child who’s taking the meds out of the medicine cabinet,” Brown said, “but if your child’s friend comes over and uses the bathroom, they’re essentially in a candy store.”

The search for answers to overprescribing has led to more focus on guidelines for physicians. Not every state has guidelines, and prescribing rates vary widely by state. Opioid prescribing rates are highest in a cluster of 13 Rust Belt and Southeast states, where painkiller scripts per 100 people are 50 to 100 percent higher than in the Upper Midwest.

When prescribing guidelines are in place, physicians immediately prescribe fewer opioids and sustain the lower rate over time, according to a recent study involving Temple University Hospital-Episcopal Campus. The study’s results appeared in the January issue of The Journal of Emergency Medicine. (Episcopal Campus traces its roots to the Hospital of the Protestant Episcopal Church, established in Philadelphia in 1852, but now has no affiliation with the Episcopal Church).

Advocates say congregations and dioceses can help the risk-reduction cause by joining efforts to push for new legislation. Hirsch argues that state databases on patient medications do not provide enough information. If a patient were to ask a doctor in New Hampshire for opioid relief for pain, that doctor’s database would tell him only whether the patient had received the same medicines recently in New Hampshire. It would reveal nothing about prescriptions the patient might have received days or hours earlier in nearby Maine, Massachusetts, or other states. Hirsch is among physicians calling for a national database to prevent interstate doctor-hopping.

Action in legislatures has helped slow the practice of obtaining pills from multiple doctors, which heightens the risk of overdose, according to the CDC. In 2012, New York and Tennessee enacted laws requiring physicians to check individual patients against state databases of prescription histories. The result was a 75 percent decline in the practice of seeing multiple providers for the same drug. Tennessee saw a 36 percent decline.

In local settings, congregations can also help by conditioning churchgoers against the habit of expecting immediate relief from all discomfort. Hirsch notes that religious communities have opportunities to remind people that discomfort is part of life and that shortcuts to pain relief, including pills, can have steep consequences.

“We have a society where we medicalize everything,” Hirsch said. “When you have someone who needs help, the answer is not always to get another pill. How can we support people emotionally and psychologically without having to support them with another medication?”

Because addiction to prescription opioids can begin at many seemingly innocuous points, congregations have many fronts for prevention. Most involve learning about risk factors and equipping people to mitigate them. Congregations are eminently qualified to do this work, experts say, and they ought to do it now, when their surrounding communities face a crisis.

“People seek to feel better, and one of the things opiates do, in addition to relieving physical pain, is to relieve emotional pain,” Stuchin said. “Clergy have been talking about this forever: there are no shortcuts. Seeking emotional relief through substances — whether it’s shopping, food, sex, alcohol — can never fill our emotional needs. That’s not new. And that’s why we have spiritual lives, because our spirit can only be filled by Spirit.”

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