In early November, the kids in Olathe started passing around a virus. It was not cleared up by Thanksgiving and my mom and I woke up exactly 7 days after the holiday sick. I was running a fever and felt blah, mom was coughing and felt blah. Seven days later, I made her go to urgent care; because her primary care doctor didn’t have any openings until Mid-January and she needed to be seen faster than that. The coughing was impeding sleep and her torso had begun to hurt even with regular breathing. Going was pointless, urgent care couldn’t do anything for her they said, not even prescription cough syrup because it has codeine and codeine is addictive.
I have lots of experience with addiction; my father was an alcoholic who got sober and managed to stay sober nearly 40 years until his death. My mother is 70+ years old and is not going to become addicted to codeine cough syrup with this one prescription. When she had bronchitis more than a decade ago and they prescribed codeine cough syrup she didn’t get addicted that time.
Part of the problem is the definition of addiction, according to Webster’s dictionary the definition of addicted is: physically and mentally dependent on a particular substance, and unable to stop taking it without incurring adverse effects. Except this is the description of physical dependency and it is different than addiction because non-addictive medication can cause physical dependency. One of my mother’s statins (a medication used to assist lower high cholesterol) carries the warning “sudden discontinuation of this medication can cause adverse side effects such as migraines, feeling of lethargy, restlessness, and blah blah blah.” I don’t know anyone who is using a statin as a party drug, nor do I know anyone who would say a statin is an addictive drug.
In my experience, we should alter the definition of addicted to be: physically and mentally dependent on a particular substance and unable or unwilling to stop usage despite experiencing adverse side effects.” It’s a small wording change, but I want to share a few stories.
While I was growing up, my father always had a little yellow tin in his pocket. ALWAYS! That tin contained a handful of little white pills. If my father was in danger of running out of those little white pills, he would stop and get more. It didn’t matter if there was a blizzard or two inches of ice on the road or 3 am, when he got low he always went to the nearest gas station and bought another. What was this little yellow tin with little white pills that my father HAD to have? Anacin, a name brand form of aspirin. If you take aspirin every day for five years, then suddenly stop taking it, you will not experience adverse effects. Aspirin is in no way an addictive medication nor can you become physically dependent on it. My father’s use of Anacin was extreme. In the early 1990s he was diagnosed with a bleeding ulcer along with some other digestive issues and the doctors told him he had to stop taking the Anacin. He did not, because HE NEEDED that Anacin. It took a hospitalization and surgery on his stomach before he switched from Anacin to Tylenol for his arthritis pain. That is addiction.
Also while growing up, I ate a lot of peanut butter sandwiches, not because I liked peanut butter, but because peanut butter was cheap and my father was an alcoholic. When he got paid the bulk of his pay check went towards buying alcohol (whiskey if he could afford it, cheap wine and beer if he couldn’t afford whiskey) and Anacin. People need to understand my father having a tin of Anacin was more important than his children eating dinner. When he started the process of getting sober and entered a treatment facility, the doctors warned my mother that he might die from the DTs (DT stands for Delirium Tremens and is a serious side effect of alcohol withdraw). Normally DTs make people sick, in movies it’s portrayed by uncontrollable shaking, vomiting, crankiness (which occasionally manifests as aggression), confusion and in severe withdraw hallucinations. No one in the movies or TV shows die from DTs. In real life, people do die from DTs and the doctors gave my father terrible odds. The odds were so bad, my mom took me to the treatment facility to see my father, just in case. Remember that bleeding ulcer and digestive trouble I mentioned before, they were related to his alcohol and Anacin abuse. My father stopped drinking and taking Anacin (often together) only because the doctors told him he was going to die if he didn’t. That is addiction.
In September 2017, I got some bad news… I was officially diagnosed with CRPS and told the rest of my life would probably entail the usage of prescription pain medication. Except addiction runs in my family. My father was not a one off, all my paternal great uncles and my grandfather were alcoholics, several of my cousins on the paternal side of the family were alcoholics or recreational drug users (I am talking about serious drugs not marijuana; things such as cocaine, meth, PCP…) and often they were both alcoholics and recreational drug users. And now, I who wouldn’t even drink more than a few times a year and never with the intention of getting drunk was going to have to take 2 addictive drugs for the rest of my life: gabapentin and an opioid in order to function. To me this news was devastating. So, I called the person I knew with personal experience with addiction issues to see what to do.
My father was the person who taught me addiction and physical dependency were different things. He said “other people will see it differently, but most of us are physically dependent on medication to live. No one thinks twice about taking nitro pills for a heart condition or SSRIs for depression, but if someone is on pain medication society thinks poorly of them, regardless of their addiction status. As long as you aren’t robbing stores to pay for illegal drugs, then you aren’t an addict, you are physically dependent on a medication to improve your life and that makes you no different than anyone else. It’s when you start doing things that are detrimental to your own well being or those around you in order to get those drugs that you become an addict.” Just as he had with alcohol and Anacin. Those things were more important than anything else, even his health and making sure his kids got fed.
Now, this is not to say some people are not more prone to addiction than others, because there is a genetic predisposition to addiction. But those people do not need to be exposed to an addictive substance to have an addiction. My grandfather’s half sister did not drink alcohol and did not do drugs, but she had seven closets full of clothes at one point, several of them still had the tags on them and shopping was every bit as important to her as alcohol was to my father. Shopping was so important she went tens of thousands of dollars into debt buying clothes and when she passed away my cousins discovered it wasn’t just tens of thousands… She had taken out a second mortgage on her house to cover her credit card bills and she had a credit card for every clothing store where she lived. However, no one would label her an “addict” because she wasn’t buying booze or illegal drugs, she was buying clothes.
Technically, hoarders are also addicts, but again we don’t call them that, because they aren’t buying booze or illegal drugs, they are hoarding stuff (be it newspapers and magazines or shoes and cans of corn). Instead, we restrict the label addict to people who abuse alcohol or illegal drugs and sometimes to people who do not abuse, but simply use their opioid pain medications.
This is why we need to change the way we think. Prescribing a woman in her 70s codeine cough syrup so she can sleep and not walk hunched over for a few days while she struggles with a virus is not going to make her an addict, it’s simply a temporary improvement in the quality of her life, while she deals with a serious, but temporary health issue.
This change is something I have been acutely aware of these last several months. Starting in late June I began looking for a part time job, to supplement my income a little while the economy did it’s thing this year. Yet, after six months of looking, I was unable to find a job, even when I was the best candidate, I wasn’t hired because I use opioid pain medication to treat my neurological disease. A store manager even told me, they couldn’t hire me, because they couldn’t have me overdose in their store. Uh, I’ve been using my medication for five years and have yet to overdose, I’m not going to suddenly overdose at your store just because you gave me a job. But the perception of opioid users, even if it’s legal is that they are all drug addicts. No doubt the person had concerns beyond the possibility that I would suddenly overdose while stocking shelves at his store, I mean as a drug user can I be trusted to be around the store’s stock and cash registers? As a person dependent on pain medication, I must be an addict. That is what society has taught us the last handful of years…. everyone who uses pain medication is an addict and probably uses other drugs.
We, society, need to remember we have known for centuries (Ancient Egyptians and Greeks knew so at least that far back) that opium is habit forming, carrying the risk of both physical dependency and addiction, yet not everyone who takes codeine cough syrup while dealing with a severe cough is at risk of becoming bank robbers to feed their addiction… as a matter of fact, it’s only the few.
Before I end this though, I want to talk about the terrifying statistic being flashed across the news at every opportunity: the opioid overdose rate. The majority of overdose deaths are related to ONE single opiate derivative: Fentanyl. In 2021, more than 70% of overdoses were related to the use of Fentanyl and here’s the really scary part of that, most of those users didn’t know they were using Fentanyl. It has become more profitable to mix drugs such as cocaine, methamphetamine, and PCP with fentanyl than cornstarch. Let that statement sink in for a moment: it is cheaper to mix fentanyl into an eight ball of cocaine than cornstarch. Fentanyl is cheaper to make than buying a box of cornstarch…. Some years ago, while at a dart tournament there was a huge commotion and when I started poking around to find out what happened; I was told two dart players had been taken out of the tournament by ambulance because they overdosed on fentanyl. I later learned they didn’t use opioids, they had snorted cocaine to help with their stamina… something an opioid won’t do… So where had the fentanyl come from? The cocaine! Even tiny amounts of fentanyl can kill (seven grains is enough fentanyl to cause an overdose… seven grains! Imagine putting just seven individual pieces of sand in your hand… that’s enough fentanyl to kill the average adult male). It is the fentanyl laced illegal drugs sold by cartels and mafias driving the US’s overdose rate, not prescription cough syrup given to the elderly. According to the DEA less than 10% of opioid related overdose deaths come from prescription medications. Nine percent of 25,000 is still 2,250 people or so, but that number is less than the number of people killed by interactions between multiple non-opioid related prescriptions.
Furthermore, short term opioid prescriptions are not driving the addiction rate. Yes, we all know someone that broke a leg and became dependent on the opioid pain medication, it does happen. The majority of those people do not get cut off from their pain medication and immediately start shooting up with heroine. They get cut-off go through withdraw and denial and then they are fine. The majority of drug use is social. A bunch of people at a party decide to do cocaine or ecstasy or smoke a joint (both marijuana and ecstasy can also be laced with fentanyl, just FYI). That is how most addiction starts, at first it’s just “social drug use” akin to “social drinking” and then they start craving it when they aren’t with friends…. and then they start using without their friends and now they are spiraling into addiction.
I hold a different perspective regarding The War on Drugs as well as the battle with addiction and overdose related deaths, but that’s a post for a different day. The point of today’s post is that we need to change how we classify and view addiction and drugs. We have gone from over prescribing habit forming medications to under prescribing them and that is just as damaging.