Opioids

            Much is being made of the increase in death by opioid overdose, both accidental as well as purposeful. From 1999 to 2017, the numbers for all overdose deaths have grown from 17,000 to 70,000, of which from 8,000 to 47,600 were for opioid overdose. And the number of suicides (by all methods) in 2017 were 47,000, but I can’t seem to find any stats that show how many of those were from drug overdoses. I’m guessing it would probably be about half of those 47,000. The numbers are hard to pin down. Let’s say that about half the overdose deaths were suicides and half were accidental. Are the opioids, as with so many of our illegal drugs, used for the euphoria they produce or for the pain they alleviate? If they were prescribed, then they were for the pain. I’m now being treated for polymyalgia and have a prescription for a low-level opioid called Tramadol. I now know what recurrent pain feels like—the pain that migrates across my back and hips, that moves from shoulder to shoulder and all too often seizes my attention with pain where the shoulder joins the neck or where the back of my head attaches to my spine. It’s not the constant pain of a headache or toothache. It’s the pain that makes me howl like a wounded banshee with a trunk twist or shoulder shrug. It makes me want to take anything in any amount to stop the pain. I wonder if that isn’t exactly what happens when someone overdoses on one of the opioids. Are they trying to end life or just eliminate pain? Lee Child, in The Midnight Line, writes about several veterans whose wounds are so severe they have to use fentanyl to stop the pain, but as their bodies adjust to the drug, more and more is required to do the job. Their addiction was for alleviating pain and not for getting high. At what point, then, does a drug become addictive? How do we know when we’ve gone more than halfway across that bridge? Are these people who die from overdoses trying to relieve pain, or trying to kill themselves, or simply to feel the euphoria the drug induces? If it’s the latter, then the addiction is to the euphoria and not to the drug itself. Or do I have it backwards, that the addiction is to the fentanyl or oxycodone or any of the other opioids and that most overdoses are accidental? My head is spinning. I think I’ll go take another Tramadol or two.