Shirah Vollmer MD

The Musings of Dr. Vollmer

Women And Opiates: My Rant

Posted by Dr. Vollmer on July 3, 2013

Doctors prescribe narcotics too often for pain, CDC chief says

Pills of hydrocodone, also known as Vicodin, are shown. Drug overdose is one of the few causes of death in the United States that is worsening, eclipsing fatal traffic accidents in 2009. (Toby Talbot / Associated Press / February 19, 2013)

“About 15,300 women died from overdoses of all kinds in 2010, more than from car accidents or cervical cancer, according to the CDC.

Overdose deaths rose most rapidly among middle-aged women who, previous research has shown, are more likely to suffer from chronic pain and to be prescribed painkillers.

“Mothers, wives, sisters and daughters are dying at rates that we have never seen before,” Frieden said. ‘These are really troubling numbers.’ ”

http://www.latimes.com/news/local/la-me-rx-painkillers-20130703,0,916397.story

 

I highly suspect that many of these “middle-aged women” taking opiates, overdosing from opiates, complaining of chronic pain, are suffering from disappointments, psychic pain, and frustration with their lives, particularly their relationships. This “middle-age” for women, as we all know, is associated with launching children, coping with elderly and disabled parents, menopausal body changes, along with mid-life relationships which range from long-term marriages to being new to the dating scene to perpetuating a single life, which may or may not feel satisfying. Where do these women turn? The psychiatrist? Nope. For both social and financial reasons, these women, generally speaking,  turn to their trusted primary care physician. However,  complaining about their husbands, children or their parents, seems like a “waste of time,” so they focus on the very real pain of aging. Joints do not work as well. Injuries are more common. The fluidity of the body is slowly declining and so they complain. Exercise, of course, should be the first line of defense, but primary care physicians are usually coached to get rid of pain quickly, rather than telling patients to exercise, as primary care doctors often feel that the exercise  recommendation is unlikely to be understood as helpful, but rather the patient responds with  “yea, I know, but I won’t.” The culture of doctors wanting to please their patients, encourages physicians to give them opiates for pain that is not clearly understood, but complained about. “What is going on with your life, right now?” is the question that I wish happened in that eight minute office visit. Primary care doctors could venture an educated guess, that the pain of aging is exacerbated by disappointments in relationships. Middle-age is a hard time for women. The culture seems to understand the “mid-life crisis” of men, but women, too, examine their choices, sometimes with feelings of deep regret and despair. Maybe opiates numb that despair, and over time, as the feelings mount, so does the opiate use, leading to tragic and preventable death. My solution: Exercise and psychotherapy for these women who come complaining of body pain, while working them up to make sure that they do not have an underlying disease process which requires medical intervention. Opiates are wonderful drugs for those facing the end of their lives due to a debilitating disease. By contrast, opiates ruin the lives of those who could have a lot to look forward to, but who need to get over a major hurdle in their lives.  Physicians need to understand that. Women deserve it.

9 Responses to “Women And Opiates: My Rant”

  1. Jon said

    Your advice for exercise is both wise and old. The standard aphorism “A healthy mind in a healthy body” or “mens sana in corpore sano” is ascribed to the Latin satirist and poet Juvenal.

    While the wisdom is quite accurate, there is much room also for humorous speculation – what does this have to say about a dirty body? Also, one must be careful to follow the even older apollonian maxim of moderation in all things. As one wise 20th century man (my father) once said, “Show me an athlete, and I will show you a cripple.”

    • Yes, indeed, moderation in all things, including the prescribing of opiates! The ability to be moderate, that is, neither obsessive nor negligent, is a goal which becomes particularly difficult under stress. In this case, illustrating the stressors on middle-aged women, one can see that even though many might have been able to be moderate in earlier decades, the arrival of multiple life-changes, can throw one into either neglect or obsession. The physician is in the wonderful spot of being able to identify this change of course, and offer behavioral suggestions to re-establish a healthy lifestyle. Sadly, it is the rare doctor who takes this approach.

  2. Ashana M said

    I think maybe you’re being unfair. All of my physicians suggested exercise for chronic fatigue and pain. None of them went to medication first. It’s just that exercise didn’t help. What did help that was directed at the body was stretching and meditation. It just took me a long time to figure that out. And I probably wouldn’t have bothered with it if they hadn’t been able to provide me with a sound reason it would help–I had, after all, tried so many other things that hadn’t helped. I had to discover the reasons it would help on my own.

    Different kinds of pain respond to different approaches. Exercise isn’t a cure-all or a one-size-fits all. What will help depends on what is actually causing the pain.

  3. Shelly said

    I agree with Ashana and understand what you are trying to say, Shirah. However, you are making the case for exercise and psychotherapy to cure the mental pain that leads to one’s overuse of opiates to block out difficult and painful things in one’s life (both emotional and physical). First, when a physician begins a lecture to me when I come to him for physical pain (say, for a herniated disc) with, “You need to exercise more! You think you’re busy? I’m busier than you and even I can exercise!” I immediately block out what he has to say because he’s opened the discussion with a criticism. If he had said something about the medical benefits of exercising decreasing the pain associated with degenerative disc disease, then perhaps I would listen, but to simply rant and criticize, why should I listen? Second, when people are in pain, they want it to stop. They don’t want long-term solutions like exercise and therapy which may show benefits in months or even years! My five cents worth.

    • Shelly, I think you bring up the very important issue of persuasion. Physicians need to learn how to talk to patients so they can listen and not feel defensive. In the “good ole days” this was taught in medical school. To my knowledge, the idea of talking to patients to change their behavior is not as universally taught. There is a school of thought called “motivational interviewing” which attempts to help physicians to motivate patients towards behavioral modifications, but to my mind, this is not one-size fits all, but rather, each conversation has to be customized to the particulars of the patient’s life circumstance. Shaming you into exercise is not a useful interviewing technique. Providing education, as you suggest, is often helpful. Of course, this education does not have to be done by a physician, but on the other hand, when a physician takes time to educate his patients, then that goes a long way towards inspiring behavioral changes. Thanks.

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