I wrote my first “Letter to the Editor” to Time Magazine in response to “The Opioid Diaries” (http://time.com/james-nachtwey-opioid-addiction-america/). It didn’t get published, so I thought I’d share my thoughts. In short, the media has been very focused on the side effect of death for people who overdose on narcotics, while not shining light on the other side effects they can cause patients who are responsible users. The media has also been making patients who are in pain, feel guilty and stigmatized.
THE LETTER TO THE EDITOR THAT DIDN’T GET PUBLISHED:
Dear Editor:
As a human being, the opioid overdose epidemic feels heartbreaking, as was depicted in “The Opioid Diaries”. As a physician, the issue goes beyond overdose. The media hasn’t been speaking to the person in pain who has purpose in life, for example, the executive, the mother, the athlete. It makes these people feel stigmatized. Opioids are often started without explanation, before the cause of pain symptoms are addressed.
Opioids cause a slow decline in body function, affecting hormones, gut function and pain levels. In interacting with hormones, opioids affect libido, impotence, sleep and bone density. Cortisol levels can drop, changing stress responses. Depressed mood, loss in muscle mass and fatigue due to anemia go unnoticed. In the intestines, the gut microbiome (the colony of bacteria living in your digestive system) is altered and water and nutrient absorption can be compromised. This leads to constipation, systemic inflammation, increased risk of infection or disease progression. Not only do opioids affect hormones and the gut, “opioid-induced hyperalgesia”, a paradoxical response whereby a patient receiving opioids becomes even more sensitive to pain, can occur.
These are just some examples. These less obvious but deleterious effects put patients in between a rock and a hard place, leaving them feeling judged and uninformed. We need better solutions for acknowledging and rehabilitating people who are in pain.
Dr. Mikiko Murakami, DO
Pain medicine and Physical Medicine & Rehabilitation