Reprinted from Newsday June 17, 2010

Opinion: Our aversion to pain is driving heroin addiction

By: Patricia Hincken, President of NAFAS

Patricia Hincken is director of Alcohol and Substance Abuse Services for the Long Beach Medical Center and president of Nassau Alliance for Addiction Services.

Long Islanders are getting used to seeing headlines about the growing heroin use here. And as parents, health and law-enforcement officials grapple with finding the proper response, there's one question we should all step back and consider:

When did we start believing that life without pain was not only attainable but a basic right?

Prescriptions for opioid pain medicines have skyrocketed over the past 10 years, leading to prescription-drug addiction, heroin use and overdoses - particularly among teenagers and young adults.

Drugs such as OxyContin, Vicodin and Percocet are in the same class of drugs as heroin. Powerful and highly addictive, these opioid drugs produce an effect of euphoria and sedation, and as with any drug, the body builds a tolerance over time that diminishes their effects. Those of us who work in the field of addiction treatment know well how people addicted to opiates describe being high as better than sex, family, love and any other human comfort.

Treating opioid addiction is challenging, since many clients start using the drug under the care of a physician. Once addicted, it's natural for them to justify use and seek reasons to continue it.

Often those who need addiction treatment have multiple scripts from different doctors, - and most often, the doctors aren't aware of each other. In treatment, one of our jobs is to untangle the medical from the addiction. The person before us clings to the legitimacy of a prescription, even if they have been arrested for selling pills or writing scripts, or are now crushing and snorting their "medicine."

Not long ago, doctors were wary of prescribing these drugs, fearful that their patients would indeed become addicted. Some patients who had extreme pain - such as late-stage cancer or post-surgical pain - were not getting enough medicine, and their comfort and ability to function were compromised. In 1994, the New England Journal of Medicine published a study that found that doctors were not treating pain effectively.

So efforts to better assess and treat pain became a focus of the medical community. And in 2001, the Joint Commission - an independent, not-for-profit that accredits and certifies health-care organizations - instituted new pain assessment and management standards. Pain assessment became a significant issue in the accreditation process for hospitals, creating significant change in hospital policy and procedures.

The main assessment tool is a self-report: On a scale of 1 to 10, how severe is your pain? A Joint Commission brochure provided to patients - "What You Should Know about Pain Management" - reassures them that addiction to pain medicine is unlikely. The message to doctors is simple: The patient determines the level of pain, and neither patient nor doctor should be concerned about getting or giving a prescription for an opioid drug.

Word got out: We have a right to be pain-free, and it is as simple as taking a pill.

What's gotten lost is the plain truth that pain is part of the alert system of the body. A friend of mine was given pain medicine for a stomach ailment for more than a year, until her insurance company demanded her doctor do more testing. As a result, she discovered a hard-to-find cancer. Joint pain may be alerting us to a need for a lifestyle change, such as losing weight or increasing exercise. Stress headaches may alert us to problems in our marriage or work.

As adults have bought into the illusion of pain-free living, they've passed this on to their children. When kids enter the awkwardness of the teen years, worrying about fitting in, too many find it is much easier to reach for a handful of pills than to confront their sense of inadequacy.

We need to remind ourselves of some old wisdom and share it with the young: If it sounds too good to be true, be cautious. A pill won't answer all of our human problems, and in fact, it can lead us to disaster.

And it's also time to share a new message: Pain-free is not free.