Opiates & Pain

Sometimes I make a sound when I’m surprised, that sounds like “huh”.

I passed a billboard on the Pennsylvania Turnpike this morning.  “152 Montgomery County residents died of drug overdoses in 2015”.

I made a sound of “huh”.


More Americans died of drug overdoses in 2015 than from car accidents.  And a lot of Americans died in car accidents last year.

While I didn’t know any of the 152 people who overdosed and died last year in Montgomery County, I know several people who have died as a result of overdoses in Chester County, and Philadelphia County.

Pharmacists.  Professional people.  Family people.  People like you and me.


Opiates are a class of pain medication that includes morphine, codeine, oxycodone, hydrocodone,  and others.  Some are available by prescription, and some (like heroin) are available illegally.  They are very effective, and very potent, relievers of physical pain.

If I remember my pharmacy school classes well (there is no guarantee of that…), opiates bind at the mu receptor in the central nervous system to create the effect of analgesia.  In other words, they block pain by interacting at a cellular level.  The effect is so pleasurable that some users want to re-create the experience over and over again.

Opiates can be very addictive.


I just finished reading an article about an epidemic of fentanyl use in Canada.  According to the article, fentanyl (an opiate 100x more potent than morphine) is widely available, and can be ordered online.  It is being mass-produced overseas, and shipped directly to the homes of Canadian addicts.

In the United States, we have the same problem with oxycodone.    American users purchase prescription opiates online (or on the street, or with a physician’s prescription).


Some municipalities have taken to providing an opiate antidote, naloxone, to those who request it.  The antidote is highly effective if it is administered quickly to someone who is experiencing an opiate overdose.

While I support this measure, it really only scratches the surface of the problem.  Providing naloxone to those who are overdosing will save some people from overdosing.  But it won’t decrease the supply of opiates, and it won’t decrease the demand for them, either.

The “war on drugs” didn’t decrease the demand for drugs, and it didn’t decrease the supply of drugs, either.    It just created a much larger prison system.  We have way more people imprisoned in 2016 for drug offenses than we did in 1980, and more drug use too.

The supply of drugs isn’t going to go away.  In the article I read about Canada’s fentanyl problem, the authors described the economics of drug distribution.  A user can purchase $10,000 worth of raw fentanyl powder, tablet filling supplies, and a tablet press, and sell the end product for as much as  $2,000,000 worth of fentanyl tablets.

That is a 200x profit.  As long as 200-fold profits are available, someone will be willing to sell drugs, regardless of the consequences.


The drug epidemic is a problem that doesn’t have an easy answer.  I wish it did.  So what follows are not suggested solutions.  They are some of my thoughts about the problem:

What if the problem isn’t about drugs?  The kinds of drugs we are dealing with existed 50 years ago.  Some of the drugs are new, but they are really new variations of older drugs.  What if the drug epidemic is a symptom of something else?

What if the problem is with us?  What if we changed?  Suppose the problem is that we seek temporary comfort from permanent problems?

What if the type of pain that we are trying to medicate isn’t physical pain?  What if the type of pain our society is trying to medicate is spiritual pain?  What if opiates can’t scratch the kind of itch that we have?

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I don’t like to ask these questions.  I would much rather stick my head in the sand and hope that the problem goes away.

But no matter how much I stick my fingers in my ears and say “na na na na I can’t hear you!”, the reality is still there.  Right in front of me on a billboard on the Pennsylvania Turnpike.



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