Chad’s opinion: Duty of care vs Dignity of risk

Chad has written this opinion piece, reflecting on the shifting sands around accessing prescription opioids based on his own use of pain medications.

It’s obvious that using strong medication comes with risks that need to be managed. But is that enough to defend bringing in systems that mean everyone loses their power?

Doctors are being watched more and more when they are prescribing — and so are patients, who have to suffer increasing policing and stigma when trying to access prescribed drugs. It has not only become harder to ‘doctor shop’ or get illicit meds, it is more difficult for people with a physical health problem to get meds, too.

I had been noticing all this from afar for some time but following a car accident 3 years ago, I started experiencing it for myself. I’ve watched general concern around painkillers increase while trying to access my own medication. I was prescribed Lyrica following the accident. It’s a well-designed painkiller that helped me a lot — but after 3 years of being prescribed this medication, it’s now being removed from my scripts. For a while there was no issue in getting these meds from a chemist, but now meds are supplied in stages. Pharmacists won’t dispense my Lyrica without a direct call from my prescribing doctor.

Many people I know have talked about being prescribed S8 opiate medications for decades, only to suddenly be faced with being reduced off them with steep tapering regimens. They say they have been offered the choice of either no pain medication or switching to methadone or buprenorphine on the stigmatised Opioid Treatment Program (OTP). That means having to be dosed daily, or at best weekly, for a higher price than their current meds, through a registered clinic.

Right or wrong?

It seems that in our society, it is considered better to live a life of pain, without dignity, than to have a dependence on a drug that works for you. Yet a lifetime of dependence is tolerated as long as there is control, discrimination and no pleasure from the drugs taken.

Sadly, drugs are not only seen in terms of their practical use. Drug use has become all about right and wrong behaviour. But abstinence from drugs doesn’t make you morally superior. Taking drugs does not make you morally inferior. Both are simply personal choices that we make, based on things like our health (and our pain), wellbeing, lifestyle and finances.

Finding peace

For me, drugs are part of my tool kit that makes life bearable in this chaotic world we are living in. I find a lot of psychological peace in opiates, as do many people, but in 2021 this is just not acceptable. In fact, it is a red light to doctors. They will always think that pleasure in opioids adds an unacceptable level of risk. Their thoughts turn to overdose. So they will try to legally protect themselves from this risk by refusing to prescribe to anyone who actually enjoys their meds.

So, as my friends in their 50s and 60s complain about this trend of increasing restriction to opioid medications, I realise I need to do all I can to avoid the nightmare scenario of being under-medicated and in pain and distress. Especially when that might mean I become too unwell to effectively advocate for myself.

Mental health has been a growing concern during this period of uncertain economy, isolation and the revelation that the systems we all thought were rock solid are instead constructed from bubble gum and string. So while doctors try to protect themselves against risks associated with prescribing, the leading cause of death for men my age is actually suicide.

Inconsistent reasoning

Currently we live under a regime dominated by political lobbying supporting alcohol and tobacco. Many substances that kill freely are available from the supermarket. Alcohol, a class 1 carcinogen, was considered as ‘essential’ during the most restrictive period of the recent COVID-19 lockdown. It makes it hard to respect the very inconsistent reasoning around reducing the availability of other drugs — especially pain medication. We need to come clean about what is really unhealthy and what is conveniently demonised and made illegal. While pharmaceutical corporations make millions from peddling their wares and medical professionals become moral police, users are criminalised.

Connection has long been my solution to any mental health crisis — connection to a community that hears and understands my anguish. If we are going to improve community health and wellbeing, we need a more honest society-wide conversation about drugs, duty of care and dignity of risk. All people have a right to dignity of risk — to be able to take a reasonable personal risk when needed to improve our quality of life. This right should be recognised, validated and enacted upon.

To be voiceless and vulnerable, in pain and under-medicated is an unnecessary torture that people need not endure. That should not be where duty of care takes us.