The Language of Addiction

The struggle stigma is real.

I'm the mayor of my hometown. I'm a college professor and director-level employee. I'm a founder of an endo support group. I am a statewide board member of Equality PA. And I'm a drug addict. 

Wait, no. I'm not a drug addict. But according to many peoples' perceptions of addiction and drug abuse history, I probably am. Why? Not because I have to pain manage with prescription medications on a daily basis, but because of the perception of what addiction and drug abuse is.

I recently started serving on a local, county-wide Heroin Task Force. The need for education, awareness and support for heroin users is almost frightening; heroin is infiltrating every community, effecting every socioeconomic class, and damaging every family it touches. Even my own family has struggled with addiction--how to intervene appropriately, where to draw the line, who to ask for help and where to go when you do need help. While the heroin epidemic is a significant subject of discussion, I found myself thinking more and more about the women whom I have connected with in the Central PA Endometriosis Support Network. Many women whom I've encountered take prescription pain medications to help regulate their symptoms of moderate to severe pain. As the task force continued to talk about "why is heroin becoming the drug of choice," the conversation shifted to prescription pain medication, particularly opiates, and the over-prescription of them.

The task force is comprised of many community-based agencies--some of which are in the social/human services field, some criminal justice, some non-profit and some in education. Great! A wide range of professionals is exactly what a community needs in order to appropriately tackle heroin use. As we took turns speaking about how our agencies could contribute to the task force, I started hearing some familiar language and terminology being used to describe heroin users: addicts, drug addicts, criminals... 

Does heroin lead to criminal behavior? Often times, yes. Are the people who become addicted starting off as criminals? No. But the perception of drugs is this:

1) you take pain meds
2) you become addicted
3) you are a drug addict
4) you are a criminal

Admittedly, I used to think this way. I used to be the person who could never understand why someone would abuse narcotics because I didn't like the way they made me feel: detached, loopy, not in control. In the task force meeting, one of the members said, in essence: I don't get it. I have a hard time wrapping my head around addiction as a disease.

I appreciated his feedback and perspective because it was honest. I think the thing that shook me at my core was that I know this perception of addiction is probably the majority perception. And I used to be a part of that majority. What made me change? Endometriosis and suffering from chronic pain. 

Because I have to take pain management medications on a regular basis, I have become hyper-aware of the risks involved with opiods and opiates. Because addiction runs in my family, I am always self-monitoring and making sure I don't over medicate. 

But over the past 10 years or so, I have been treated as a drug-seeker in emergency room visits because, as we all know, you can't see endometriosis with an MRI, CT scan or ultrasound. I've felt judgmental eyes scan over my prescription list a the pharmacy and had pharmacists even ask me "what are you taking this medication for?" My doctor has referred to me as an "old lady" because of my past prescription list. Have I asked for any of this feedback or commentary? Nope. 

In all this commentary, has anyone asked me if I think I have a potential problem? Has anyone said, "are you talking to your physician regarding the risks of taking opiates?" Has my primary care doctor said anything about me taking prescription pain medications for endometriosis? No. But...why? If it's second nature to evaluate someones' potential addiction from afar, to assign a (negative) quality to your relationship with pain management prescriptions, then why is it so difficult to encourage a dialogue about the risks of addiction? If it means so much to people--sometimes complete strangers--why aren't they asking you if you need help? 

You'll tell me: "It's very personal to talk about potential addiction," or "I don't want to upset them by making accusations." So it's not okay to talk about help, but it's fine and dandy to discuss someone's social downfall? Whatever. Look, I get it. I also want to judge in silence...or judge by calling my bestie to gossy. However, the fact remains that addiction is a social stigma, not a disease.

Wait, no. It is a disease. We need more people to approach addiction with these words. 

Finally, I'll mention that I feel quite strongly that the conversation about addiction should, in all cases, start between the doctor and the patient when these meds are prescribed. If my doctor said to me, "Hey, look, I know these can be addictive, so let's make sure we keep in touch if you feel like your body is responding in these ways (list risk factors here), and I'll make sure to help you." That's it. The 'helping' can be seen any way the patient wants to see help--whether they think it's code for "I'll help you get more meds" or "I'll help you if you think you are beginning to see patterns of addiction." Who cares! As long as the doctor and patient are having these conversations, we're doing the right thing. Nobody's perfect. Nobody is automatically immune to prescription drug dependency. Until we can accept that fact, we will be speaking the wrong language. I won't understand you, and you can't understand me.