Opioids and Mental Health Disorders

Opioids and Mental Health Disorders

Opioids and mental health disorders probably do not seem like a good mix in anyone’s mind. I’m sure most of the general public would find it problematic to prescribe opioids to someone with a mental health disorder, but every day, physicians across the country prescribe large numbers of opioid prescriptions to these patients.

 

Dave Chase, in his book The Opioid Crisis Wake-Up Call, writes, “According to a recent study, more than half of all opioid prescriptions in the United States annually go to adults with a mental illness, who represent just 16 percent of the U.S. population.”

 

Why do we over-prescribe so many opioids to people with mental health illnesses? I can think of three potential causal models that lead to our over prescription of opioids for people with mental health disorders. 1: our system was never set up to treat health broadly speaking, 2: mental health has always been stigmatized and hidden in America, and 3: we have sabotaged ideas of community in the United States as we pursue our own self-interests and spend unreasonable amounts of time working and commuting.

 

1: The history of the American medical system was focused on interventions and solving health problems after the problem had popped up. Insurance companies were created to help people access different parts of the medical system, and over time private insurance has become more or less the only way to reasonably access affordable medical care in the United States. Our reliance on third party payers allowed prices to profligate, and it feels as though we are at a point where we can’t turn the ship around. If you have a mental health disorder, you are less likely to have stable employment, which means you are less likely to have quality health insurance provided through your job, and less likely to establish the mental health care that you need. As a result, you probably see your primary care provider and end up with an opioid prescription during your 10 minute appointment because your doctor doesn’t have time to really work with you on addressing your mental health challenges.

 

2: There are many examples throughout history of people hiding children with intellectual disabilities. Generations before us warehoused children in mental health institutions that did little to help improve health. We are mostly beyond that today, but nevertheless, we hide anxiety, depression, learning disabilities, and other mental health challenges from our friends, families, and coworkers. We still don’t do a good job of accepting that mental health disorders are not something that people should be ashamed of, and many people do not seek appropriate care but instead life lives that are less than healthy, where ending up with an opioid prescription, or self-medicating with something worse, is a less public alternative to dealing with mental health challenges.

 

3: Tying both points one and  two together, our lack of community makes mental health management almost impossible. We don’t have a lot of friends and family members that we can truly rely on for help with physical, mental, and emotional challenges. It may take a village to raise a kid, but we have run away from our villages to hide in our suburbs. We have dis-invested in the communities where we live and as a result, people with mental health disorders lack the social support systems necessary to truly address their needs. Even if people with mental health issues have some family and friends close by, those who they rely on probably lack the support they need to care for someone with mental health challenges. We spend too much time at work, spend too much time commuting to work, and don’t have time to help those who are more vulnerable. As a result, we simply shut people with mental health disorders out of our lives and out of society, and numb their lives with opioids.

 

Our country has not set up a system that truly takes care of our health, from before we are sick or have significant health challenges through to a successful recovery. We have overloaded the system that we built which was designed for people with the means to afford care after they were ill. We have ignored mental health and pretended we didn’t know it was an issue, until now, when it is too late and we don’t have the supports we need. Our communities are non-existent, and taking the steps to care for our community feels impossible.

 

The path forward involves a shift in how we provide, pay for, and think about healthcare. The systems we turn to for health need to move up-stream, where we focus on health before people are sick. To do that, we have to be honest about things like mental health, we have to be willing to provide spaces and community so that people can engage with healthy lifestyles and behaviors. We have to break out of our 40 hour work-weeks, and find ways to work closer to where we live, to end the soul sucking commutes that so many of us have. We have to give people time, and develop communities of support so that we can take care of our health and the health of those most vulnerable people in our communities. Without making these transformational changes, we will be stuck in our default of opioid prescriptions, unable to give people what they need to live healthy and meaningful lives.
Our Efforts to Avoid Pain

Our Efforts to Avoid Pain

I had an amazing track coach at Reno High School. His name was Mark Smith (everyone called him Smitty) and like all great coaches, he knew what high school students needed in their workouts and in their heads in order to be successful both in sports and in life.

 

Some of the neighborhoods that Reno High School draws from are among the nicest and most expensive in all of Reno. Many students have very dedicated parents who will do anything to help their children succeed, be happy, and avoid pain and suffering. However, these parents often miss an important point, a point that Coach Smitty would always remind parents and athletes, “you can never eliminate suffering, and you can’t protect your child [or yourself] from all pain.”

 

Sam Quinones, author of Dreamland would certainly agree. In his book he writes, “In heroin addicts, I had seen the debasement that comes from the loss of free will and enslavement to what amounts to an idea: permanent pleasure, numbness, and the avoidance of pain.”

 

Our society, in TV shows and commercials, continually pushes a narrative that we should be happy and have lots of consumer goods in our lives. We seem to believe that every moment of our lives should be nothing but entertainment and enjoyment, and we pursue that, continuously trying to buy our happiness and avoid any possible pain or suffering. As Coach Smitty said, however, this is not possible, and as Quinones shows throughout Dreamland, this can lead to dangerous consequences. Part of the opioid problem in our country, Quinones argues, is that we place too high a value on never feeling pain and suffering, and we under-invest in the real things that would help us actually overcome and reasonably manage and respond to pain and suffering.

 

Our mental health, counseling, and therapy services are under-developed and costly. Our economic system doesn’t provide people the support they need in difficult times, and we don’t do a good job of helping get people into jobs that actually feel meaningful. We have built suburbs and isolated ourselves from community, and when we face hard times, we are afraid to admit it and don’t have many close people to turn to. We seek avoidance from these challenges with chemicals like alcohol, opioids, marijuana, or worse. We try to blunt the pain and reduce the suffering artificially, which doesn’t work, and doesn’t help us feel happy or fulfilled.

 

We have a myth that we can eliminate all the suffering in our lives and in the lives of our loved ones. However, the reality is that we must work to overcome that suffering together. As a team, we can support each other, train each other to be strong during adversity, and learn how to put in hard work and lean into the uncomfortable reality of the world to find a place where we can accept and appropriately respond to suffering and pain.

 

Coach Smitty passed away on October 12th, 2018. He was a truly great influence in my life and in the life of others. I hope everyone has a Coach Smitty in their lives, and please reach out to say hi and thanks if you do.