I recently read an article in The New Yorker about the Sackler family: a family highly involved in the business of prescription medication, especially opioids. The Sackler family created Purdue Pharma, the pharmaceutical company that developed the prescription painkiller OxyContin. The author of the article took the time to explain family’s overall contribution to the opioid epidemic in our country, which seems to have grown completely out of control. The author claimed that despite reputable philanthropy and significant positive contributions to the community, the Sackler family fortune had resulted in the overdoses and deaths of thousands of Americans per year. The New Yorker article consisted of multiple pages of research, all dedicated to the blame of a family that advertised and pushed their medications to a point of danger and disaster. The article left me uneasy. Sixteen pages of blame and information topped off with a rushed personal story about a past addict, “a man [the writer calls] Jeff.” This was my favorite part of the article. The very last column, consisting of just four paragraphs, gave me a microscopic view of a larger problem, yet this is what I considered the most important aspect of the issue: the people themselves.
I was intimidated when starting my first job as a medical assistant at a pain management clinic. I already had a fear of being responsible for others and giving care that affected the way that they live (or die). I made the decision not to become a doctor because of the looming anxiety such a responsibility gave me, but to test the waters, I earned my certification as a Nurse’s Assistant. In the beginning, learning my way around a new environment and all of the rules and processes that came with my job distracted me from the weight of the situation I was in. My particular office was consistently prescribing opioids and managing the care of patients who needed these medications. While I was surrounded by potentially addictive drugs all day, my daily routine was quite simple: patients came in, I took them to their rooms, went through the basic procedures to get them ready for the doctor, checked off my list of duties, and then went back to the medical assistant station.
Being around these medications was a big responsibility. I spent all day talking about opioids, sending prescription requests for opioids, getting insurance authorization for opioids, taking patient calls about opioids, and even physically counting a variety of pills. I eventually became intrigued by the pills with unique colorations. Most pills were white, maybe a light yellow, but the morphine could come in vibrant hues. Some patients came with beautiful blue and purple pills that were so tiny they looked absolutely harmless. I always felt funny commenting on the colors of their medication but most patients agreed with me, “They are hypnotizing,” one patient said, already looking lulled.
I don’t know much about the chemical makeup of opium-based medication or which pills solve which specific problems, but the more pills I counted, the more names I got to learn. There are standard generic names like: hydrocodone, hydromorphone, oxycodone, methadone, fentanyl, or morphine. Then the brand names, categorizing the amount of medication in each variation: Percocet, Norco, Lortab, MS Contin, OxyContin, Tramadol, Dilaudid, Hysingla, Zohydro, Opana, and I am sure the list goes on. At first, it was daunting having to become familiar with all the names and permeations of the drugs prescribed. It might not have been my job to become the expert, but the more I worked with the medications, the more they became a part of my vocabulary. Slowly I could work them into office conversation without feeling like a fake.
Still, I didn’t fully understand the severity of my position until one day, a physician’s assistant (PA) asked me to come back into the room to help recount a patient’s pills. As part of rooming a patient, we had to count their medication, which was done at each visit to make sure patients weren’t over taking. The medical provider would calculate the amount they should have left, but this particular patient seemed to have less than they should. I was brought in to recount the pills and make sure there hadn’t been any mistakes in my initial count.
When I went into the room, the patient was crying. I was shocked, considering they were seeing the gentlest PA in the office. I tried to act natural as I counted the pills again. It was 34; the same count. I verified the count with the PA and he thanked me before I left. About 30 minutes later, the patient walked out with the PA. The patient thanked the PA for his time and understanding. Because she was short on her medication, the patient got “the overdose lecture” and a smaller prescription. Many of the medical providers I worked with would have reacted the same way: some leniency, giving the patients second chances with new, but smaller, prescriptions and more frequent visits. But, when the patient hit a certain amount of strikes, they were out. The doctors would no longer medicate.
Considering that my time at the clinic was mostly non-dramatic, certain moments did stand out. These moments moved me to mull over the implications of addiction. Once, a patient came into the office declaring that his cat had knocked his open bottle of pills to the floor, causing a handful of them to bounce into the vent. He was hysterical, acknowledging the absurdity of the story, and recounting it to every new patient who came into the waiting room until we called him back.
“I know,” he was sweating through his shirt, “I just know you think I’m lying.” His arms were shaking. I remember thinking, is that withdrawals or just nerves? How many times do you need to tell a story before you begin to believe it yourself? What are you willing to lie for? And what color did he say his cat was again?
Addiction can turn you into a person you never thought you would become. One patient, who was normally pleasant, came into the office experiencing full withdrawal symptoms, begging for a new prescription and reaching the point of demand. She claimed to have flushed her last prescription down the toilet because she didn’t want to rely on the hydrocodone anymore. I tried to extinguish her fire, calmly repeating that her doctor was in another appointment and that we would get her help as soon as we could. After five minutes, the patient looked at me and something clicked; the person I knew had come back. She realized immediately that she had been acting irrationally and started crying and apologizing.
“It’s okay,” my voice cracked as she fell and hugged me. I was trying not to cry myself. Opioids got very personal for me at that point. My position not only increased my exposure to the problem, but it also changed how I empathize, and suddenly I was feeling for all the patients involved.
Opioid addiction is a widespread problem, but it is only one of the many measured addiction rates growing in our country today. In a world that is trying to find blame for these epidemics, medical doctors are an easy target. But after working with eight different M.D.’s and PA’s, I don’t think I could rightfully put the blame on them. Once, I sat with the head doctor of the office and listened to him talk about a patient like someone might talk about their own child. He personally fought an insurance company to get coverage for one his patients’ medication, detailing a tapering plan to help get her off opioids and to a safer treatment. This wasn’t a person handing out prescriptions like tissues.
I like to imagine solutions to the opioid epidemic though I understand that there really isn’t just one. I’m treading water trying to find a solution for something that might simply be a part of the human condition: we all want to feel good. Maybe the real culprit is just biology. Maybe there’s no real culprit at all. However deserved our targeted blame may be, it doesn’t seem like accusation is solving much. As a medical assistant, I grew to love the patients I worked with, and I like to consider the possibility that they grew to love me. These people who are considered “at risk” for addiction were mostly average people: a well-dressed lady you might see at the grocery store, a college dance professor, a shy custodian, or your next-door neighbor. My perspective started to shift during my time at the clinic and I realized that there were no clear answers around this seemingly endless debate.
One of my favorite doctors, probably the most passionate in the office, pulled me aside on my last day of the job and gave me a speech about the work I had done there. He wanted me to remember the experiences I had had in that office. “You have connected with these people,” he told me, “and that is an opportunity not many involved in this issue get.” And this is true. I have thought back to the person I was before this experience. I have seen the ways I changed in relation to the issue. I still don’t know what the best solution for the epidemic is. I’m not sure that anyone has that answer. What I do know is that compassion to all involved will be more effective than conflict or blame. Sometimes I feel like I have nothing to add to the fight because I can’t fully relate or because I am just one person, but the one thing I can do is be aware. I can take control of my body. I can educate. And I can empathize with all those involved in the same fight.