Becoming-Curiosity: The Opioid Crisis is more than just a matter of Opioid-Induced Hyperalgesia.

Much of the evidence supports the view that opioids when used under close monitoring, treat acute pain and are to be taken over the short term. I understand the oral administration of opioids is no longer than 15 days within a 3-month period. Undoubtedly, there is limited evidence to support opioid use in the treatment of chronic non-cancer pain, which ultimately can perpetuate persistent pain states, something called opioid-induced hyperalgesia.

What I am particularly interested in is the historical and resultant socio-political and economic determinants that have led to the opioid crisis. Historically, the impact of western medical practices born out of the period of the enlightenment has distorted the understanding of generations through the concept of the “killing of pain.” (Illich, 1976). Medical enterprises (driven by neoliberalism) control the experience of pain through the offering of medication, surgical treatment, and other medical practices. Concurrently, it disregards the individuals’ will to suffer their reality. The phrase “pain is inevitable, suffering is optional” became popular in the early 2000s, which invalidates the individual and denies their will to suffer. Through the killing of pain, there is no reason to suffer.

When I refer to the killing of pain I don’t only refer to the medical impact, I also refer to societal and psychological impacts. It is taboo in society to live with pain because it is expected that the treatments we have eliminate pain, thus when a family member suggests taking some medication or a neighbour suggests going to see a healthcare professional for a minor ache, this perpetuates the concept of the “killing of pain”.

The shift from biomedicalism to biopsychosocialism is an attempt to resituate healthcare into a position of holism and to understand the wider social, emotional and spiritual aspects of healing. However, biomedicine has occupied these areas through the use of medication to treat mental health issues perpetuating the dominance of biological determinism and reductionism. Naturally, we cannot disregard the fact that there are societal rules, norms, morals, etiquette that permit us to be free in the world, yet it can also be said that through the “killing of pain” people unlearn the acceptance of suffering and, as previously mentioned, people living with pain are imprisoned by their pain because they are unable to express their suffering. The opioid crisis in my view is a wonderful example of this. Take your medication, become inebriated, unable to express any sense of coherence, and become stigmatized for being an addict, resulting in a silent suffering.

The author, Byung-Chul Han, The Palliative Society (Han, 2021), argues that society experiences an algophobia: a generalized fear of pain and that the ability to tolerate pain is rapidly diminishing. Han claims that neoliberalism has espoused an “ideology of resilience” consistent with healthcare reforms.

Where in the early 1950s the traditional biomedical idea of health, in which people were healthy for most of the time but occasionally took on a ‘sick role’ necessitating the intervention of a wise doctor, was replaced two decades later by the more diffuse neoliberal notion of ‘optimal’ health. Optimal health refers to an aspirational but also unachievable goal since no one can ever be optimally healthy.

This idea of optimal health plays into what Han describes as the ‘Mission Happiness’ of positive psychology, whereby the movement away from the psychology of suffering is replaced by a positive psychology of optimism, well-being, and happiness. He refers to the opioid crisis as ’emblematic in this context’, in which the notion of optimal health and ideology of resilience became the precursors to the administration of a ‘medication originally used for palliative medicine’ distributed on a mass scale to healthy individuals. He quotes David B. Morris (The Culture of Pain, 1991) ‘Americans today probably belong to the first generation on earth that looks at a pain-free life as something like a constitutional right. Pain is a scandal.’

The challenge to address the opioid crisis is monumental and profound. How do we address such a complicated legacy left behind by “ideology of resilience” healthcare reforms? Having left a significant proportion of the world’s population living with significant disability, dependence, and living in the shadow of stigmatization, one can only feel overwhelmed by such a crisis that goes far beyond the biological rationale of disinhibitory mechanisms, to socioeconomic and societal plight on a mass scale.

Furthermore, the issue of aesthetics as a reason for medication use may infer exactly what the biomedical model is predicated upon. The deviance of pathology ostracizes those who endure it. It separates them from the normal, and biomedicine is seen as a protagonist, controlling the pathology within the body (Fox, 2012).

Thanks for having a read

TNP / The Curiouser

References:

Fox, N. J. (2012). The Body: Key Themes in Health and Social Care. Polity Press.

Han, B.-C. (2021). The Palliative Society. Polity Press.

Illich, I. (1976). Medical Nemesis: The Expropriation of Health. Pantheon Books.