A Jagged, Bitter Little Pill to Swallow

Pain is designed to scare us.

It’s a warning that we’ve been hurt — a red flag that something isn’t right.

Though it’s a universal human experience, it’s also so individualized that we can never really know how someone else feels in it. Most of us desperately want to avoid it.

I’ve been thinking a lot about acute and chronic pain since my mom broke her arm last month. After a complicated surgery to repair her fractures, the surgeon prescribed opioids to deal with the pain. This is standard medical protocol.

But anyone who has paid attention to the country’s opioid crisis may wonder about the safety of taking these painkillers. In a Morbidity and Mortality Weekly Report published last spring, the Centers for Disease Control and Prevention estimated that more than 51 million people — more than 20% of U.S. adults — have chronic pain, and that 17 million — almost 7% of adults — have high-impact chronic pain (pain that limits their activities most days, if not every day).

Chronic pain is more common among older adults than any other age group. And yet their treatment options come with significant risks, including addiction to pain medication.

The billionaires sitting atop America’s empire of pain are the Sackler family, owners of Purdue Pharma and the highly addictive and wildly profitable drug OxyContin.

The hyperaggressive marketing of Oxy contributed to a devastating and worsening national epidemic. From 1999 to 2021, nearly 645,000 people died from an overdose involving opioids, including prescription and illicit opioids, according to the CDC.

In December, the Supreme Court listened to the government’s objection to a multibillion-dollar bankruptcy settlement with Purdue Pharma, in which the company would be restructured as a nonprofit to address the public health crises created by the epidemic.

Members of the Sackler family agreed to contribute up to $6 billion to the plan in exchange for immunity from future civil liability for opioid-related claims. The Sacklers want to protect the $10 billion moved to offshore accounts in the years leading up to Purdue Pharma’s bankruptcy. (Sackler lawyers say more than 40% of that went to pay Purdue’s taxes.)

The Supreme Court will decide later this year whether the Sacklers get this shield of immunity and remain one of the wealthiest families in the world.

In a sane society, a high court would be deciding if the Sacklers ought to rot in prison.

In a 2021 story for The Bulwark, writer Saul Lelchuk asked if the Sacklers were “the most evil family in American history.” He argued that the Sacklers caused more widespread harm to America’s social fabric — and correspondingly, more American deaths — than any other single American family in history.

That ought to win them the title.

I asked an older reader who lives with chronic pain to describe what it’s like trying to manage it with opioids. Until recently, he had been functioning while taking a painkiller called tramadol. But he thinks he may have fractured his back, which caused his pain to spike, and now his doctor has prescribed oxycodone — a much stronger opioid.

“Taking sufficient painkillers to reduce (not eliminate) the pain means I do not think clearly unless I make a special effort, on even the simplest of chores, to ensure I am doing it correctly,” he wrote. Every act of basic living, such as balancing a checkbook or putting the groceries away, requires extra attention.

It’s more mental stress on top of the physical stress.

“And being spaced out or snarling in pain really doesn’t help my relationship with my wife,” he added.

The most disturbing part of his account described how little the medication was helping him improve.

“Unfortunately, the pain keeps increasing, and as it does, my dosage amount gets higher,” he said. “The worst part is it is not a pleasant ‘high.’ It just makes me drowsy, and I sleep for two or three hours until the pain wakes me up again. The cycle is somewhat vicious — pain, increasing pain, drugs, sleep, wake up to pain, increasing pain.”

The last thing I want to do is scare my mother about the risks of pain medication while she’s still reeling from post-surgery pain. She’s well aware.

All the doctors can offer her is this double-edged sword.

Meanwhile, the Sacklers await their shield of protection.