I have a good, nay, a great, friend who is a chemist. She does work that impacts/has relevance for the drug industry. We are argue about physiology and drug impact on physiology a lot, although neither of us exactly works in that field.
Part of what I know is from my own experience. A little less than 10 years ago I was very sick. In the hospital twice, once to figure out what was wrong (a massive rare infection in bone) and a second time to repair what the infection did (eat away significant parts of bone that were critical for my ability to... well, do anything). The pain, originally and then following surgery, was excruciating. 11 on the scale to 10. I was unable to do anything but lie there and moan.
The docs put me on Oxycodin/contin. In the hospital I had one of those button thingies, but at home I took pills. I was taking very large doses when I left the hospital the first time. The pain was under control, so it became important to me to Get Off the Drugs before I had surgery, which was about 2 months later. I started gradually which was hard, but going ok.
One day, about 2 weeks before the surgery, I decided to just stop. It was a mistake. My BP dropped to about 80/50 and I passed out. Luckily, my partner was there, took me to the ED, where I got an IV and a long lecture on going cold turkey. This lesson learned, after surgery, I set a schedule (I still have the little notebook where I kept track of times), and spent a few weeks watching the clock, several times each day, till I could take another pill.
The oxy did not give me a high. It did not make me feel like superperson, or anything like that. All it did was keep me from feeling the pain from the surgery, which involved significant metal implants, and transplant of bone to the metal and the place where the bone came from and the muscles that had to be cut to get to the place bone had been eaten away by infection. Yeah, I was a mess. And it kept me from feeling the pain of withdrawal from not having oxycontin in my system.
I remember sitting there, looking at my notebook, wanting a pill, hoping I got the time wrong, hoping that I could take another pill, realizing, no, I could not. I would go and walk for 2-3 minutes, which is all I could do, and sit back down. By my own, pre-illness standards, I would stop and think how pathetic I was. And then I'd look at the clock again.
But I was motivated. At the time, I had a job loved (albeit with the chair from hell), I had a partner who loved me. I did not have financial worries, or children to take care of. I had great friends. I had lots of stuff that made life very worthwhile for me, and very little about which I was worried that was urgent. I was motivated. So I could wait, and stare down the clock, and took a pill with relief on the schedule of reduction. It did not bring me above baseline, but it erased the cravings, it erased the pain.
As time went on the pain receded, and the time between craving became longer. I could walk for 20 minutes, and get myself a glass of water without shaking like someone with late Parkinson's. I rehabbed myself, and it is without question, one of the hardest things I have ever done.
How hard? Harder than writing a thesis, getting NIH funded, training for the swim leg of a triathalon, planning a wedding, planning a funeral, having a baby. But those things? They are all positive, improvement-things. They are things that when done, there is an accomplishment. Healing from surgery, from the drugs, etc? That only brought me back to baseline, and honestly, it was a baseline that hasn't ever been quite where I was before this happened.
(btw- no one ever figured out how I got the infection. probably walking through the hospital. but it didn't really matter in the end)
So, when the self-righteous talk about "getting off drugs", especially with respect to the current pain-killer crisis, I want to ask if they've ever been there. Do you know what it feels like to look at a clock, waiting to take a pill to end the need? Have you ever had pain that keeps you from thinking, and then the drugs to make thinking possible again, knowing that those drugs are really not very good for you?
My wonderful friend talks about addiction to food, to sugar, to salt. And I say: that's not the same thing at all. Of course we are addicted to food: we die without it. But denying oneself sugar can be hard, and it can make you grumpy and you can feel the need, the desire, and the craving for it. But it is not the same thing at all as what Oxycontin feels like. And certainly, that craving and withdrawal are not the same for the rest of your (non-mind) body.
And for those people struggling with addiction: I had everything going for me when I stopped. I can imagine if one of those things wasn't in place: the partner, the job, the security of belief that my research was important (delusional as that may have been), let alone the security of knowing I could pay my bills, that I had good health insurance, a roof over my head. If any one of those things was not there, I might not have made it clean.
I had a big bottle of pills, that I kept for years, just in case the pain came back. I was never ever tempted to take. It's not because I object to feeling good. I drink wine, and beer, and a cocktail now and then. And it's because I don't hurt. I do hurt, it's just not like it was then. The oxycontin didn't make me feel good. In the beginning it kept the pain at bay, and then it didn't just keep me from feeling bad, I took it because I had to.
The answer the "addiction crisis" right now may partly lie in restricting access to the drugs, more reasoned and thoughtful scrips to people in pain. It certainly does not lie in stricter prison sentences, which will only give us very ill people going through withdrawal and possibly dying in jail. It lies in looking at the lives that people in pain live, and figuring out how to give them the reasons for getting off the medicine. It means figuring how to deal with that craving that really has nothing to do with getting high, and everything to do with the cold hard reality of the physical legacy of pain medication.