The death of the New York Times journalist, Sarah Kershaw, reminds me painfully of too many conversations I had with my patients during the course of my career as a pain doctor, about whether or not they wanted to live.
During the 30 years of my practice, countless patients told me they had no hope for a life without severe disabling pain and would, therefore, prefer to die. I believed them.
The CDC reports there are 44 deaths per day that involve opioids, but there are more than 105 deaths per day from suicide. An undoubtedly significant (but uncertain) number of those suicides can be attributed to people with severe pain.
Suicides, by the way, come in at least two variations: active and passive. Active suicides intend to commit suicide and usually plan it. Passive suicides happen without premeditation by a person who finds it acceptable that her behavior might lead to death.
Of the opioid-related deaths, it is not clear how many either are active or passive suicides yet, are not counted as suicides.
The Misery of Chronic Pain
My patients often expressed to me that death seemed to be the only way out of the misery of pain. I often felt the most important role for me, even when I couldn’t relieve my patients’ pain, was to give them hope.
But, reality often trumped my best intentions. After living for years with little improvement of their pain, some my patients found it hard to sustain their hope, regardless of my efforts.
Here is where the intersection of relieving pain and preventing harm from opioids exists.
I always warned patients that, if they took more painkillers than I prescribed, they might not awaken. More times than I care to remember, after I said this, my patient would look me square in the eye and say with complete sincerity, “That’s okay, doc. It would be better to die than to live with my pain.”
Through the years, I had patients who died from suicide. Some used a gun. Others used the pain medications I prescribed.
It was never easy to prescribe an opioid to someone who had such intense pain that she wished to die, but, often, there was no alternative unless I ignored the person’s need to mitigate the pain.
I worried whether the medicine I prescribed to help my patient get through days and nights of horrific pain would be used as I directed, or whether it would be used to enable my patient to escape a world of suffering.
I could never be sure, and it was a constant source of stress and unhappiness for me. To an extent, it was beyond my control. As a physician, I had to give my patients something to enable them to survive with pain. Yet, as a human being, I had to deal with the fact that the pain medication might be used when the patient could no longer survive with that pain and had lost hope.
Whether opioids are a reasonable treatment for people with disabling non-malignant chronic pain will continue to be a subject for debate, but there should be no debate about one thing:
People with chronic pain should not view suicide as their only option for relief. We have to do more to prevent tragedies like the death of Sarah Kershaw from ever happening again.
Purchase my book The Painful Truth: What Chronic Pain Is Really Like and Why It Matters to Each of Us (available on Amazon) or read a free excerpt here.
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Copyright 2016, Lynn Webster, MD