Two letters have appeared recently in this column underlining the benefits and dangers of opiates for pain relief. In the first letter, a concerned mother wanted her child to stop suffering needlessly, regardless of his addictive history. In the second, a wife described her efforts to protect her husband and family from the same nightmare of addiction they have fought and survived before, regardless of the physical pain they suffer. Both are important and legitimate concerns, and together serve as a metaphor for mankind’s struggles with pain. And that history is defined primarily by the opium poppy.

First cultivated by the Sumerians in 3400 B.C., the opium poppy’s first name was Hul Gil – “the joy plant” – obviously named by someone never addicted to that particular form of joy. In the intervening 5,400 years, wars have been fought (First and Second Opium Wars) and vast fortunes were made, legally and illegally (some of America’s oldest and wealthiest families benefited from the joy). During that period of time, which is the history of civilization, millions of people have been helped by its pain-reducing capabilities, while others have been enslaved by its addictive nature.

Morphine was developed from opium and became more useful to both doctors and recreational users because it had fewer side effects, a powerful marketing concept that continues to be used today. Bayer, the aspirin company, developed heroin from morphine in 1895 and provided it to morphine addicts who were trying to give up their habit. Again, it was said to have fewer harmful side effects. Curing opiate addiction with a better opiate repeats itself today with methadone and now suboxone.

The joy plant has proliferated into synthetic opioids such as codeine, OxyContin, fentanyl, etc. The only common alternative class of medications for pain control are the non-steroidal anti-inflammatories such as aspirin and ibuprofen, but they are considered – get this – “less safe” because chronic use can damage the stomach and liver. However, no one ever lost their soul to ibuprofen.

A number of physician practices now have very specific protocols for patients who require opioids. Adam Lauer, M.D., who has a practice in Brewer, described a series of steps he believes constitute “best practice” for noncancer pain patients who need pain medications. Dr. Lauer requires these patients to sign a contract that specifies certain behaviors in order to continue opioid prescriptions. Patients may not ask for refills on the weekend. They must use one and only one pharmacy. They must submit to random urine tests. They may receive one and only one early refill. They must be willing to bring in their pill bottle if they are contacted to do so. All of these requirements guard against strategies addicts have used to procure the drug illegally.

Physicians have gone to prison because they were duped into providing prescriptions to drug dealers who sold those medications to addicts. They must protect themselves and their practices, as well as the community into which these medications enter. They’re not punishing pain patients who have addictive histories.

As long as the joy plant continues to sing its song of heavenly deception, there will always be those who listen – and there will always be some who seek to profit from their suffering.

The Bangor area is creating addicted young people at an alarming rate. Seven hundred patients now receive methadone at the Acadia Hospital clinic, and a second program is just getting started. The illicit use of prescription medications is as much the driving force of the addiction explosion as illegal drugs. Perhaps its time to ask the patients to become as responsible as the prescribers for these medications. Responsibility for one’s choices is always an important component of recovery, whether pain or addiction is the problem.

John Keefe, Ph.D., is a clinical psychologist in private practice in Bangor.

Please join our weekly conversation about Maine’s substance abuse problem. We welcome stories, comments or questions from all perspectives. Letters may be mailed to Bangor Daily News, P.O. Box 1329, Bangor 04401. Send e-mail contributions to findingafix@bangordailynews.net. Column editor Meg Haskell may be reached at (207) 990-8291 or mhaskell@bangordailynews.net.