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A dose of shame in the medicine cabinet

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“Well, I take Celebrex, which is an NSAID, which means it’s like Motrin or Aleve. It’s not, like, strong or anything. And I also take a muscle relaxer, but only a really small dose, and only at night,” I say, waiting for the unasked question behind their eyes to go away.

I am an open book. There’s very little information that I don’t offer up freely to the people around me. So when I talk to people about chronic pain, in this column and in person, I’m usually pretty honest. 

Every night, just before I go to bed, I take one capsule out of the bottle. And every other night, I take one white circle out of a different bottle, line it up in the pill splitter, and cut it in half. I put them in my mouth, and swallow all at once. It’s a routine that I’ve had for years.

And yet, every time I talk about my pain medication with people, whether my conversation partner expresses skepticism or not, I feel the need to offer up very specific explanations for why I take what I take. I make sure that they know that my pain medication is in the same class of drugs as ones you can find over-the-counter. I make sure they know that my pain is legitimate, that it’s real, that I really, truly need to take what I take.

And I still split my muscle relaxers in half one at a time, every other night, as if, one day, I will wake up pain-free. I never will.

I am an open book. But behind my honesty about pain medication, behind even my honesty about living with chronic pain, is shame. 

I’m ashamed that my body hurts. And I’m ashamed of not being strong enough to cope with my pain on my own.

Dr. Brené Brown, author, social worker, and researcher extraordinaire, defines shame as “the intensely painful feeling that we are flawed and therefore unworthy of love and belonging.” She distinguishes it from guilt in this way: “Guilt: I’m sorry, I made a mistake. Shame: I’m sorry, I am a mistake.”

I don’t feel guilty when I take pain medication because I know, at least intellectually, that I am not doing anything wrong. But I feel shame because the culture we live in makes me feel like my body and I are inherently wrong. 

It’s impossible for me to talk about the shame that comes with taking pain medication without talking about opioids. Most current Duke students were born within a few years of opioid pain medications beginning to be widely prescribed in the US, and most of us were old enough to read the news in the 2010’s, when opioid-related overdose deaths—especially from heroin and fentanyl—began to make a significant impact on communities across the country. The opioid crisis is a crisis of our lifetimes. 

But the opioid crisis looks very different from previous widespread drug crises; most importantly, the “war on drugs” and the crack cocaine crisis of the 1980’s. The rhetoric surrounding opioid use is usually free from the racist language of the crack cocaine crisis and the “war on drugs” and instead expresses the need for public health interventions. This change toward concern and away from condemnation, as well as our country’s new willingness to invest significant resources in treating, not criminalizing, opioid addiction, is directly tied to the fact that many of the people addicted to opioids are white people

But even as discourse about drugs and drug use has changed, there still remains a crushing stigma attached to taking pain medication, particularly opioids. 

In popular media, the messages attached to opioids evoke danger, and to some degree, that’s justified. Opioid addiction is so widespread precisely because drug manufacturers misled doctors and patients about how addictive these drugs can be; it makes sense that public health initiatives like television advertisements are aimed at inciting shock—even fear—in the audience. 

But in our culture of individualism and personal responsibility, these narratives of visceral fear, danger and peril reveal an underlying assumption that a person addicted to opioids has done something morally wrong to end up in their situation: that they had the opportunity to be stronger or make better choices but instead chose addiction. That is a lie.

Most people become addicted to opioids because they hurt, and because they were in a situation to receive medical attention and have their pain taken seriously. They are addicted because drug manufacturers lied to the public for years about the risks associated with these medications. They are addicted because, for a long time, doctors didn’t know how dangerous these medications could be. And they are addicted in part because the very language used to try to curb drug addictions makes people feel crippling shame that keeps them from getting help. 

They are not addicted because they did something wrong. They could have made every “correct,” moral or informed choice along the way, and still be in an incredibly dangerous, life-threatening situation through no fault of their own.

In other words, someone addicted to painkillers is me under other circumstances. 

I know all too well that there is a scenario in which I didn’t get the care I deserved, in which I didn’t transition from opioids to NSAIDs after I had surgery, in which I instead became addicted to opioids. This is something that could happen to anyone.

A person can do everything right and still be in pain. A person can do everything right and still be addicted. I did everything right and am still in pain. I did everything right and still need to take pain medication. 

The myth that people who use pain medication have done something wrong is a myth that keeps people addicted. It’s a myth that makes me feel shame when I take pain medication every night. But it is just that: a myth. It depends on all of us believing the lie that we are fully capable of controlling our lives and our bodies and that any circumstance could make any human inherently wrong for existing as they are.

Dr. Brown says that the one cure for shame is empathy: “shame depends on me buying into the belief that I’m alone.” I guess that’s a good reason to keep being an open book, not just about living with pain, but about the shame that comes with it. Because as long as I tell the truth about how I hurt, the world around me will always remind me that I am not alone.

In the words of Andrea Gibson, “They're going to keep telling you are a crime of nature, and you're going to look at all your options, and choose conviction...choose to spend your whole life telling secrets you owe no one, to everyone, until there isn't anyone who can insult you by calling you what you are.”

Here’s a secret I owe no one, that I’m telling everyone: I am no crime of nature. I’m just a person in pain. 

Liddy Grantland is a Trinity senior who has been rage-snacking again. Her column runs on alternate Tuesdays.

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