Report — From the April 2018 issue

The Pain Refugees

The forgotten victims of America’s opioid crisis

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The night after the patient meeting, my last in Great Falls, Sell invited me over to the house he shared with his mother and children. On the way, I stopped at a red light and noticed, looming above me, a billboard I’d passed several times that week. It showed a ponytailed Native American man holding a framed photograph of a teenage boy — his younger self, presumably — standing beside a smiley, elderly woman. end prescription drug abuse, it read. watch real stories from montana. The message was paid for by the Montana attorney general’s office.

When I rang the doorbell at Sell’s rental duplex, it took some time before he appeared, grimacing, greeting me with a feeble handshake. I followed him inside. Built in 1904, the clapboard home contained three tiny bedrooms but hardly any storage space, which explained the living room clutter: toys and laundry hampers and several makeshift wardrobes. Sell limped his way over to the sofa, rearranged an assortment of pillows for his back and legs, and gingerly lowered his bulky frame. He made room for me next to him; the kids played on the carpet across the room.

I mentioned the billboard, and asked whether he thought such messages were unnecessarily alarmist or overblown, as many in the pain advocacy forums had suggested.

“I don’t think so,” he replied. He had seen the ravages of addiction firsthand — relatives on his mother’s side of the family, friends who had struggled with heroin and crack cocaine. And there was truth, he said, to what people were saying about pain pills; until recently, it wasn’t hard to get your hands on them. In the waiting rooms of walk-in clinics and emergency rooms, he had seen men and women who appeared perfectly fine until their names were called, at which point they feigned a pained expression. Minutes later, they walked out with a prescription. He told me about Cody Evans, his sister’s ex-boyfriend, who, at nineteen, died after a Great Falls woman sold him six methadone pills for forty dollars; she was subsequently given a twenty-year sentence for negligent homicide. “So, no,” he said, “I wouldn’t deny that there’s a problem here.

“But can’t it be possible,” he added a moment later, “to tackle addiction and care for those who are in real pain? Can’t we do both? Why do you have to harm some people in order to help others?”

Marc Mentel, the chair of the Montana Medical Association’s Prescription Drug Abuse Task Force, voiced a similar thought when I spoke with him. In the name of saving lives, the Missoula-based physician said, “I worry that we may be throwing the baby out with the bathwater. But suffering is suffering.” Untreated pain and opioid addiction, he noted, have a great deal in common. They both tend to be accompanied (and exacerbated) by conditions such as depression and post-traumatic stress — and both are rampant in areas with the fewest resources to deal with them. He referred to it as a perfect storm of scarcity: a lack of access to addiction specialists, a lack of mental health services, and a lack of the knowledge and the wherewithal to effectively treat chronic pain. Throw in poverty and joblessness, and the vicious circle becomes apparent. As a society, we’ve found it easier to dismiss pain patients as addicts, and to regard addicts as criminals, than to confront the tenacity of these American maladies.

This neglect is continuing apace under the Trump Administration. In January, the attorney general, Jeff Sessions, announced an impending “surge” of DEA arrests targeting providers whose prescribing patterns seemed excessive. As with similar crackdowns in recent years, however, there was no mention of a plan to offer support or treatment to their patients. What would happen to them? “Part of the reason we got so enthusiastic about the prescribing of pills — not just opioids, but many others as well — was because we didn’t want to deal with complex human needs,” said Stefan Kertesz, the professor at the University of Alabama. “So is it any surprise that we’re now trying to get out of this crisis by controlling pills, instead of building systems of care that will attend to those needs?”

In Sell’s living room, I asked him what his immediate plans were. He had just been hired at Teriyaki Madness, a local fast-food restaurant, and he was nervous about standing at a hot grill for hours on end. But his family needed the money; Mitchell was already working three part-time jobs to help support them. He hoped, he told me now, that he could someday return to college. He hoped that becoming a physician assistant might still be in his future. He hoped a lot of things — and that, he felt, was exactly what he needed not to do.

“I think most people in the patient group, the majority of them, they have a false hope. They think that life is going to go back to what it used to be. But I don’t see that happening. I guess I’ve come to terms with the fact that this is what life is going to be like.”

“Which is what?” I asked.

“Which is that I’m not going to get the help I need. I’m not going to get treated the way that I was with Rod. Benefis is not going to change.” He told me that as in the months following his injury in 2011, he had begun experiencing the pain as a total, crushing presence. “It sounds crazy,” he said, “but I’ve almost started looking at it like it’s a real person — like there’s this abuser standing over me, tormenting me. It completely controls me.”

The very worst part, he said after a long pause, was seeing the toll his pain was taking on his children. He explained that Isaiah, his five-year-old, had been especially affected by his mom’s leaving, and a few mornings earlier, still half-asleep, had grown distraught. “Do you have any idea,” he asked, “what it’s like when your son needs you to comfort him, he needs you to pick him up, and all you can tell him is, ‘I’m so sorry, I just can’t right now’?”

Sell excused himself and stepped outside for a cigarette. From the couch, I glanced at him through the window. He was barely visible despite the porch light.

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’s most recent article for Harper’s Magazine, “A Prayer’s Chance,” appeared in the May 2017 issue.

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