What 'This Is Us' Misses About Chronic Pain and Opioids

Sometimes the news isn’t as straightforward as it’s made to seem. Erin Migdol, The Mighty’s Chronic Illness Editor, explains what to keep in mind if you see this topic or similar stories in your newsfeed. This is The Mighty Takeaway. 

The opioid crisis has found its way into the Pearson family.

The second season of the hit NBC tearjerker “This Is Us” began earlier this fall with Kevin Pearson (Justin Hartley) getting the big break most actors dream of: a part in a movie opposite Sylvester Stallone. But after injuring his knee while filming an action sequence, Kevin turns to opioids to kill the pain — both physically and, as it quickly becomes clear, emotionally as well.

In the last few episodes, we’ve seen him washing down pills with alcohol, frantically calling every doctor he’s ever had asking for a refill on his prescription, forging a prescription for fentanyl, dealing with withdrawal symptoms and sabotaging his relationships. “Kevin, you’re spiraling,” Kevin’s ex-wife Sophie says worriedly.

As viewers have come to expect from the show, “This Is Us” tackles Kevin’s opioid addiction with sensitivity and grace. Some viewers may even recognize Kevin’s struggle among their own family and friends. His anguished cry, “I am in pain here… I just need somebody to help me” during last night’s episode was heartbreaking and beautifully captured the emotional turmoil of his addiction. 

Kevin’s story is an addiction story you may have heard before. In fact, you’ve probably also read similar stories before, straight from today’s headlines about the opioid epidemic. It’s hard to scroll through Facebook without seeing a story about real people who have also spiraled from using opioid painkillers to abusing opioid painkillers, to eventually turning to heroin or fentanyl. It’s scary, it’s a real problem that needs to be addressed, and Kevin seems to be in danger of heading down that exact path.

But there’s another side to the opioid issue “This Is Us” and the rest of the media isn’t showing — the side of the chronic pain patient, and how stories like Kevin’s can have a real-world impact on their quality of life.

The fact is, the majority of people who use opioid pain medication don’t follow Kevin’s trajectory.

In 2015, 92 million people received a legitimate prescription for an opioid painkiller, according to the National Survey on Drug Abuse and Health. But just 2 million people met the diagnostic criteria for an opioid addiction. Studies indicate only around 8 to 12 percent of people using opioids long-term develop an addiction.

Politicians often bat around the shocking statistic that 80 percent of heroin users start with prescription opioids, but it’s important to balance that with this statistic: 75 percent of all opioid misuse starts with medication that was not prescribed to them. That means they’re not simply ill or injured and addicted to what they were given; they’re actively seeking out medication on their own. The majority of people who are were prescribed opioids take it without developing an addiction.

And yet, the opioid narrative we usually see is one of addiction, like Kevin. Politicians and newspaper headlines focus on the number of deaths from opioids and the towns ravaged by prescription drugs and heroin, without noting that statistically, most people prescribed opioids don’t become addicted. TV shows, like “Brothers and Sisters” and “This Is Us,” tell the stories of those addicted to painkillers instead of those who use them responsibly in order to live with chronic pain. 

When society’s only representation of opioids is that they lead to addiction, millions of people with chronic, incurable conditions that cause debilitating pain, like fibromyalgia, ankylosing spondylitis and Ehlers-Danlos syndrome, ultimately suffer. Suddenly, society looks at them as if they’re addicted to their medication, too. They’re questioned in doctors’ offices and refused in emergency rooms when they ask for pain relief. Even though they already sign contracts and submit to random drug tests to ensure they’re taking their medication as prescribed, politicians have enacted laws that limit the amount of opioids doctors can prescribe, leading to patients’ dosages being cut and their pain levels to rise.

To be clear: Kevin’s story is important to tell. It’s true that opioids have become the “drug of choice” for many people, the way it is for Kevin. Doctors should be making sure they’re prescribing opioids responsibly. And the side effects, risk of addiction and fact that they don’t work effectively for every person and type of pain, are all worth keeping in mind as we work through the opioid crisis and hopefully find more pain relief options.

However, when the only story about opioids being told is one of addiction, it leads people to believe that in order to solve this problem, we need to get rid of opioids, full stop — that opioids are the problem, and no one truly needs them. That, in turn, makes it that much more difficult for the people who are being treated successfully and responsibly to get the care and quality of life they deserve. And when I say “quality of life,” I mean literally being able to have a life — to get out of bed, play with your kids, even hold down a job — not to “get high.” Kevin’s life is falling apart thanks to his opioid use, but for many chronic pain patients, responsible opioid use helps them get a least a little bit of their lives back.

So, as Kevin battles his opioid addiction this season, here are three things people should keep in mind:

1. Remember that other factors, besides the fact that he was prescribed opioids after his knee surgery, contribute to Kevin’s addiction, like family history, his own issues with alcohol, and his emotional pain.

Kevin’s father, Jack (Milo Ventimiglia), struggled with alcohol addiction, and Kevin frequently flashes back to his childhood before taking pills. His sister, Kate (Chrissy Metz), even looks at her father’s ashes, in an urn on her bookshelf, and remarks, “He’s just like you,” referring to Kevin while he’s shown taking pills. Kevin also drinks frequently, enough to lead Sophie to question why he’s downing a beer before a formal event. He’s never quite recovered from his father’s death or losing his football career, and is struggling to deal with his grief.

Yes, Kevin was prescribed opioids after his surgery, and yes, he has started to abuse them. But we need to remember that addiction is about more than just the drug itself, as “This Is Us” actually portrays quite well. Any attempt to understand the opioid crisis needs to acknowledge other factors that lead to (and correlate more strongly with) addiction, like age, mental health, issues with other substances like alcohol and family history.

2. Most chronic pain patients who use opioids do not go to the lengths Kevin goes to in order to get them, and have tried other pain relief options.

Kevin calls up past doctors and asks them to refill his prescriptions in order to get more pills and even forges a prescription himself. However, many people using opioids long-term sign contracts that stipulate they can only get prescriptions from one doctor, or else they risk being cut off completely — not to mention the fact that chronic pain patients are law-abiding like anyone else. When you encounter someone with chronic pain who is taking opioids, remember that they likely aren’t forging prescriptions or doctor-shopping; they’re taking their medication as prescribed from a doctor who is helping them manage their pain (and may even be forced to make do with a lower dose than they originally got, thanks to new laws that limit opioid prescriptions).

Chronic pain patients also usually try multiple pain relief techniques before and while receiving opioid medications. Opioids are most often a last resort, after other drugs and alternative methods like physical therapy, yoga, massage, and diet have failed or are not covered by health insurance. So for Kevin to turn to opioids only (and even reject Toby’s [Chris Sullivan] suggestion to follow RICE, or rest, ice, compression, and elevation) is not common among chronic pain patients.

3. Ultimately, Kevin does not represent everyone who uses opioids, but believing he does can cause real harm.

In terms of addiction, Kevin’s story is presented thoughtfully and sensitively, and it’s commendable that such a popular show is taking on an issue so many families are dealing with right now. Hopefully, representations like this can help reduce the stigma of addiction and make it easier for people to get help, and for their families to understand what they’re going through. But Kevin represents just one side of the issue, and it’s crucial that viewers, lawmakers, and medical professionals don’t assume all people who use opioids are abusing their medication like he is. That perception leaves chronic pain patients as collateral damage in the war on opioids and makes it harder for them to get the pain relief they need.

So the next time Kevin takes an opioid on “This Is Us,” remember there are millions of chronic pain patients hoping their treatment and quality of life aren’t hurt as a result.

Opening photo courtesy of YouTube