Can we have nuanced opioid reform?

When the medical examiner's report revealed that Prince died of an overdose of the powerful opioid Fentanyl, it worried me. A national conversation about curbing the growing opioid painkiller abuse epidemic has finally bubbled up to the congressional level and the last thing that conversation needed, I thought, was a high-profile celebrity death to stir emotions.
Emotional appeals seem to have become more a feature of government in recent years. They're effective politics, because they spur action, but they're not always great for making careful, nuanced policy. Based on personal experience, I think that's what the opioid epidemic needs.
I have a complex relationship with Fentanyl. I'm deeply grateful for it, but also kind of scared of it.
The first time my mom went and filled a prescription for my Fentanyl patch after I was released from the hospital following my meningitis-related brush with death 12 years ago, the pharmacist said "He's been on this awhile, right? Cause if you just started him at this dose, it could kill him."
Indeed, I had been on Fentanyl for awhile at that point. About four months, actually, while hospitalized with the bacterial infection that caused horrific damage to my limbs. It was Fentanyl that got me through the trips to the "tank room" where wound techs and a plastic surgeon sliced off layers of dead tissue on my arms and legs until they bled — the signal that they had reached living tissue that could be saved. It was Fentanyl that allowed me to rest when I woke up racked by post-surgical pain after amputations of my fingers and toes.
I had a port in my neck where nurses would inject the painkiller directly into my bloodstream. No matter how much pain I was in, that shot was accompanied by an immediate wave of warmth and all my tensed muscles went limp. For me, it was a wonder drug.
I didn't ask any questions at the time. I was just grateful for the pain relief. But my parents were concerned from the beginning about the possibility of me getting hooked.
When they asked the pain management specialist about it, she was adamant that as long as I was taking it for legitimate pain relief, there was little chance of dependence. It would be after the pain had subsided that they would have to watch me carefully.
By the time I left the hospital I was in the process of being weaned off. The injections had been replaced by slow-release Fentanyl patches, which in turn would be replaced by little Fentanyl-laced suckers. Yes, suckers, like candy.
And then it was time to go off those too. My wounds were not completely healed, but they were more garden-variety, surface-type injuries and the pain was manageable with less extreme meds.
I had taken the painkillers as directed and was weaning off them properly, under a doctor's supervision. And yet those first couple weeks without any Fentanyl at all were kind of miserable. It wasn't so much that I was in pain. It was that I just felt sapped, fatigued, without any motivation to even get out of bed in the morning.
Those days passed and I eventually felt like myself again. But I had gotten a window into how easy it would have been to get hooked. To go drug-seeking, if I had been more mobile and under less parental supervision. To look for another doctor who would prescribe me more Fentanyl. To substitute something less regulated but similarly opium-based, like heroin. Scary.
So when people say we need to rethink the ease with which patients get opiates and the amount they get, I think back to those days and tend to agree with them. But then I think back to those days in the tank room and find myself hoping that the regulatory pendulum doesn't swing too far in the other direction, because these drugs really can make life tolerable for people who are experiencing intense suffering.
Clearly, when people who have a history of drug abuse and aren't trying to hide it get prescribed opiates with hardly a word of warning or a plan of action, there's a problem.
But by the same token, not every patient's pain can be effectively managed with harp therapy or trigger point injections.
So we need to have a really thorough, nuanced policy discussion before we make new regulations. That's the way to honor Prince. Here's hoping we're still capable of doing that.