I walked into my bathroom feeling the wet floor. I traced the source back to a toilet overflowing with a neon green T-shirt lodged in it. The T-shirt failed to evacuate into the nexus of sewage. My 7-year-old son hates the T-shirt. Having watched for years foul things disappear when flushed down the toilet, he attempted to rid himself of something he disliked. It failed and the toilet overflowed.

I called my son over and looked at him. He was picking at his fingers and on the verge of two worlds; one of self-loath and one of defense.

I snapped and angrily cleaned up the mess. When I calmed down, I thought about what I failed to do. I guess I failed to tell him that the toilet wasn’t the answer to distasteful things and that not everything can or will or is meant to be flushed down the toilet.

The problem with opioid addiction may be so fundamental we are missing the mark. It’s not a blame game. It’s a social failing that humans can’t cope with suffering well and we assume they already know how addiction works.

It starts at times with innocent dealings with real pain. It starts at times with desperate need for escape from intangible pain. It materializes always in the grips of a force that can’t be reconciled without amnesia or higher power or more social support.

Let’s be then very clear.

1. Suffering happens. It’s a fact of life. If you have physical pain, you deserve some relief if it is unbearable. You deserve definitive remedies if available or limited use of pain medication. If you are in mental anguish, you deserve to be heard and held. If thoughts torture you then perhaps we can help control those thoughts that now are harmful. Pain medications don’t control thoughts. They deaden them.

2. Use of pain medication will beget desensitization. Meaning, as you use narcotics over time, you likely with have less effect for less duration. Use the least narcotics needed for the shortest duration.

3. Any “sleep” you get on narcotics isn’t sleep. You are likely sleepy and then unconscious. Poor sleep is a rampant complaint, and the risk is great that once someone “sleeps” while using narcotics they get addicted to the idea or experience of being “asleep” by or with narcotics. “I have to take a Percocet at night to sleep,” are dangerous words of addiction. Expect as a human to not “sleep” in blocks of 4 to 8 hours. Try to explore better life balance and sleep hygiene or even better diet and exercise before succumbing to the perceived blessed rest of pain medications and drugs.

4. Unconsciousness does not solve problems. Checking out to not feel or worry or stress does not flush your problems away. It floods the bathroom with sewage. Many things in life are hard, if not impossible. Look for solutions even if initially it looks like setbacks and invest in a long-term plan bravely. Humanity will champion those that try.

5. Don’t justify the lack of prescription drugs for the need and use of heroin. A growing sentiment is to blame heroin usage as the eventual result of a narcotic addition gone full bloom. I have heard increasingly people state their heroin addiction was the end result of either not being able to get more narcotics or because of an increasing need for the same escape they can no longer achieve with narcotics. Don’t go there. Heroin is a deep well you will not escape easily.

6. Once you are addicted, you are always addicted. No one can be rid of the idea that an easy fix is around the corner without amnesia, a higher order, or so much social support you no longer live a truly independent life. People become addicted to a memory of ease and a need to realize it. Life’s purpose become chasing the white rabbit or the promise land. Neither exists. It is just a lie and will consume you.

7. Don’t assume people know these truths. We didn’t tell them and so we should.

Your pain is real. Your pain is human. Your pain can’t always be addressed. You will always have some pain. You need to use pain medications with awareness and responsibility. You can get addicted. Addiction happens because we don’t think we are vulnerable or no one has told us what we get addicted to. “Sleep” and unawareness or not caring feel like freedom. They are not true solutions or even escapes. Once addicted you will need help to come clean and stay clean. The toilet does not flush all problems away, and there will be a huge mess if you try to use a toilet that way. When the mess is actualized, society will stand as the parent cleaning up sewage and feel both responsible and angry. The child will stand unsure with self-loathing and defensive.

8. Let’s fix a problem before it floods the bathroom by talking about how we got to this dilemma really. Stop blaming the possible players in an evolution of tragedy. It doesn’t complete the picture really. Doctors didn’t create patients. Doctors didn’t create demand. Doctors are humans and for the most part just tried to help relieve pain.

9. The pain of addiction is all our faults. We are all vulnerable to seeking and wanting and feeling a need for things that we think feel great.

10. Don’t get defensive if a health care provider mentions these tenets. The immediate reaction is to feel insulted like a child. It’s a public service announcement because maybe … We didn’t ever say what a toilet is for, how it works, and what happens when you try to flush inappropriate things down it.

Jean Robey is a nephrologist who blogs at ethosofmedicine.

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