There’s little doubt that an opioid crisis is in full swing in the United States. The Centers for Disease Control and Prevention reports that overdose deaths involving prescription opioids have quadrupled since 1999. From that year through 2015, more than 183,000 people have died from opioid overdoses. Half of those deaths are related to prescription opioids.

The problem is a global one, too. The United Nations Office on Drugs and Crime reports that opioids are the most harmful drug available, responsible for over 70 percent of the negative health impact caused by substance use disorders.

Still, the topic isn’t black and white. Opioids serve a purpose. The drug interacts with opioid receptors on nerve cells in the body and brain to help stop pain. They’re prescribed to help people manage pain following surgery, as well as to help manage chronic pain caused by conditions such as cancer, multiple sclerosis (MS), arthritis, back and hip problems, headaches, and more.

For people living with daily pain, opioids may be their only means to functioning for the short- or long-term, depending on their condition.

We reached out to a few people with chronic pain who rely on opioids. They were willing to share their stories. Here’s what they had to say.

43 years old from Northern Ireland, living with multiple sclerosis

Julie-Anne Gordon received a diagnosis of MS at 30 years old. Relapses and symptoms such as inflammation and pain progressed quickly. In addition to medications to treat inflammation and muscle spasms, Gordon tried several drugs to manage pain. She currently takes the opioids Maxitram and co-codamol daily.

“I am in pain from the moment I open my eyes at 5 a.m.,” Gordon says. “I have to have my medication on my bedside table to ensure I can take it while still in bed as I can’t begin to function until they have started to work.”

Gordon says getting ready in the morning is a slow process. “If I shower and have to dry my hair, I struggle with the weight of the hair dryer so I have to stop and start constantly, which can take up to half an hour,” she says.

Getting dressed isn’t any easier. She sticks to clothes that are easy to slip on and off, but requires help for putting on her socks and shoes.

Once she arrives at work, Gordon fights to stay awake throughout the day. “Work is a good distraction, though, and having people around me to keep me motivated makes a huge difference to my mood and my ability to stay focused,” Gordon says.

Still, her vision gets blurry when looking at the computer screen for long periods of time, and she takes multiple breaks just to keep her eyes in focus. Plus, urgency for the bathroom means she needs to be stationed near a toilet.

“I get so tired I want to cry, but the mortgage has to be paid and other bills, so I have no choice but to work. Without [painkillers], I couldn’t function,” she says.

“Taking opioids helps to take the edge off. That’s about as good as I can get. They enable me to be able to sit up, walk, engage in conversation, think, work, be a mum, all the things that I want to be able to do.”

Even so, Gordon recognizes that there are limits to the amount of pain relief she can be given. She admits that dependence is an issue. “It is a long, scary road, as pain relief is only ever on a short-term basis,” she says. “You start to need a higher dose to help you cope with pain as the medication becomes less and less effective, and I become more and more reliant on taking something just to get through the day.”

Side effects are a concern, too. With only one kidney functioning below 40 percent, Gordon worries that pain medication may be doing more damage, making a kidney transplant inevitable.

Without opioids, though, Gordon says her life would be in tatters.

“My family especially gets shocked if they see me without my medication, as I try to shelter them from the reality of MS and how it affects me,” she says. “The difference between Julie-Anne on medication and off medication is quite shocking for people to see. The pain medication keeps me being me, and without it, I simply become an MS sufferer and nothing more.”

55 years old from California, living with osteoarthritis

After taking a hard fall, Ellen Porter experienced moderate osteoarthritis in her hip and back for two years straight. “I went from being a healthy person who ran several days a week, to one who was in a lot of pain,” she says.

So much pain that she had to drop out of her running group and join a walking group instead.

“Because the arthritis problems did not heal quickly, my doctor asked me to quit [walking] for a few months,” she says. Her doctor also prescribed ibuprofen, Vicodin, and Norco. Porter took them three times a day at first, and then once or twice daily over a two-year course.

“They took the pain away. I found myself needing less over time as the fall injury healed,” Porter explains. “I think I quit taking the opioids long before I quit taking the ibuprofen because of the horror stories I was hearing about addictions. But now I’ve heard horror stories about how too much ibuprofen can mess up your kidneys.”

Porter also received physical therapy based on her doctor’s recommendation and sought out chiropractic treatment and yoga.

Fortunately, as a work-from-home author and marketing professional, she was able to still work following her injury due to her situation and help from pain medication. Eventually, what gave Porter permanent relief were steroids called caudal injections.

“They have mostly kept the pain away for two years,” Porter says. “If I had not had access to opioids, while I would have been in more pain, I probably would have moved sooner to the caudal injections.”

47 years old from Wisconsin, living with Crohn’s disease and fibromyalgia

After several misdiagnoses throughout her life, Rochelle Morrison finally received diagnoses of Crohn’s disease and fibromyalgia at 30 years old. Due to symptoms such as severe fatigue syndrome and pain in her joints and abdomen, Morrison went on disability shortly after her diagnosis because she could no longer continue working as an appraiser.

“It’s like if you were to put a mixer in my stomach and turn it on. That’s what it feels like,” she says of her stomach pain.

To treat her conditions and symptoms, Morrison takes Remicade infusions, Lyrica, and Cymbalta, as well as hydrocodone to manage pain. She’s been using painkillers for about seven years.

“I’m at the point where I need opioids. If I were off them, I’d literally be bedridden because the pain would be unbearable,” says Morrison. “Opioids are the only way I can have any quality of life. They are absolutely necessary.”

She says this became especially clear when she recently went off opioids after undergoing two surgeries. “I tried to manage my conditions by eating right and exercising, and I was doing OK for a while,” she says. “But then my ankles and arms got really swollen, and it got brutally painful again, so I went back on opioids.”

However, Morrison stresses that she doesn’t want to be dependent on opioids for pain control. She wants to feel better with more natural measures.

“I don’t want to just mask the problem. I know I may never be completely pain-free or symptom-free, but instead of just accepting that I have to take drugs and lay on the couch all day, I’d rather find other solutions that bring about a better quality of life,” she explains. “There are some solutions out there, like medical marijuana, that I believe will become more mainstream, but not everyone has access to these options, so we’re stuck with taking opioids.”

Morrison believes in this notion so much so that she’s attending school to become a health and nutrition coach. In this career, she hopes to act as a liaison between pharmaceutical companies and doctors to help get people off opioids.

“In my heart of hearts, I do believe if we had more information on how food and ways of living can help with conditions like Crohn’s, rather than just relying on prescriptions, we’d be much better off,” Morrison says, adding that a lot still needs to be done before we get to that point.

“I fear for the opioid crisis. It’s real,” says Morrison. “But here’s the thing: If you’re not in pain all the time, you’ll never be able to relate to what people have to go through who are.”