an angry man screamin

The CDC has issued new guidelines (JAMA, March 15, 2016) that strongly urge doctors to stop prescribing narcotics to patients with chronic pain. This public health organization believes its mandate will reduce deaths from opioid overdose. What the feds have not considered is the impact on people with long-standing severe pain, especially if they are disabled.

The Drug Enforcement Administration Changed the Rules:

In the last couple of years there has been a huge effort to make it harder for doctors to prescribe opioid pain relievers. In the fall of 2014 the DEA made it much harder for patients to obtain hydrocodone combination pain relievers (HCPs such as Lortab, Norco, Vicodin, etc). Previously, prescribers could call in or send in an electronic prescription to a pharmacy and could give a pain patient several refills. Now, patients can only get a 30-day supply and must visit the doctor’s office each time they need a new prescription.

Stories from Readers in Severe Pain:

The new DEA scheduling change has made it much more challenging for a patient who is disabled or in severe pain to access an opioid medication. Here are just a few stories from hundreds of readers who responded to our post on the DEA decision.

Stefany in Maryland shares:

“I have had 10 orthopedic surgeries–two on my back, plus a spinal fusion. I have also had four hip surgeries. These are only a few of the many surgeries I have had.

“I used to hate pain medication. I did all that I could to avoid taking opioids, relying on 800 mg of ibuprofen instead. Sometimes I try to avoid pain medication, but it is physically impossible. I hurt all over and become so miserable when I am off my meds. Since there is such a strict limit on them I usually run out. Trust me; I do not wish to be on them, but the alternative after 10 surgeries is basically impossible if I am to maintain two jobs and college classes.

“While I completely understand the DEA’s reasoning behind their new laws, all they are accomplishing is making people like us live in hell and for the drug seekers to turn more to heroin. You cannot control the people who are drug addicts. To punish people who do not abuse pain medicine and need them to live a more functional life than one of severe depression due to pain is really unjust.”

John in College Station, TX writes:

“I have been taking hydrocodone for over 25 years because of a severe accident. I have had a total knee replacement and neck fusion surgery. I have three bulging discs in my lower spine with nerve damage in my back.

“Last year the doctor said no more hydrocodone, per the new law, and changed it to Tylenol #4. It’s 80 percent less effective.

“Why did this new law punish me? I was barely surviving with the hydrocodone, and now this. I call it abuse to the elderly. I have a track record of 25 years of taking my hydrocodone and NEVER called in for extra or EVER abused it. Now I suffer in severe pain because others abuse it. The DEA, who got this law passed, did not think how it would effect the people who really need it to survive.

“I’m only 55 yrs old, and I’m scared to death what the rest of my life may become. I do not wish harm to anyone but if the people passing these laws ever experience the pain I have they would never have never passed such a law which amounts to ABUSE OF THE ELDERLY.”

Jake the Vet:

“I am a 28-year-old army veteran. I have a spinal cord tumor located in my nerves and am consistently in extreme pain–8 out of a possible 10 points on a 1 to 10 point scale.

“All I can get from my pain management doctor is a back brace, anti-inflammatories and acupuncture in my ears or gabapentin, which makes me feel awful. I have seen three neurosurgeons, none of whom will touch me. What am I suppose to do? Things need to change in this country. It’s an outrage!”

Carolyn in Nevada:

“I too have been taking hydrocodone for many years for chronic pain. Today I went to the pharmacy and was told I can no longer have it. My doctor prescribes it but the pharmacy says no. I’ll be spending my days in bed, I guess. May as well be dead.”

Charles in Ft. Worth:

“I was in a bad elevator collapse and have numerous spinal fractures as well as bulging, degenerated disks and bone spurs. I have lost two inches in height because of my back problems.

“I am living in pain I wouldn’t wish on my worst enemy. I need pain meds and I can no longer get any refills. My pain is making my life unlivable.

“The new laws have caused more damage than you can imagine. My mobility is very limited. I can no longer get out of bed or carry on my daily duties as I was able to before the laws changed last October. I feel my life is over. I can’t live with this pain. I don’t know what to do.”

The CDC’s New Guidelines:

In essence, the new federal opioid guidelines state that narcotics should not be prescribed for chronic pain patients. Instead, doctors should recommend acetaminophen (Tylenol) or NSAIDs like aspirin or ibuprofen. Other suggestions include cognitive behavioral therapy, exercise therapy or antidepressants. We suspect that there are many patients, like those above, for whom such suggestions will not be met with great enthusiasm.

For acute pain, such as after surgery or an accident, the CDC recommends that doctors prescribe opioids for no more than three days. Really? Some “acute” pain lasts substantially longer than three days!

The CDC acknowledges that cancer treatment may require opioid medication during the active phase of therapy. What the CDC has not taken into account is that cancer survivors may have to deal with chronic pain. The president of the American Cancer Society Cancer Action Network said it eloquently:

“Pain does not end when an individual completes treatment. Most often, cancer patients deal with lasting effects from their disease or treatment including pain for a significant period of time or indefinitely.”

The CDC guideline does not seem to take this into account.

Walking the Tightrope:

We recognize that there is tremendous abuse of narcotics in this country, but we are not sure the new guidelines will help reduce the problem. We have not seen convincing evidence that making it harder for chronic pain patients to access drugs like hydrocodone will make a huge difference in abuse or overdose deaths.

We also believe that it is virtually impossible to generalize about the most appropriate treatment for people with severe, chronic pain. Some people will do well with cognitive behavioral therapy; others can only function on opioid medications. These drugs allow them to work and function with dignity. They do not abuse the pain medicine, do not increase the dose and do not sell their medicine to drug abusers. They are about to become vulnerable to a huge federal mandate that will impact how physicians practice medicine.

It is our belief that the CDC should not tell physicians how to practice medicine, especially when it comes to something as complex as chronic pain. Each patient needs to be evaluated individually and treated with respect. The new guidelines will likely scare many doctors away from prescribing potent pain killers for longer than a few days or weeks. That could mean some patients will live in agony with no acceptable treatment through no fault of their own.

Share your own pain experience below and your thoughts about the DEA and CDC rules and guidelines. Please vote on this article at the top of the page. Here is a link to hundreds of reader comments about the DEA’s decision to make it harder for patients to get a prescription for hydrocodone-containing pain medicines.

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  1. Brent
    Norman
    Reply

    I’ve thought seriously about traveling to the CDC and blow my brains out in their head office. Just to show them what they are doing to patients with long term disabilities. I am disabled because I was almost killed in an auto wreck. Why I lived, God only knows. I was in the hospital one month in traction until I was able to leave on crutches. I then went through one year of rehabilitation before I was released back into the work force DISABLED. I’ve had a total of six surgeries. My pain is constant and has been for more than eight years now. I use to take 160mg pr/day of stabilizers and 180mg pr/day of straight pain medication. Now they want me to survive on only one hundred milligrams of med’s pr/day. I’ll be so glad to hear when these law makers are involved in an auto accident and they’re told they cannot have anymore pain med’s for the day because they have exceeded the daily legal amount. Then the joke will be on them. I’m not a drug seeker , I’m a broken body trying to be a real person again. I’ll never be the same, but it sure would be nice to be somewhat pain free and able to walk again. I don’t get a euphoric feeling when taking med’s just enough relief to function again. I still wake up in the night every two hours from pain, but without medicine I don’t sleep at all. When I do sleep its Only from exhaustion. Thanks CDC, FDA, ATF and Federal Government for saving my life from an overdose. I’ve never overdosed in the eight plus years that I was prescribed pain med’s. Passed every UA test and was faithful every month with my med’s. There should be an exception for the elderly and disabled like that of the cancer patients because it seems to be in the same classification to me. There should have been an alternate medication before making this judgement. Something in place of wat is being taken away. Physical therapy is not likely for me. I’ve rehabilitated as much as I can possibly be . This is as good as it gets. May God help us All !

  2. Marilyn R
    FL
    Reply

    I have an acute onset of severe back pain. Recent MRI showed 3 levels of severe lumbar disease with root nerve impingement. I went to a spine specialist after ER visit for acute onset of back pain and was told he does not prescribe for pain and that I would need to see my primary care doc. My primary doc tells me he cannot prescribe, as he has not taken the courses needed in the state of Florida to give anything other than Tramadol. I am not asking for pain meds for long term, only to get me through hopefully a few weeks of acute pain. Now I have to try to find a pain management doctor for acute pain. Something has to change. God help those with acute and chronic pain.

  3. Joan K
    Reply

    I’ve been taking vicodin for many years. I have RA and degenerative disc disease and spine problems. My primary Dr just had me take a drug test. I am 78. I am terrified I won’t be able to get these drugs. If I do t take them I won’t be able to walk at all. As it is I use 2 canes to walk and it is a very slow walk. I lost my drivers license but that’s ok. I really didn’t think I should be driving and I couldn’t go anywhere because once I got there I couldn’t walk. I wonder why I had to take the drug test and who ordered it. My Drs name was on it but he knows me well and I hope he doesn’t think I selling drugs. I am having trouble sleeping just thinking if they stop prescribing the vicodin will I ever walk again. I am afraid I’ll wind up in a nursing home.

  4. John
    Ca
    Reply

    I was in construction in 1993, I fell 23 feet landing on my head. Since then, I was prescribed 50 vicodine ES (extra strength). Also went to physical therapy for 5 years. After following the pt religiously i was able to stop taking the pain meds. Due to injury I could only take a desk job. So after not working out and not continuing pt my pain returned so ofcourse my doctor started my on oxycontin which enabled me to carry on a normal life working, providing for my family etc.

    Now, because of these guidelines my life has been turned upside down somthing has to be done i truly believe doctors have poor judgement prescribing narcotics to people who simply do not need it. As a matter of fact i think they are doing this to increase their financial gain also insuring patients will return and bring them more patients hence more money. Dont get me wrong im sure most doctors have enough smarts, experience to recognize this and only prescribe to patients that really need this type of pain meds. In my opinion, these money hungry doctors can be easily recognized and dealt with!! But to make people with ligitamate reasons to take pain meds is unbelievable and so far from common sense that I feel like I’m in the twilight zone. Thank you, victim of shallow minded

  5. Gayle S.
    escanaba mi 49829
    Reply

    We need to go to Washington to express ourselves.

  6. Kitty
    Texas
    Reply

    I AM A DOCTOR who has had lower back pain since I was in residency. My attending told me I needed to let him give me steroid injections in my sacroiliac joints. I lost all the power in my quadriceps and could only go up stairs on all fours, like a dog, for 8 months until the nerves recuperated from that injection. The TMB told me “We are taking all physicians licenses away and hopefully prison for those who do not do surgeries on their patients, and we don’t mean trigger point injections.” This is horrible.

    Some patients have already gone through multiple mutilating surgeries in the hopes that it would relieve their pain but it only made the doctors richer, the patients poorer, and the patients more disabled. I personally ended up in that system. I had the spinal steroid injection which caused a permanent CSF leak, which caused a suction, which caused a Chiari which went from 3mm to 1.8 CM in 6 months. The doctor who did this to me told me my MRI was normal and I just needed 4 more procedures.

    I was desperate to get rid of this ever-increasing and new onset of different debilitating brain freeze headaches. I had never had a headache in my life until this spinal injection. I went blind and and to have immediate Chiari decompression surgery which is even more mutilation to my body. Now I am left which chronic mastoiditis, neck pain, upper back pain, horrible mastoiditis pain, 24/7 headache, and ringing in both ears.

    Because I am on pain medication they are now taking my license away and telling me I am an addict and impaired because of the surgery or because of the pain medication I take due to the forced surgery they made my doctor do on me first before giving me any pain relief or he would lose his license. There is no way to win. Now I am on pain medication I never wanted to be on but it is the only thing that works. I have tried acupuncture, massage, electronic stimulation, 10 steroid injections, 2 ablations, and of course the Chiari repair of sawing off large pieces of my skull and cervical vertebrae and even a piece of cow tissue sewed to my dura, and 4 unsuccessful blood patches.

    I am broke, have been an ER doc for 13 years with no lawsuits, no sanction, no peer reviews, but now I am told I violated another rule by working not while on pain medication, but by taking them when not working and not turning in my license. So doctors can never be injured and if they are, by being forced to have mutilating surgery by the Texas Medical Board, then are not allowed to practice anymore. We doctors are not allowed to have our pain relieved after we are forced undergo unnecessary and painful surgeries per the rules of the Texas Medical Board.

    They have impaired me, and now they want to prosecute me for being impaired. Even though I never took any narcotic before going to work they are accusing me of such. Even though I have pain, and I have tried all the lyrica, gabapentin (caused severe immediate swelling my hands and face) ibuprofen til my kidneys started to fail, and I had all of their required surgeries, they tell me I am an addict and I must not be on the pain medication which works. I asked them “what will you do for my pain?” They said nothing.

    Over 17 years I never graduated from the 7.5 Vicoprofen which worked for me.

    Until they forced me to have all of those surgeries. Now I have to be on a Fentanyl patch. I have lowered the dose on my own twice in the last year.

    But still I am a sleazebag drug addict who should be prosecuted and sent to prison. If any of us gets in an auto accident or are forced to have surgery which impairs us, we are to blame, not the people who inflicted this on us.

  7. Mitchell W
    New Albany Mississippi 38652
    Reply

    This must be stopped and it will be! What they have in consideration is not the answer, if we share the consequences of this so must they and that will end this pretty much forced degradation the quality of life for those who suffer sincerely suffer in intolerable pain Prince suffering if it’s good for one it’s good for all that’s my view on it. Pass this on hold our politicians accountable make them suffer the same pain that we suffer and I guarantee you the policy will change! Williams New Albany Mississippi

    • Gayle S.
      Escanaba, MI
      Reply

      Let’s march!

  8. Mitchell W
    New Albany Mississippi 38652
    Reply

    The problem is but all politicians and Rich folks are exempt from this policy and it probably will not change until all these politicians and Rich folks are Incorporated end of this policy and they are drug tested and receive the same treatment as us poor folks who suffer from severe chronic pain. Apparently these people are exempt from this policy and can and do get exactly what they need regardless of the policies they make.

    Everyone call you Representatives revolt against this government policy and bring the truth to light! Let’s go to work if we’re still able, I know you’re willing just get it done! And stop all this BS! It’s going to take some action on our part and that is to hold these people accountable and subject to their own policies for their self and their own families what’s up with the same results as they prescribe for us. Sincerely God help us all amen.

  9. William
    SC
    Reply

    My wife has had debilitating extensive spinal stenosis, disc degeneration and cysts for years. Her condition has caused her to retire earlier than expected and she cannot sit down for any exiled periods of time without excruciating pain when she stands up. Having a serious automobile accident 3 years ago only exacerbated her pain. She gets periodic corticosteroid spinal injections that help for about 3 months, but she still needs the pain meds she has been on for years. She has finally found a neurosurgeon that she trusts to do a high risk spinal fusion in a couple of months that may or may not help her severest problem in the lumbar area. Hopefully, the surgery will help that one area, but there are no guarantees due to the severity of her spinal deterioration.

    She has resisted being prescribed the stronger pain meds like OxyContin, but is in agony when she runs low on Percocet after having to take it more frequently during her worst episodes of pain due to sitting during auto/air travel of if she gets ill with the flu as she has recently. She is low on meds now and spends her days and nights in bed until the next prescription can be written. This is not living- it is just existing.

    Now, the South Carolina Legislature is considering a bill to severely limit how many and how often opioids can be prescribed. They are not doctors and do not seem to consider the adverse ramifications this broad legislation will have on the legitimate chronic pain patients.

    Please write the legislators in your state to write their laws with some flexibility for the chronic pain suffering patients who are not addicts, but depend on opioids to literally survive.

    • Gayle S.
      Escanaba, MI
      Reply

      Let’s march!

    • Helen
      Reply

      I just had this conversation with my partner. Doctors, people with primo health insurance or people with money such as my millionaire s.i. l. , will always get what they want. 20 yrs. ago I had a young doctor who liked to talk, just as I did. He admitted that they pick and choose who will get what treatment, the truth is, older people who have money, connections or the best government insurance(working for the state or local) will always win out and those who don’t will suffer in pain till death. He told me, “people have to die.” The doctor knows where each of us stands in line.

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