Watch the news on television or read a newspaper and you will likely see a story about the dangers of opioids. Here is just the latest sampling:
- “Lawmakers Seek Crackdown on Opioids” WRAL.com, Raleigh, NC
- “7 in 10 US Workplaces Hit by Opioid Abuse” WebMD
- “Opioid Rx Abuse Probe Sees A Record 31 Doctors Hit With Sanctions in New Jersey” FOX News, U.S.
- “Dentists Work To Ease Patients’ Pain with Fewer Opioids” NPR – Weekend Edition Sunday
- “Should You Fill That Opioid Prescription?” U.S. News & World Report
People In Pain Deserve Relief:
When something goes wrong in your body, the signal you get is pain. Whether it’s an emergency like a broken bone or appendicitis or something more chronic like degenerative back disease, pain is usually the common denominator.
A Short History of Opioids:
Before there were modern pain relievers, humans relied on the natural world to ease suffering. The Sumerians were using opium from the poppy plant by 3,400 BC. They shared the pain-relieving potential of this plant with the Assyrians, who passed it along to the Egyptians. Eventually Alexander the Great took it with him to India and from there opiates spread around the world.
Today, this category of drugs has captured national attention. The opioid epidemic has caused untold misery, and politicians have weighed in on measures to prevent abuse and the deaths that result from it.
The DEA’s War on Opioids:
The Drug Enforcement Administration has cracked down on the medical use of synthetic narcotics such as oxycodone (OxyContin) and hydrocodone, found in Lorcet, Lortab, Norco and Vicodin. Although such drugs have led to addiction and death, they also remain among our most powerful and effective pain relievers.
There was a time when physicians were trusted to use good judgment in the prescribing of hydrocodone and oxycodone. No doubt some were far too promiscuous in prescribing such powerful pain relievers. But others were very thoughtful and cautioned patients about abuse. These doctors prescribed opioids judiciously.
The DEA changed the rules in October, 2014. That was when the Drug Enforcement Administration moved hydrocodone combination pain relievers (HCPs) like Lortab, Norco and Vicodin from Schedule III to Schedule II. That meant no more electronic prescriptions to pharmacies. And doctors could not call in a prescription either. Each prescription was good for only one month. That meant it was much harder for patients suffering from severe chronic pain to access opioids.
Many Physicians Now Worried About Prescribing Opioids:
The media spotlight on the epidemic of opioid-related deaths has scared many physicians away from prescribing such medications. Pharmacists worry about dispensing them, and some patients are too anxious about possible addiction to take these drugs at all.
Most experts recognize that opioids play a key role in easing pain for people at the end of life, particularly those whose pain is related to cancer. Surgeons continue to prescribe such drugs following a major operation.
Chronic Pain Patients Are Suffering:
The controversy is focused on the treatment of chronic non-cancer pain. Doctors have been told that such drugs are inappropriate for people with persistent pain, and CMS (Medicaid and Medicare) has drafted a policy that would make it difficult or impossible for many patients to get prescriptions for such medications.
What impact will that have on their medical care? We have heard from hundreds of patients who are now feeling desperate. Here are just a few examples:
D.M. in Baton Rouge, LA, shared a poignant story:
“It is really a shame how a physician who took an oath ‘To Do No Harm’ out of medical school can bow down to a government that has no business meddling in the practice of medicine.
“I was injured twice in Vietnam, and in 1988 a backhoe drove over me. I’ve had four back surgeries as a result, but am left with chronic pain. I haven’t told the VA that this 65-year-old soldier who proudly served my country in time of need often thinks about taking my own life. It is truly sad that the very country I went to war for is the one that is going to be the death of me.
“I will fight this pain with all I have because I care about my family. But since my dosage of Oxycontin was reduced, I have a hard time getting even two hours of sleep a night. I can not find a position in which I am not in pain.”
Many other chronic pain patients who never abused opioid pain relievers are now at the end of their rope. Many have suffered unbearable withdrawal because they can no longer access medications that allowed them to function. Others, like this Vietnam vet, are becoming suicidal because the pain is so excruciating.
Other Stories from People In Pain:
Jan in Plano, IL, is also at the end of her rope:
“I had a crush injury to my feet and legs 17 years ago. All my nerves died. I have been on everything, but mostly just Fentanyl patches every other day.
“A neurologist who knew nothing about pain stopped my Fentanyl when I tried to have a spinal stem implant. I felt like Joan of Arc burning at the stake. I couldn’t lift my head off the bed, and vomited till taken to the hospital.
“The pain was excruciatingly unbearable!! If I couldn’t get my Fentanyl I would have to find a way to end it. So the deaths from drug addicts that the DEA is trying to prevent will just be made up in suicides from people in severe, unending pain! The government needs to stay out of our lives.”
Rose in Cape Vincent, NY, is also desperate:
“I injured my back at work 8 years ago. I have herniated, bulging discs and scoliosis as a result of my accident. I have Protein C deficiency, a blood clotting disorder, and therefore am not a candidate for surgery.
“I’m 42 and live with horrific pain. I’m on disability and walk with a cane. My quality of life continues to deteriorate every day. I spend much of my time in bed and am no longer able to enjoy the things I used to do.
“Because of the Protein C deficiency, I am not supposed to take NSAIDs or steroids. These drugs can cause fatal bleeding problems. Last year my pain management physician was arrested. At that time, I was prescribed morphine. After his arrest, I ran out of medication and suffered terribly from withdrawal.
“I’ve suffered so much since then and I’m no longer able to live alone. I was taking copious amounts of ibuprofen, despite the risks of internal bleeding. I was recently hospitalized for chronic pain because I could not get out of bed and could not walk. I spent 8 days in the hospital where my pain was controlled for the first time since my former doctor’s arrest.
“While I was hospitalized, I was referred to pain management. I was given enough pain medication to get me through until my appointment. The medication barely makes any difference whatsoever in controlling my pain. I never abused, misused or sold my pain medication. I don’t understand why I’m being punished, along with so many others who suffer from chronic pain.
“I’m so miserable that I wish I’d get another DVT [deep vein thrombosis] or pulmonary embolism and just be put out of this misery. Animals are treated more humanely than those of us who suffer this way. I really believe the CDC and DEA are depending on all of us to kill ourselves. I believe that they want to eliminate all of us who are disabled and rely on SSD or other forms of government assistance because we’re “burdens” to society. I know this must sound crazy, but why are those of us who suffer so terribly being treated like drug addicts?”
“Perhaps if we all joined together, we could stop this horrendous patient abuse. I only want some quality of life back.”
The Terrible Dilemma:
There are few medications that work as well as opioids to control severe pain. That is why surgeons still prescribe drugs like Vicodin after a major operation and why hospice workers rely on narcotics to ease the pain of terminal cancer patients. Medications like NSAIDs or tramadol just do not work as well and they carry their own risks.
It is not clear that the war on opioid medications will reduce the death toll. Some drug abusers will turn to heroin or other illicit drugs instead of prescription narcotics. It does appear that these policies have left millions of chronic pain patients abandoned without much of a safety net.
If you would like to read more about how patients are coping with the new laws, here are some links: