Deaths from opioid overdoses have been surging. The CDC reports that fentanyl and its chemical cousins are increasingly responsible for the dramatic increase in casualties (CDC Health Alert Network, July 11, 2018). Much of the fentanyl is counterfeit and is manufactured abroad. Headlines and soundbites on the evening news highlight the war on opioids but ignore the after-effects for people in pain.
Demonizing Opioids Injures People in Pain
There is a downside to demonizing opioid pain medicines. Many chronic pain patients have been denied access to drugs like hydrocodone and oxycodone.
That’s because of pressure from the CDC, the DEA and insurers to discourage prescribing or dispensing of opioids. Many well-intentioned experts believe that overprescribing pain medicines is behind opioid misuse and overdose deaths.
The message is that opioids should be used only for acute pain such as after a serious accident or surgical procedure. Health professionals are being told that prescribing these drugs won’t help patients in chronic pain. But most patients are not being offered alternatives.
The FDA Listens to Patients in Pain
The Food and Drug Administration held hearings this month and patients in chronic pain voiced their frustrations (FDA Meeting on July 9, 2018). You can watch the videos of the:
The Other Opioid Crisis for People in Pain:
Many people in pain complained at the FDA meeting that the medications that helped them function previously are now being withheld, even if they took them precisely as prescribed.
One patient who testified at the FDA hearings was a disabled registered nurse with cervical scoliosis and ruptured disks that cause unremitting pain. She has been treated for a decade, going to the pain clinic each month and seeing her primary care physician every three months. Although she never was identified as a problem patient, she is now unable to access the pain medicine that allows her to function.
The Government Makes Opioid Access Challenging:
Many doctors have been intimidated by government restrictions on opioid prescriptions. The CDC has issued guidelines that discourage the prescribing of opioids for chronic pain patients (March 18, 2016). Patients in severe pain may feel as if they are being treated like drug abusers or criminals because of this CDC recommendation to physicians:
“When prescribing opioids for chronic pain, clinicians should use urine drug testing before starting opioid therapy and consider urine drug testing at least annually to assess for prescribed medications as well as other controlled prescription drugs and illicit drugs.”
Medicare and Medicaid Dosage Restrictions:
Millions of pain patients could be impacted by a new proposal. The decision by the Centers of Medicare and Medicaid Services (CMS) not to cover opioids above a given dose next year is likely to make the problem worse for people in pain.
We have heard from hundreds of people in pain who are desperate as a result of these restrictions.
One person wrote:
“I have more than I can handle just typing right now. The pain meds don’t make it so I can walk. At times, I even try not to drink anything for fear that I might have to go to the bathroom.
“If the restrictions get even tighter, I won’t be able to tolerate it. I only tolerate it now so I don’t leave my golden retriever alone. He’s the reason I haven’t killed myself already.”
Another man wrote:
“I had back fusion surgery involving multiple vertebrae. It left me worse than before. I’ve been on [opioid] pain meds for five years, with a drug test every month, and I have never caused any problems.
“Now the doctors are cutting my meds so much that my quality of life is zero. It was bad enough before. I am considering suicide and I wonder if that is what they want.”
Erin in Reno Nevada shares this story:
“I have been looking for nearly a year now for a doctor to help me with my chronic pain. Because of the limitations that the DEA and now the state has put on doctors, the majority do not want to prescribe opioids.
“I moved from California to Nevada for retirement. I am having to drive to California to my doctor there to get my prescriptions because no doctor wants to prescribe what I need to control the chronic pain I live with 24/7.
“It’s horrible how the doctors and the DEA are treating patients in pain. We are just trying to live a normal life. We get our meds the right way. We do not abuse our medications but we are treated as if we are drug addicts. It is sooo unfair.”
Jeff is considering suicide:
“I’ve had 381 total surgeries. I’ve always done the right thing, whatever the doctor has told me. I have never taken more medicine than I was supposed to. Now they look at a computer and say we have to cut your meds since the computer says so.
“I use ice, constant getting into a tub of ice. It’s great for a few minutes. The only option I can come up with is to now drink enough alcohol and see if that helps. IF that won’t help then I’ll be looking face first down the end of a gun barrel. I can’t stand it and I’m not living in an ER any longer.
“People who have abused the medicine have made it terrible for the ones that need it. My life will have to end without any help.”
What About Cancer Patients?
Even cancer patients are not immune to the increasing restrictions:
“My father attempted suicide last week because the director of his pain clinic abruptly cut all his pain meds. He suffers irreversible chronic cancer pain!”
Not every person in chronic pain is considering suicide. But they all deserve compassionate treatment to alleviate their agony.
Read more stories at this link. Over 700 people have shared their experiences here.
Where are the Alternatives to Opioids?
Opioids have been used for more than 5,000 years. They are powerful analgesics. Until drug companies develop more effective and safer alternatives, decision makers need to recognize that people with intractable pain deserve relief. For some, that will require opioids.
Keeping illicit fentanyl and its derivatives out of the country might be a more productive way to control the opioid epidemic that is killing people.
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