Oxycodone tablets, narcotic, lack of opioids

Everyone knows we are in the middle of an opioid epidemic. Hardly a day goes by without a headline or a TV news story about a tragic overdose death. There is no question that far too many people have died from opioids during the last few years. Unfortunately, however, the crackdown on prescription medications like hydrocodone and oxycodone has had an unanticipated outcome. Many people in severe pain have been cut off from access to relief. The lack of opioids has some chronic pain patients turning to street drugs to ease their pain. Others may consider suicide as the only way out of excruciating agony.

Opioid Prescribing Has Changed:

For many years, the best-selling drug in America was hydrocodone with acetaminophen (APAP). A decade ago more than 120 million prescriptions of this combination pain reliever were dispensed in the US. Three years ago that number had fallen to 43 million.

Some physicians were doubtless too promiscuous in their prescribing of opioids. But many doctors were sincerely trying to ease the suffering of people who had no other way to overcome severe or chronic pain. The DEA reclassification of hydrocodone from a Schedule III to a Schedule II drug made it much harder for doctors to prescribe this opioid to patients.

You can read about consequences of this policy at this link:

Patients in Pain Are Outraged about New Hydrocodone Rules

Patients in Pain Are Outraged about New Hydrocodone Rules

Is a Lack of Opioids Leading to Suicide?

An intriguing “News and Analysis” article in JAMA (April 29, 2019) is titled

“Limits on Opioid Prescribing Leave Patients With Chronic Pain Vulnerable”

The author, Rita Rubin, describes a doctor who has been swimming against the tide of opioid emotion. Thomas Kline, MD, PhD, treats “pain refugees.”

These are chronic pain patients who have been cut off from opioids.

“Kline accepts these patients that no one wants because he’s trying to keep them off another list, one he has helped compile: a list of US residents believed to have committed suicide because their physicians would no longer prescribe adequate doses of opioids to treat their chronic pain.

“As of late April, the list was 40 people long, but it is not inclusive, Kline said. ‘The problem is a lot of families don’t want this public. I have to respect that.’”

Has the Pendulum Swung Too Far?

We have heard from hundreds of patients suffering from chronic, intractable pain. Most never abused opioids. They took their prescribed medication exactly as directed, never increasing the dose. They are now suffering the consequences of a lack of opioids. That means withdrawal symptoms and excruciating pain. Here are just a few stories from readers.

Bill is himself a health professional:

“If anyone decides to write their Congressman, please check your spelling and grammar so you don’t come across as someone whose brain is foggy from too much pain medication.

“Maybe my own brain is fried from two Vicodin plus 4 Ultram a day, but I don’t think so. I have been on it for 10 years. I’ve never taken more than that and never used more than one doc. Still, CVS, Walgreens and Walmart are refusing to fill my prescriptions unless the doctor agrees to taper. My doctor bent over backwards with multiple calls to clarify my diagnosis, alternative treatment plan and other medications and modalities tried. It doesn’t matter. I can’t get any more Vicodin. No one cares if we jump from a bridge. If we go to street drugs, that is further justification that prescribed medication leads to criminal behavior. If we are on disability, we are a liability. We are not contributing through taxes.

“Use your pain and channel it to fight if you can. Make your voice heard somehow. Take responsibility. I too must learn to live without anything for my severe pain. I am not sure how I will continue to be productive consistently without medication.

“As a health care provider, I can tell you that nobody is going to buy that someone has 10/10 pain but can still sit at a computer and type. I have worked in ERs and Orthopedic floors and not one of those 10/10 patients in 25 years were interested in their computer or their phone. If this makes people angry, then good. To everyone struggling with this issue, including myself, breathe and learn to live with it, for this is the lot we have been given. No one cares if I commit suicide and the government won’t care about you, either.”

Nick is a veteran who has suffered severe pain for ten years:

“I am a 100 percent disabled veteran and have been a pain patient for 10 years. The VA cut my oxycodone dose from 120 mg a day to 60 mg cold turkey. I found a civilian pain management clinic and was doing OK until the CDC/DEA came out with their bogus long-term (6 weeks) study by anti-opiate doctors.

“Suicides among pain patients are up 38%. Two friends, both vets, took their own lives after their pain meds were cut off. I was desperate to find something to hold me over until my next prescription. Kratom in capsules worked for me, though it is certainly not for everyone.. It is not a miracle, but it does take the edge off withdrawal symptoms, restless leg syndrome, etc. You must stay hydrated, eat plenty and rest. Kratom saved my life a few times when I wanted to check out. I hope the new rules will let doctors put us back on our original doses.”

Jaylene is incensed by her experience:

“The war on drugs doesn’t do anything but come between doctors and patients. My doctor says I have legitimate reasons for pain medication and he wished he could give me what I need. But instead, he is forced to cut patients off their medicines. I’ve gone from 60 pills a month to 50 which means I can no longer can have two a day. When I told my doc how much this affects me, he said he would not cut my prescription any further, but he added, ‘Life is pain and you cannot take a pill every time you feel it!’ He said I just need to learn to deal with it! I couldn’t believe he said this knowing how much legitimately documented pain I’m in.

“Until recently, I was getting Xanax for severe panic disorder and anxiety. I’ve been so upset because yesterday my doctor informed me that no longer is a patient allowed to be prescribed both opioids AND benzos. He told me I have to make a choice: one OR the other, not both.

“The sister of a friend of mine committed suicide four months ago. It was because of a lack of opioids. She could no longer get her meds because of these new rules.”

Where Do We Go From Here?

Everyone understands that far too many people are dying of opioid overdoses. What seems to have been lost in translation is that many of those deaths have been caused by fentanyl, carfentanil and other potent synthetic opioids made in China. They are smuggled into the U.S. using the United States Postal Service and other shipping strategies. A small amount can kill hundreds or even thousands of people. So far, US law enforcement hasn’t figured out how to stop the flow of these killers.

The CDC has asked doctors to clamp down on opioid prescribing as a way to control the epidemic of opioid overdose deaths. In many cases, patients in pain have been abruptly cut off from their pain medicines. Not only are they suffering from the pain, they are experiencing withdrawal symptoms from lack of opioids.

Perhaps regulators will one day realize that people in severe pain are not the cause of the opioid epidemic. Cutting them off from their pain medicine is not likely to solve the crisis, though it may be create its own epidemic of suicides. They should not have to suffer from a lack of opioids.

JAMA, April 29, 2019

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  1. Carolyn H
    Virginia
    Reply

    As usual, once something becomes an “issue” the politicians go to extremes without considering the consequences. The persons that are dying because of the opioid crisis are not folks with chronic pain, or a legitimate need for temporary pain relief–it is folks who buy street drugs with heaven knows what they really are swallowing who are killing themselves. It is crazy when patients have to practically beg their physicians for a medication that helps them be more active and function better with adequate pain relief.

  2. Robin M
    California
    Reply

    Let me add something here regarding medication procurement. IF people cannot get them rightly and legally through the physician then they will get them by other means. This is a truth the FDA, CDC, DEA, and the medical associations of America simply refuse to acknowledge. Individual people are driven to do what they must to alleviate pain, anxiety and depression, and to be listened to and taken seriously.Congress refuses to listen to anyone but the FDA and the DEA. Does that make sense? Yes, it does. These two entities are govt. funded so they have pull and power with congress.
    I hated to see many of the drugs we take to alleviate pain get rescheduled to levels that are, frankly, unnecessary. Hydrocodone spent years a s a lower scheduled drug. Tramadol was never a scheduled drug and is not even a moderate pain opiate. Tramadol, by the way, decreases seizure threshold…..much like Darvocet and you will never see that drug again even though Darvocet worked wonders for many an arthritis patient.
    Hydrocodone was raised on the charts, too. All this because of Fentanyl and Heroin.
    Hydrocodone was never an abused agent, either. Oxy, Fentanyl, Heroin, Morphine……these were and are the drugs abused. Codeine……now this drug is a mild to mod. opiate, but not on a par with any of the known pain relieving opiates. It is an anti-tussive medication usually given with Phenergan for coughing.
    What a messed up system we have hear in the USA. It is only likely to get worse in the coming future.
    A prediction: Narcotics will not be prescribed for pain in the near future. Benzos will no longer be prescribed short or long term use. This is called prohibition and we will see how long it lasts before we get another amendment to the patient pain relief constitution! The increase in Alcohol, Marijuana, Heroin, and other illegal drugs will be mass prevalent to relieve pain, anxiety, and relief from neuropathy.
    This is what we have come to folks and it is for real. I am never an advocate of illegal behavior, but if my patients are in constant pain, then I am advocate first and a follower of the written law second. Laws can be changed, but a bold and gutsy person needs to have the balls and the power to stand up for the people and not for government entities in the halls of power.

    Says the old retired RN.

  3. Robin M
    California
    Reply

    You Know they won’t bring back Darvon or Darvocet. The cardiac ramifications and possible seizures are the reasons why. The fine print on the studies surrounding these drugs does not make it clear that in both cases it is only regarding people at risk for QT cardiac related arrhythmia and already established seizure disorder patients, that really need to worry. The rest of us….no, we don’t. This issue was also made of Demerol. The metabolites might increase QT or onset of seizures in those susceptible. If you are not in either category it would be okay for short term use.
    What is not taken into account is that we live in a highly litigious society. Law suits are not to be taken lightly. People want their cake and eat it too. So, law suit and courts drive many of the FDA rules and new CDC rulings. I don’t even want to get the DEA involved in this discussion…..they are a big scam and racket just like the DMV. Both of those entities are money making only and make little sense as far as funding priorities.
    Oh, I am an old retired RN.

  4. Louanne
    Los Angeles
    Reply

    I bring this up as possibility for those in severe pain. Medical marijuana has been used quite successfully for many types of pain. CBD is a type of medical marijuana that doesn’t get you high at all and it comes in various edible forms, so you don’t have to smoke it. Anyone who has severe pain should find a good medical marijuana dispensary with trained attendants who can advise you on what is best for you. (This is not something you can get at the local “head shop.”) I’ve sent several people in for just this sort of thing and they have found relief. It’s certainly something to consider!

  5. Susan
    US
    Reply

    I have severe inflammatory arthritis, scoliosis, and have had multiple jaw surgeries. I also have anxiety, which runs in our family but quite honestly I feel is fueled by my constant dealing with medical bills, pain, and wondering how I will manage. I am given low dose limited pain medication, but am being made to get off my anxiety medication. I have been on it 12 years. If it were going to kill me it would have by now. I broke my ankle and the ER doctor shamed me, put I am a drug abuser because no one needs pain medication for years, and called my doctor. If I lose everything I have no life.

  6. BILL (PHARMACIST FOR 50 YRS)
    HICKORY, NC
    Reply

    BRING BACK DARVOCET !!!

  7. GiGi B
    Hawaii
    Reply

    Legitimate pain patients and veterans are dying today due to government regulations which deny them access to healthcare for no other reason than, a medication they take is something sold by a criminal element and abused by others sick with the disease of addiction. The failure to make a distinction between these groups is a failure of our democracy and the government to ensure balance and equality between groups.

    Involuntary euthanasia can occur indirectly when laws are passed which gives preferential treatment to one group at the expense of another.
    Such laws deem one group’s needs as greater than another. Still, this is not the mandate of a democratic government. A Democracy’s mandate is to write laws which balance the needs of one group with another. Equality is the essence of any democracy. Any law which denies one group access to resources in favor of another, knowing that such laws contribute to the loss of life, liberty and good health, are in fact laws more closely akin to fascism.

    In 1993, at Queens Hospital after undertaking my third neck surgery, that had broke before I was able to leave the hospital, I was diagnosed with a very painful rare generic bone disease Alkaptonuria/Ochronosis where my bones turn black, brittle and all the cartilage and disc are eaten away from between my joints and vertebra and there is no treatment in which to make it stop. I have my bones grinding against each other, in my neck with this disease progressively stripping away all the cartilage and disc on down my spine= along with my hip, that they cut into to take a plug to put in my neck BUT this disease they diagnosed me with is a NON-operative disease – they only made my condition worse every time they cut into me- its painful to do most everything.

    There is no known cure for this rare generic bone disease -pain medicine is the only way I can get dressed in the morning or walk or do anything – when your bones have NO cushion between them and your bones are grinding against bones, it is impossible to do anything without being in PAIN.

    How dare politicians use power and influence to torture pain patients. Medical professionals are trained specifically to heal. There will always be individuals that do not follow the rules, and rules do need to be followed, but politicians, and the like, do not have the right to take away medications to ease the patient’s pain. They are not doctors. They are breaking the law, and causing terrible suffering, even death.

    Many of those suffering are the very veterans who fought for our basic humanitarian rights, one being the right not to suffer in pain. Obviously compassion, and pleas for mercy have not worked. It is time for those suffering in pain to start taking legal action to protect themselves. Certain people know fear is an incredibly manipulative emotion, and they utilize it to fuel their own agendas. The guilty need to be held accountable. Let doctors do their jobs.

    Torture has many faces, including refusing to treat those in pain. It is time to address those breaking the law, and end the torture. Stand up for your rights. If we do not, what will be next? We have a right not to suffer in pain. The crimes against legitimate pain patients must be addressed immediately, and those who have caused these crimes, medical, political, etc., must be held accountable.

  8. Crystal G., RN
    Florida
    Reply

    I just buried my husband in March. He had pain in the thoracic spine from 2 compression fractures. He was in such pain with them that he chose to go into hospice once neurosurgeons refused to do a kyphoplasty since the fx were more than 2 wks old. His attending didn’t have a clue about getting an orthopod in to see him until it was too late and I had pitched a fit. His low blood pressure prompted a spinal cord infarct and when he was in hospice he was able to get Dilaudid 2 mg every hour for the pain. He died within 48 hrs. Prior to going to the hospital by ambulance, I found him with his Glock at his head and got to it before he fired it. He basically committed suicide legally. He was never on narcotics prior to 2018. He was retired law enforcement.

  9. Carolyn
    High Point
    Reply

    I too am a “victim” of the pain medication regulations. My rheumatology doctor is sending his patients to a pain specialist. He does not want to get in trouble for prescribing pain meds. I have rheumatoid arthritis, osteo arthritis, bone spurs, degenerative disc disease, and fibromyalgia. Learning to live with pain is impossible. I am making an appointment with the pain specialist to see if I am eligible for pain medications. I am not an addict but I need pain meds to function and have a better quality of life.

  10. Tracy K.
    NJ
    Reply

    Ok. Finally, some truth about this “opioid crisis “! I have to add that it should be called “heroin/fentanyl crisis”. It is mostly due to the illegal drugs that are imported into our country and consumed by people who do ILLEGAL DRUGS! I am a CPP with chronic intractable pain 24/7. I go to a pm dr that still writes scripts, PT, acupuncture, injections and massage. I am very happy with how I am treated there. I am very concerned that my meds will be reduced more OR cut off completely. I am in pain and opioid therapy works best for ME as a last resort since I have tried every treatment except surgery. I am terrified of surgery on my spine. So many things can go wrong…..
    The opioid “guidelines” were NOT supposed to effect the CPP community but it HAS TREMENDOUSLY. I feel bad for all of the people (especially the veterans) that cannot get pain meds, it is truly disgusting how they are being treated. Just because someone takes opioids, it doesn’t mean they are an addict. Their body has become used to the meds so they are dependent NOT addicted.
    The CDC has stated that the “overdose numbers “ are NOT CORRECT. That statement should be announced EVERYWHERE that the numbers are inaccurate!!!
    It isn’t the individuals in the CP community that should be effected by this “heroin/fentanyl crisis “, it should be the illegal drug users, the cartels, the govt, the CIA and ALL others that are contributing to this “heroin/fentanyl crisis “. Leave the CPP’s alone! Another thought, Kratom, wild lettuce, turmeric and Cbd oil help with the pain and inflammation. Kratom can help people with the withdrawals and pain. It has saved so many people that were abruptly cut off from their pain meds. Good luck to all in the CP community as we are in the fight of our lives…

  11. Frank
    Earth
    Reply

    Well, far be it for me to be a pessimist but no one seems to consider that perhaps people over fifty are not overdosing due to opioid addiction but are committing suicide. Have you looked at the world around you, lately?

  12. Jean
    IL
    Reply

    My uncle was wounded at the Battle of the Bulge. He committed suicide in the 70s, because doctors would not prescribe medication to ease the excruciating pain from nerve damage. This was pre-Kevorkian when doctors routinely denied pain medication even to decorated soldiers and cancer patients.

  13. Helen
    Alabama
    Reply

    “In a new commentary in the New England Journal of Medicine, authors of the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain (Guideline) advise against misapplication of the Guideline that can risk patient health and safety.” This includes a list of things that can put patients at risk. It should be pointed out also that these are guidelines, not law.

  14. Jean
    Chicago
    Reply

    What do I think? I think this is outrageous! Chronic pain patients should be prescribed drugs to ease their pain. Many of us may be in that position someday.

  15. Binky
    North Carolina
    Reply

    I can only object to the description here of this inhumane situation as an an “unanticipated consequence.” Even a non-physician like myself thought immediately of those suffering from severe and intractable pain when I first heard about the early efforts to stem the tide of opioid addiction by limiting everyone’s access. The implication that the medical community, FDA, and policy makers are caught off guard by the impact on patients with severe pain cannot be true. That sufficient provisions were not made for those who legitimately need opioids was unconscionable. Perhaps using a blunt force solution was just as simple as choosing to save some younger lives over destroying some older ones. I know 2 people who died of overdoses and I know several with severe, chronic pain. It is not that difficult to tell them apart.

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