One of the Google topics I “follow” is “pain management”, and because of the current scene regarding the opioid crisis, I come across stories about chronic pain sufferers vs. the CDC on a daily basis. My hope is that Pain Awareness Month will help shine a broader light on what chronic pain sufferers have been hit with recently. As the country tries to come to terms with the role prescription painkillers play in the continually rising opiate overdose rate, heroin use and addiction in general, law abiding pain patients everywhere have been left with little support in regaining any quality of life.
It really feels like there’s too many cooks in the kitchen, and none have ever had to eat the food they’ve cooked up for the rest of us. I don’t disagree that there is a problem. More than a problem, this is rightly labeled a “crisis”. I know that prescription painkillers played a role in causing mass addiction and overdosing. I know there are bad actors in every group involved – directors, physicians, patients, family and friends of said patients. That said, somewhere along the timeline of recent developments and decisions, something went very wrong and missed the boat completely.
I could have told “them” that villafying all opiate prescribing doctors and all opiate prescription holders would backfire. Any idiot could have foreseen that lumping everyone into the same pool and treating them like criminals would only worsen the very problem they’re trying to solve. If you threaten physicians with loss of license, career, financial stability, reputation and very livelihood for prescribing opiates, there won’t be any physicians left willing to treat pain, chronic or acute. What happens to the patients that, while may not be terminal, have diseases that cause widespread chronic pain? How many of these patients have been on their opioid medications for years without ever exhibiting any “drug seeking” behaviors such as requesting early prescription refills, filling police reports for “stolen” prescriptions (not that painkillers can’t be legitimately stolen, they certainly are, and there was a time when doctors made it known they’d only replace a stolen prescription if there was a police report and I know more addicts that made false reports than actually had it stolen) and failed random urine analysis? Or, how many returned to the office with the correct amount of medication for an unscheduled “call back”?
I recently met Bibi Hahn, an extremely empathetic and intelligent woman running for West Virginia’s House of Delegates (District 58). She was the first person running for office that has ever visited my (obviously lower class, lower income) neighborhood. I generally dread unexpected knocks at the door and looked a mess, so I was ready to politely decline a conversation. I glanced at the handout she had and saw “…address West Virginia’s Opiate Epidemic” and decided I wanted to talk to someone who might just have the ability to make a difference, even if I looked like I’d just crawled out of bed. She also had a man with her, I believe her husband, who turned out to be a physician. I expressed to her my concerns regarding the CDC’s prescribing guidelines and WV inadvertently just exacerbating their heroin overdose crisis with the knee jerk reactions in the attempt to curb abuse, and decrease opioid prescribing. They both seemed extremely receptive and agreed that chronic pain patients are being unfairly targeted and tormented. “Unfairly” feels like way too mild an adjective. What is happening is more than unfair, it’s downright DANGEROUS.
I said that I didn’t understand why doctors couldn’t have all their patients on opiates sign a treatment agreement, and continue medications AS NEEDED per medical records unless the patient violates the agreement in some way. If it’s shown that they have no opiates in their system but their medications are decreasing throughout the month and it looks likely they’re diverting medications, those patients would have no recourse or reason for complaint if they are then discharged from care with no further prescription and no referral to a new doctor. Dr. Hahn replied in a defeatist tone, “We can have them sign the contracts but they don’t do any good.” We were all three talking a mile a minute about 10 different subjects and they’d not yet knocked on one other door, so I didn’t inquire what he meant. However I’d like to, and hope I’ll get the chance when they come to Martinsburg, WV for the candidate open forum on October 23, 2018. I have questions, because I just don’t understand what’s happening in the medical world, specifically pain management.
If a patient has a painful, chronic condition and their quality of life and health in general responds positively to opiates, then opiates should be an obvious consideration for their treatment plan. I don’t know of a single person who is prescribed opiates for a verified medical condition that would willfully jeopardize their access to pain medication by violating their doctor’s trust in any way. Sure, 10 years ago, there were people who were given prescriptions they didn’t really need by doctors that ran “cash-only” medical clinics (rightly labeled “pill mills”), and those pills made it to the streets. That scenario is unheard of today. The DEA has done an excellent job of rooting out the bad apples. Unfortunately, it’s as if they just couldn’t take the time to investigate all the possible bad guys so they just assumed EVERYONE was a criminal, or itching to become one. Now the nation is fighting the worst opiate addiction and overdose epidemic we’ve ever seen. West Virginia continues to lead the nation on rising overdose rates DESPITE the sharp decline in opiate prescribing.
I just want to grab someone, anyone who has a brain and a voice in Charleston, in D.C., and shake them and scream “YOU’RE KILLING YOUR CITIZENS! YOURE MAKING IT WORSE! YOU’RE CREATING CRIMINALS & HEROIN ADDICTS OUT OF LAW ABIDING PAIN SUFFERERS! STOP IT! STOP IT! STOP THE INSANITY! STOP YANKING EVERYONE’S PRESCRIPTIONS! STOP TITRATING PATIENTS DOWN TO AN INCAPACITATING AMOUNT OF PAIN KILLING, LIFE SUPPORTING MEDICATION!”
Everyone I’ve spoken to is terrified. Everyone also agrees they’d LOVE the chance to sign a pain management agreement. Everyone agrees they would jump through the requires hoops: give urine every day if asked, bring medication in to be counted as often as needed, notify their doctor before leaving the area and even put in special requests for vacation or anything that might take them away overnight, in case of a call back. If you’re not trying to con anyone and simply want the peace of mind in knowing you have medication for the pain that wreaks havoc on your whole life, you’re going to agree to anything that allows you to keep that medication. It’s not even about “addiction vs. dependence” because it really is the same thing. The difference is the legality. Are you stealing pills from Grandma or is that your valid, medically necessary prescription? Are you telling your ailing neighbor with the swollen tooth abcess that you’ve got something that will help, or are you telling them that under no uncertain terms would you ever share your prescribed medication? Are you pawning your mother’s jewelry for enough money to buy street drugs to stifle the agony of withdrawal, or are you discussing rising prices and appealing to the pharmacist for a discount card for your prescribed opioid prescription? All of these people are addicted to opiates, dependent on taking opiates to both ease pain and stave off withdrawal. Only some of these people are criminals and in danger of both continuing criminal activity and overdosing due to ingesting an adulterated substance. Addiction…dependence…it doesn’t matter. What matters is the powers that be have the ability to actually turn the tides on this virtual death sentence, but so far all they have done is created terrified doctors that won’t treat pain patients, and created more criminals who’ve chosen heroin over suicide, many of whom will overdose and die, all because they couldn’t get a proven treatment they desperately needed.
Operation Felicity 