The Opioid epidemic is real. last year nearly 35,000 people died from overdoses of the drugs. No one denies that the issue must be addressed. It is a national tragedy. But, it should be addressed fairly and specific problems should be targeted rather than using a shotgun approach. In its zeal to save lives, and some will be saved, nearly 30 million Americans who suffer from chronic pain will suffer. That’s not a guess, it is a fact. For the last decade, I’ve suffered from osteoarthritis one of the conditions that can cause chronic pain. I’ve taken Opiods all that time with no ill effects. The painkillers have allowed me to lead an almost normal life. Without them, I am immobilized. The government’s blanket approach is harmful, painful and unnecessary and I am already seeing and feeling the results.
Before we get into further analysis, though, let’s define terms. First, what are Opioids?
Opioids are drugs that include the illegal drug heroin, synthetic opioids such as Fentanyl, and pain relievers available legally by prescription, such as oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, morphine, and many others. https://www.drugabuse.gov/drugs-abuse/opioids
What is the Opioid epidemic?
The National Institute on Drug Abuse (NIDA) says this. In the late 1990s, drug companies told physicians that patients wouldn’t get addicted to the new prescription opioid pain relievers like Oxycontin. So, doctors prescribed more. This subsequently led to significant abuse of the pain-killers before anyone knew how highly addictive they were. Overdosing has since become common resulting in the thousands of American deaths I referred to earlier.
Enter “The War on Drugs.” While the number of deaths is appalling, attacking the problem with stricter law enforcement and cutting the number of prescriptions are blanket policies that will harm more people than they help. We’ll put a lot of people in jail while depriving chronic pain patients of the only relief they can get.
The 30 million number I used earlier is a conservative estimate. Patients who suffer a torn ligament or broken rib fall into the “Acute” pain category. The pain is real and intense but usually short-lived.
Chronic pain is a whole lot different. It doesn’t heal and doesn’t go away. It often persists for weeks, months, even years and the pain can be excruciating. It never goes away. There can be many causes of chronic pain like arthritis or neuropathy or back problems and sometimes the cause is unknown. I have suffered pain so bad that I found myself on the floor crying. Yes, it’s that bad and I’m a typical chronic pain sufferer. Most of us are older Americans.
The Government approach to the problem was wrong-headed when it started under President Obama and has gotten worse under President Trump because it gave little or no attention to chronic pain sufferers, It is a two-fold blanket approach. The first is, “Cut the number of Opioid prescriptions, through stricter regulation of healthcare providers and number two is, “start throwing more people in jail,” or tougher law-enforcement. That effort has caused many physicians to refuse to write Opioid prescriptions for anyone. Some clinics have signs in their lobbies proudly proclaiming they are opioid-free but have effective alternatives (they don’t). So, when the feds talk about pressure on health care providers they really should use the word “intimidation.” While unsaid every healthcare facility and every physician knows that their licenses are at risk.
As a chronic pain patient, I know how difficult it is to get prescribed painkillers. It should be easy for me because I have the radiology pictures and physicians diagnoses to prove my condition. I have visited the same pain clinic for almost two years. Once a month I get a new prescription. When pain is really unbearable I will also get steroid injections in my neck. They help but without the Opioid the pain would be far worse.
As a result of the war on Opioids. patients have to re-qualify whenever they go back for a new 30-day prescription. For example, with each visit to the clinic, I am required to bring the containers for my last prescriptions with me so they can count the remaining pills. Then I am interviewed about pain issues, tested for the range of motion in my neck and back and questioned for about 5 minutes. Then, on a random basis, I am asked for a urine sample.
The difficulty doesn’t end there because pharmacies are now taking it into their own hands to cause further restriction and control. My pain doctor limits Opiod prescriptions to a 30 day supply. The pharmacy then places further restrictions on the availability of the drug. My pharmacy, for example, allows me to fill the prescriptions no sooner than one day before I run out. Other pharmacies have their own safeguards. Frankly, I don’t mind any of that hassle but I think that’s tough enough. The process is thorough and almost impossible to game. Unfortunately, it doesn’t end there.
I take two pain-killers. One for long-term relief and the other for break-through pain. I’ve been on that regimen for about a year. It works. I was happy with it and so was the pain clinic. But…when I went back last week I was told that they can no longer provide the same break-through pain-killer I’ve been getting. They said they could give me something significantly weaker. There was no medical reason to do that nor was there a legal reason. I have never abused the drugs. I follow all the rules, I take the medication as directed and I pass every qualifier they use. Those who don’t really understand chronic pain and that includes a good many physicians have adopted a new philosophy that says, “You’ll just have to bear some pain.” I say, why? What in the world does that accomplish?
So now, because the feds want to cut back on prescriptions with their blanket rulings I and millions like me have to be in pain. Is that nuts or what?
What you have read so far would seem to be strict enough, but the bureaucrats who designed all of this are just getting started and there’s little or no resistance. Here’s what I mean. Some of the companies involved in the chain of Opioid handlers have announced restrictions they say will help in the fight. The fact is they are covering their own butts. They are so intimidated by all of this, they just want to get out of the business entirely. Two examples are the CVS pharmacies and the Cigna Insurance Company and they may not be alone they are just the first two dominos. You can bet others will follow suit.
CVS now caps the number of pills it will dispense. They will allow a patient a seven day supply. How absurd. How do you get an appointment to see a physician every week for a new prescription? Additionally, many of us are disabled and couldn’t go if we could get an appointment. CVS says they will also educate patients regarding the importance of taking the least amount possible so they don’t get addicted. CVS, then, has taken it upon themselves to determine the patients’ level of need and how long they will need relief. Since when do pharmacists have medical degrees? They are making these arbitrary decisions without ever seeing my medical record.
Then, there is the Cigna Insurance Company. Not to be outdone by CVS, Cigna says that beginning on January 1 of 2018 they will no longer be providing coverage/payment for scripts for OxyContin/Percocet/etc., no matter what the reason or duration of its use. You can bet they’ll save a ton of money, money they can use to better compensate their executives. I don’t know about you, reader, but I’m quickly getting the message, “If you have pain, learn to live with it because we don’t care.”
We’re still not done with restrictions. Some 1.2 million Americans with substance abuse disorders have been getting help through Obamacare’s Medicaid expansion but now the Trump administration wants to end that. The president’s own budget calls for $100 million in cuts to the Substance Abuse and Mental Health Services Administration’s funding. One of the Trump campaign promises was that he would “work with” addicts and “make them better” By that budget cut he is letting down the very people who supported him from the start by treating addiction as a crime rather than a disease.
The war on Opioids whether intended or not is also a war on chronic pain patients. Just last week, the ramped up the pressure. U.S. Attorney General Jeff Sessions says the Justice Department is going to crack down on marijuana growers whether legal for medicinal purposes in a state or not. There is no good reason for such a move other than ignorance, vindictiveness or a bully showing off his power.
Addiction experts will tell you there are alternatives to opioids. They often recommend Tylenol or steroid injections, or classes in pain management or even acupuncture and hypnosis. Don’t you think that if Tylenol worked I’d be taking it? As to all the rest not one of them offers instant, dependable relief from pain. Take classes? Who could concentrate on a class when you are in pain? Opioids give instant relief. None of the alternatives can be said to do that. Waiting for days or weeks to see what works is extreme cruelty, I’ve experienced it first hand. Not long ago I was at a clinic looking for alternative treatments. They offered several options all of which took time and offered no guarantee. I asked the physician if I could get something to relieve the pain while we explored the alternatives. His response? “Sorry, I can’t do that,” and he walked away.
In all of this hullabaloo the facts don’t support the contention that people who take opioids will become addicted. According to the National Institutes of Health people who are prescribed opioids for pain generally do not get addicted if they take the medications as directed. Among people who take prescription opioids as directed for a year, about 5 percent will develop an addiction disorder. I’m 78 years old if my pain is controlled and, as long as I take my meds as prescribed so what if I am addicted?
This is a very important issue. It could affect you or someone you love. Let your congressman and senator know what you think.
If you’d like to read more about opioids and pain control, here are some excellent resources.
- http://www.slate.com/articles/health_and_science/medical_examiner/2017/08/cutting_down_on_opioids html
And from where I sit, that’s the truth.