The worst of both worlds: the war on opioid abuse becomes the war on pain patients
The opioid abuse (and overdose) epidemic isn’t fueled by chronic pain patients. Most of the abuse problem involves the use of illicit drugs by addicts, and then to a lesser extent the selling of drugs left over from short-term prescriptions to deal with acute pain. There are also patients who fake pain in order to obtain drugs.
Many people who truly suffer from chronic pain of a serious type often need to be on opiates in order to have any quality of life at all.
The government is trying to deal with and control opioid abuse, but somewhere along the line the message got garbled and some chronic pain patients have been the ones to suffer, while the abuse statistics continue to climb in the rest of the population.
It’s the worst of both worlds:
Political leaders and government officials often failed to note the bulk — at least 60 percent, according to the U.S. Department of Health and Human Services — of the overdose epidemic was caused by illicit drugs, not prescription painkillers.
And when officials did address the portion of deaths due to prescriptions, advocates of safe opioid use argue, they often lumped together pain patients and people with addiction who illegally obtained someone else’s prescribed opioids. That made for a perfect storm, which formed the basis for a slew of hardline state and federal policies, including a Trump administration vow to slash prescriptions by 30 percent over the next three years.
Either in response to the CDC guidelines or as proactive measure to deal with the opioid crisis on their own, at least 33 states have enacted some type of legislation related to prescription limits, according to the National Conference of State Legislators. Health care providers and pain patients who have Medicare prescription plans are bracing for January, when the federal insurance program will give its insurers and pharmacists the authority to reject prescriptions that deviate from CDC recommended dosage.
“The CDC guidelines were geared to primary care doctors, but they have been hijacked and weaponized as an excuse for draconian legislation,” said Michael Schatman, a clinical psychologist and director of research and development at Boston Pain Care, a multi-disciplinary pain clinic, and editor-in-chief of the Journal of Pain Research. “Illicit opioids, not prescription opioids, are driving overdose deaths.”
The article describes some chronic pain patients who are committing suicide as a result of doctors cutting back even now in anticipation of later cutbacks. It’s a sad and terrible situation.
I was a chronic pain patient for close to 13 years, beginning in my early 40s. For much of that time my pain was fairly severe and sometimes very severe, and it was neuropathic pain, a type that’s particularly difficult to control even with narcotics (I’ve written about it here and here). I wouldn’t wish that degree of chronic pain on a dog or my worst enemy.
I never took narcotics, but that was because I was literally terrified of them, plus I was told that opioids wouldn’t even help with my condition. This was a long time ago, and perhaps the medical point of view on that has changed in the intervening years, but I remember one of the first doctors who treated me saying to me, “Nothing will touch this pain, not even morphine.” That made me understand why people with chronic pain sometimes kill themselves.
But it’s been my impression that a lot of people who’ve never faced chronic pain do not understand the phenomenon at all. They imagine a type of pain that’s not as severe as chronic pain can be. But perhaps more importantly, they imagine a type of pain that’s time-limited and that improves on a daily or weekly basis. The thing that distinguishes chronic pain is the fact that it does not improve and the patient sees no end in sight, which saps the two basic ingredients patients require to carry on: energy and hope.
What states have passed these laws limiting chronic pain patients to the CDC prescribing guidelines? How strict are these laws? How many insurance companies will deny drug coverage if a patient exceeds those guidelines? This could be a real disaster for people who are already suffering more than enough.
The problem here, as in so many other cases when the government attempts to “help” people, is that government is mostly stupid, and stupid multiplied by stupid equals stupidity squared. Drugs? Attack the doctors and pharmacists, because they are the visible and obvious targets. Never mind that most drugs don’t come from pharmacies.
Gun violence? Attack the gun stores and gun manufacturers, because they are visible and don’t move around. Never mind that most criminals didn’t buy their guns. Never mind that most criminals don’t go to the range very often; ban ammunition, because gun stores are visible.
Progressing from one real and perceived extreme to another seems to be a persistent human folly.
This has affected a person very close to me. That person was disabled due to chronic pain starting about 20 years ago and until very recent times, was doing fine on the same dose of the same medicine that person had been taking for a long time. Then came doctors removing useful pain medication from chronic pain patients, and now this person puts on a brave face but suffers daily with the completely useless medication that has been prescribed as a substitute. People wouldn’t do that to a dog – but they do it to chronic pain patients and pat themselves on the back for their do-gooding.
As noted already, it’s stupid * stupid. Sadly, many involved really do think they’re doing a good, noble and right thing. But it fills me with rage. Good intentions are not a justification for bad outcomes.
In dealing with my Father’s final illness I came to understand that no one understands another persons pain. I have long thought that this “war” on opioids would cause much more damage that real help in controlling drug deaths.
Policy should be based on statistics (boring), not on the latest MSM created crisis (fascinating). But how can you get elected by quoting statistics?
I fear that so long as we use a one-man/one-vote model of democracy, our elected officials will be of mediocre character and ability.
What we need are more experts or unelected civil servants to solve the ethical and moral dilemmas intrinsic to human existence. (not)
Yeah, this is pretty horrible. I have a friend with serious health conditions, some quite painful. It’s become difficult for him to get pain meds. If it gets too bad, he goes to a local bar where he can score hero in. Not his preference.
He hasn’t had to do that for a while. Now there’s the additional problem that heroin is being adulterated with fentanyl which is quite dangerous.
I have a couple oxycodone scrips leftover from a hernia operation and a shingles bout that I guard jealously in case my shoulder bursitis kicks up again.
A burn victim once said the worst part was there was never a vacation from the pain.
I treat people with chronic pain. The “guideline” is a maximum daily dose equal to 60mg of morphine a day. What do I tell the guy who is on time-release morphine capsules 200mg three times a day? There’s supposed to be a study somewhere the guideline was based on. Too bad my patients didn’t read the study, so they’d know they’re not supposed to have any pain..
I could tell you first hand stories of the “thought leaders” in pain management.. God I hate that term “thought leader”. The ones I’ve met have never had an original thought that wasn’t bought and paid for. They’ve never experienced real pain, and when their ideas fall flat their answer is just “Oh well, guess I’m out of ideas!”, but delivered oh so politely by their PA, so they don’t have to look at the patient again.
It’s a problem here in Tennessee.
Another reason why I am glad I’m retired. I have sympathy for my friends in pain management. My wife has rheumatoid arthritis and cannot take any of the immunosuppresive drugs for it because of lung problems. I’m deciding rheumatologists are the most useless human beings. Fortunately, she had an immunology guy who figured out her major problem and she feels OK except the joints.
I can’t find a source for this, so I don’t vouch for its truth, and (heaven forfend) it’s just barely possible that I have it a bit garbled. But my best friend lived in Arizona, and she told me that the rules for pharmacies in Arizona were to limit the amount of opioid pain-killers they were allowed to sell each month. As a result, a lot of people with chronic pain turned to street heroin because they couldn’t get their prescriptions for opioid painkillers refilled.
Internet searches do turn up results saying that fentanyl is worse than opioids (opiates???) in terms of addiction, and that the results of the war on opioids include increased usage of fentanyl. My friend ended up with fentanyl patches for awhile, to treat her cancer pain. Because she was in Hospice care, she was subsequently able to get proper meds, for awhile. Ultimately that route also failed. There are also articles to the effect that nationally, many doctors have cut back on the number of opiate prescriptions they write, and that in many cases long-time sufferers of chronic pain, who were supposedly exempt from the new limitations, found themselves nevertheless limited to doses that were wholly insufficient to manage their pain.
I don’t agree with government’s prohibitions on drugs anymore than I would with the failed Prohibition, but I do concur that addiction, at least in our culture, tends to bring with it a host of problems for people who see their families or their communities badly damaged or outright wrecked by irresponsible “recreational” use.
Still, a lot of that damage (such as the drug-gang violence) wouldn’t exist, or would be much, much less if it did exist, absent the War on Drugs. Or so it seems to me.
And demeaning people like Rush (of whom I’m not a fan, as well as not a “hater”) and Burt Reynolds, both of whom became addicted to prescribed painkillers, as “druggies” is unconscionable.
It has long been clear to me the opioid “crisis” is manufactured. By our politicians in a rare right-left do-gooder alliance; by China (where all illegal fentanyl is made), about which we will do nothing because of “trade”; and the Mexican narcotraficantes, about whom we can do nothing, not even build a Wall. Plus, of course, our good ol’ local drug dealers like MS-13. Don’t hear much, though, other than opioids are “overprescribed”. By doctors, the putative sole source of this evil!
Meanwhile the Dems promise us a bed of thornless roses with single payer health insurance for all. You ain’t seen nothin’ yet in terms of suffering needlessly.
It is an obscenity to hamstring proper palliative care with the excuse that druggies are ODing too often on illegal drugs or legal drugs obtained illegally. Palliative care can be long-term; it is not just for the last few weeks or months of life.
Absolutely, on all counts, Cicero!
(Save only the bit about China’s providing the illegal fentanyl. Since I’ve never actually dated China.)
There is a new hope for pain patients: extract of a Moroccan plant euphorbia resinifera can kill pain for several months just by one dose without any side effects for central nerve system. This is not a narcotic at all, it simply short-circuits peripheral pain receptors for good, and the effect lasts until new receptors grow. But probably it would not affect neuropathic pain at all.
Julie mentions part of the problem, without quite hitting on it:
Over-prescribing and scrip-hunting as against actual need.
Are there folks over-using and abusing legal prescriptions? Absolutely. And there have been lots of efforts to reduce that (some partially successful).
But, like so many other things, the gov’t feels the need to stop this problem. And since the doctors are the ones they can control, they look for a way to find the “bad” doctors. And the only basis on which to measure whether they’ve been bad is by looking at the number of prescriptions for opioids which they write. So they *all* cut back – regardless of the validity – so they won’t fall under the fiery gaze of the Eye of Gov’t.
But, hey, you just *gotta* have a national solution to this, right? *smh*
Soon, it might not matter:
Russia has tested a new hypersonic anti-ship missile that can travel a blistering 6,138 miles an hour, or 1.7 miles a second. The missile, known as Zircon, will attack ships at sea and land-based targets. It is in all likelihood unstoppable by modern air defenses. – Popular Mechanics
The real threat, however, is from the Russian Navy’s new Yasen-class submarines. According to TASS the same vertical launch missile launchers that allow the Yasen class to carry up to 40 anti-ship missiles also allow the submarines to carry Zircon. Unlike surface ships, which could be tracked, a Yasen-class submarine could launch them from an unexpected location and direction. – Popular Mechanics
Although the U.S. Navy has a variety of defenses, from SM-3 ballistic missile interceptors to SM-6 surface-to-air missiles, each is optimized against certain threats. While SM-3 can take on incoming ballistic missiles moving at a similar speed, it does so at the borders of space, far above Zircon’s likely flight profile. SM-6 can shoot down short-range ballistic missiles, cruise missiles, anti-ship missiles and aircraft, but whether or not it can hit something moving at 1.7 miles a second is unknown.
Where Zircon could really excel is as a nuclear weapon. Fired from a submarine off the Eastern Seaboard, a hypersonic missile could hit a target at 186 miles in just 109 seconds.
In BC, it is illegal fentanyl killing people.
https://d2ciprw05cjhos.cloudfront.net/files/v3/styles/gs_large/public/images/18/03/fentanyldeaths_180313.jpg
Most overdoses these days are fentanyl. It was never intended to be used as an oral pill. Patches can be used in cancer and other severe chronic pain. I used it when doing surgery and it was given IV by anesthesiologists. It is now showing up as an adulterant in street drugs like Oxycontin.
There used to be drug users who sought, and often obtained, prescription drugs. Some were from MDs and DOs who were crooks. One was an old GP in San Juan Capistrano 50 years ago who would have young obvious adits lined up outside his office every day at 6 AM.
Others would try to fake chronic pain. One good trick was to come into an ER complaining of what sounded like a kidney stone. The inventive would prick a finger and add a drop of blood to a urine sample. We all got wise to that eventually.
The present hysteria is dangerous to people with real pain. Before Trump, there was a real issue of joblessness and despair by middle aged people with no modern job skills. That is being dealt with by getting jobs returned from Mexico and China. Illegal immigration is next and that will be a real fight.
Hmmm. Comment vanished.
Mike K:
I rescued it from the spam filter. A couple of comments had gone in there for some reason. My guess is that the spam filter is focusing on words like “fentanyl” and thinks that makes a comment likely to be spam. But it’s not doing it to all the comments with that word, so I’m not sure what’s really triggering it.
Artfldgr:
You have to choose what to worry about; out of control feminists, or the new Russian threat of the day, or the Big One, or the Yellowstone super volcano, or …., maybe people overdosing on painkillers.
The problem with fentanyl is its very low therapy index, that is the relation of the lethal dose to the effective one. It is very hard to avoid overdose even with the best efforts to apply it responsibly, so it would be better to use this drug only by qualified personal in operation room or ICU, where counter-measures can be swiftly provided.
My comment has also disappeared.
What with getting hit by other cars a time or two and the resultant injuries, other medical conditions, and one surgery, over the years my wife and I ended up in the Emergency Room a couple of times.
Each time they kicked us loose with a prescription–filled by the on-site hospital pharmacy–for a lot of heavy duty painkiller pills–OxyContin, Hydrocodone, etc., and sometimes, if I recall correctly, with refills.
Knowing how addictive these drugs were, we each took none or one or a half of a pill, and then dumped the rest of the prescription in the trash, and just dealt with the pain, which wasn’t that severe.
Always amazed at how liberal they were with these very dangerous painkillers.
Street fent***l is problematic when used to simulate oxy. They can’t grind it fine enough (and consistently) to be safe. You always end with a chunk big enough to kill you.
Snow on Pine:
Your comment had gone to spam, and I found it and rescued it. I think that the problem, once again, had something to do with the fact that several meds were mentioned, although not every comment like that gets tagged as spam.
Anyway, it’s appearing now in the thread.
By the way, it is often the case—or at least it was often the case—that opioids are prescribed for acute pain such as surgical pain, and people don’t need them and don’t use them. It’s happened to me many times. Sometimes people sell their extra pills on the illicit market (I’ve certainly never done that).
Govt is the most beneficent drug pusher. Friends go to the VA and walk out with literally hundreds of opioid pills. 80,000 deaths from these drugs and the best they can come up with is limiting older folks prescriptions. Every narcotic prescrption is recorded in a database.Feds could shut down pain mills and egregious script writers tomorrow ,but no; take away grandma’s pain meds
Somewhat related, When working as a Directional Driller in North Dakota a driller offered to sell me some of his Vicoden IIRC. He had a prescription because of rheumatoid arthritis, so he could skate on the mandatory drug tests. He was much younger than I, in his late 20’s. I wanted no part of that and declined the offer. That was 8 years ago and fatal highway accidents were common place at the time. Dangerous work, dangerous driving conditions, sleep deprived workers, and addicts. People didn’t OD, accidents culled the unlucky.
Quite a lot of people use marijuana for pain relief, particularly the CBD varieties. CBD marijuana doesn’t provide much of a high, but does relieve pain, though not at a heavy-duty level.
When I had my wisdom teeth removed in 1975, the dentist gave me a prescription for barbiturates. I threw them away and got by on some Columbian Gold I had lucked into — still the strongest high I’ve ever experienced, despite all the hype one hears about today’s products.
Neo: This is a bit OT, but maybe not: this (12/28) is the first time I’ve been able to access your site in four days. Have any of your other readers reported problems? I tried two different browsers and kept getting error messages like “no data sent” or “site has closed down abruptly.”
Update for Neo: I just now tried to move from this comments page to your home page and got the error message that your site “has closed abruptly.” I used the return arrow to get back here. I have no idea what is causing this problem– I haven’t had difficulty with any other websites, just yours.
PA Cat:
So far I haven’t had anyone else report a similar experience. It may be some glitch on your computer’s end, but I’m not sure. Let me know if it continues. Did you try another browser?
I just now tried to move from this comments page to your home page and got the error message that your site “has closed abruptly.”
Once in a while I get “404 error” messages but just wait a bit and all seems OK.
Maybe “504 error” but haven’t had one in a while.