Pain patients deliberately forced into withdrawals

A patient at one of the Tennessee clinics that decided to stop using opioids (See Tennessee Pain Clinics to Stop Using Opioids) contacted me in desperation and anger after her opioid pain management was suddenly stopped. I urged her to write a letter of protest, as we all should when these things happen.

The CDC Opioid Prescribing Guidelines are suggestions, not legal regulations to be indiscriminately applied to all patients in all cases.

The guidelines were never meant to apply to pain management specialists, only primary care providers, yet they are being used to terminate successful opioid therapy on a moment’s notice.  

Some will provide one final month of prescriptions, but 30 days is not nearly enough, according to medical standards.

A medically correct opioid taper calls for a 10% dose reduction every week and thus requires 2 1/2 months.

These abrupt policy changes will force patients into horrible withdrawals from a medication that was working effectively for decades.

How can this be proper medical care? Deliberately inducing opioid withdrawals in their patients sounds like malpractice to me.

Her letter is a good template for others who might be facing the same situation:

Letter of Protest after Termination of Opioid Therapy

On Friday, May 6, 2016 I arrived for my scheduled appointment at the Tennova Pain Management Center on Broadway (the “Center”).  I was abruptly told that they were no longer prescribing opiates and I was handed the attached letter.

I was then asked if I wanted to discontinue the opiates I have been taking for years immediately or if I would prefer another month to taper off.  In disbelief I was then told to sign a form saying that I wanted a prescription for one more month of opiates.  Our meeting seemed to be over.  No advice was given for tapering off until I specifically asked about it. I was told to reduce the dosage weekly.

I have been a patient with Tennova for over eight years.  I have never missed an appointment, never taken more than prescribed, and have never failed a urine drug test.  Although I still experience continuous pain and cannot hold a job, with the help of opiates I am able to have some quality of life. Without them I will essentially be home bound, possibly bed-ridden, for large parts of a long 24-hr day.

This abrupt news came after months of other changes at the Center that have caused me physical pain and mental anguish.  They began several months ago when the Center made the decision that patients across the board would no longer be prescribed Opana which was working beautifully for me.

This decision was completely voluntary.  In the Tennessee Chronic Pain Guidelines there is no recommendation for discontinuing the use of Opana.  In fact, the Guidelines state that “The long term goals of appropriate pain management are to improve symptoms, function and overall quality of life while minimizing adverse effects, addiction, overdose deaths and NAS.”  This goal was being met in every aspect with my use of  Opana.  When I questioned why I could no longer take Opana I was told that “someone might get hold of my pills and die.”

I was then prescribed MS-Contin which had intolerable side effects.  Finally, after a month of misery, I was prescribed Oxycontin.  I do not receive the pain relief I need with Oxycontin and my functionality has declined significantly.   .

The next visit I was told that I could no longer take clonazepam because Tennessee requires that patients can no longer take benzodiazepines with opiates. In reviewing the TN Chronic Pain Guidelines I see that this is a not a rule but rather a suggestion.  I have general anxiety disorder that sometimes results in severe panic attacks.  Receiving this news obviously had an adverse impact on my anxiety levels.

The attached letter says that Tennova will “work with you to develop a clinically-appropriate tapering regimen to transition you to the appropriate alternatives.” I do not believe that, after taking opiates for over eight years, I will be able to wean off of them without withdrawal symptoms in one month.  I cannot believe that this a “clinically-appropriate tapering regimen” for my situation.

The letter continues with “If despite our best efforts, you experience withdrawal symptoms, please seek treatment at the nearest emergency department.”  Going to an emergency room in a state of withdrawal will not result in an appropriate tapering off regimen.  It will result in being admitted to a psychiatric unit where the patient will be detoxed with absolutely no regard for the pain that they will experience without opiates.

The state of Tennessee  seems to be exhibiting a knee jerk reaction to the upcoming CDC Guidelines for Prescribing Opioids for Chronic Pain.  These guidelines are voluntary and apply to primary care physicians.  Tennova has taken it another step forward by throwing up their hands and indiscriminately cutting patients off from the pain relief they need, regardless of the cause of their pain.  And they have done so in a most irresponsible and cruel fashion.

I do not know why Tennova has decided to take such unneeded drastic steps but it certainly is not for the health and well-being of their patients.  If Tennova is worried about law suits from people who have been prescribed opiates and their families, then they should be doubly worried about the lawsuits that will inevitably come when their former patients suffer the excruciating effects of withdrawal, or worse, decide they cannot face another day without some hope of pain relief and commit suicide.

Below is the letter these clinics sent their patients:

It’s hard to believe three doctors signed off on this new practice of sending patients into forced withdrawals. This is NOT proper medical care and I can only hope that someone will start a class action lawsuit.