Pain patients are being cut off from their medications

Pain patients are being cut off from their drugs. Here’s why. | Cindy Perlin, LCSW | September 18, 2016

Since the guidelines [from CDC in March 2016] were released, reports of pain patients being abruptly cut off of their medication or having their medication abruptly reduced have become rampant.

These patients report they were using opioids long term, sometimes for decades, with no evidence of addiction.

Many patients who moved long distances report being unable to find a doctor who would treat them, or, if they found one, who would give them their usual dosage of medication.  

These patients report significant increases in pain and severe deterioration in function. Usually, no alternative treatments were offered. 

Why would a doctor do this to a patient?  Here are a few reasons:

Doctors have been criminally prosecuted for prescribing opioids

Not wanting to blame drug companies, who had lied about the drugs’ addiction risks, the authorities focused on doctors.  

There were a few unscrupulous ones who had set up “pill mills,” practices where people without any legitimate medical need for the drugs could obtain opioids for the right price.  Apparently, there weren’t enough of those to make a big enough impression, so the Drug Enforcement Agency (DEA) started targeting other physicians.

Some doctors have been tried as drug kingpins and dealers and prosecuted for manslaughter when their patients died of an overdose. When convicted they are subject to the same mandatory sentencing laws as violent individuals dealing illegal drugs. The assets of suspected drug dealers can be seized without hearings or trial; consequently, they are stripped of the assets they require to defend themselves.

Graves was the first doctor to be convicted of manslaughter as a result of prescribing painkillers to patients who died of an overdose. During his career, Graves worked as a medical missionary and served 17 years as a Navy flight surgeon before being honorably discharged in 1994.

Graves was arrested, and his practice was closed down in 2000. He had no income or savings. The court declared him indigent, and he was represented by public defenders. Prosecutors persuaded drug addicts facing extended jail time to testify against Graves in exchange for more lenient sentences.

Two doctors testifying for the defense stated that Graves’s treatment of the patients who died was within the standard of care of medical practice and was for a legitimate medical purpose.

The prosecution failed to prove that he was medically negligent, or even that he was the cause of his patients’ deaths. Some of the deceased patients named were not even his patients or had died long after he stopped treating them.

It was never proven that he accepted any money in return for drugs.

Despite all this, Graves was convicted and sentenced to 64 years in prison.

Cases such as Graves’s allow the government to assert that it is doing something to address the problem of prescription painkiller addiction

Practice guidelines are generally treated as “standards of care” and physicians who don’t adhere to them are at greater legal risk if a complaint is filed.

Many physicians no longer make the policy decisions about their practices

physicians are often being told how to treat their patients by practice managers or the legal counsel’s office of the hospital.

Generic managers installed by financial interests are taking over healthcare:

These individuals are usually even more risk-averse than the doctors themselves and make decisions without seeing their impact on patients.

Physicians have not been trained in how to appropriately withdraw patients from medications

Pharmaceutical companies like having lifelong customers so they rarely discuss how to safely withdraw patients from drugs.

Why are doctors relying on pharmaceutical companies for information about the drugs they are selling?  This is a gross conflict of interest when companies selling a product have the last word on its use.

Physicians lack knowledge about and access to alternative pain treatments

There is little to no insurance coverage, and most pain patients can’t afford them.  Also, many of these services are not available in many communities.

What needs to be done

The DEA’s reign of terror over physicians needs to end.  

Physicians need more education about addiction and safely withdrawing patients from opioids.

Patients who are comfortable with their long-term opioid use who show no evidence of addiction should be offered alternative treatments but allowed to stay the course.  

Alternative pain treatments need to be adequately covered by insurance companies, and all physicians and patients need to be educated about them.

Author: Cindy Perlin is a social worker and author of The Truth About Chronic Pain Treatments: The Best and Worst Strategies for Becoming Pain Free.

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15 thoughts on “Pain patients are being cut off from their medications

  1. Dave

    The madness in pain care wont end without a pain rights movement. Medicine and government wont fix the problem. It is up to people in pain and their loved ones to transform pain care.
    Unfortunately.many people in pain are either consumed by pain and our poor pain care sysyem and or overconformed to the designs of others
    It is tragic and absurd the mess pain care has become. And i think it may get worse in the next few years.
    It is not too late for people in pain to band together and change the system of pain care. So far only a minority of people in pain seem to be fed up and without a million detetmined people to changebthe system i dont think things will get better soon enough.

    Liked by 1 person

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    1. Zyp Czyk Post author

      Re: “I dont think things will get better soon enough”

      That’s exactly my worry. Even though I still have my meds, I feel like my access is on the verge of being cut off, which would put an end to the limited activities I still engage in This fear is getting stronger as the anti-opioid campaign scores one victory after another.

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      1. Dave

        You might consider a b and c plan in case that happens. I mentioned incarvillateine. And maybe there is a pain specialist not too far away that might prescribe an opioid for you if your current provider stops.
        I would also finf out who is on your states medical board and try to fond out their position on the issue as they might have leverage in case they stop your opioids.
        I would be willing to write a nice letter on your behalf. Notice i said nice. But the pain community should work on a letter amyone in pain can use who is taken off opioids and be willing to protest individual decisions of providers .

        Liked by 2 people

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        1. Zyp Czyk Post author

          David, you are so kind! You’re right I should look into the CA medical board and send them some letters.

          I have written so much about this, but just never in a letter to “the powers that be” about myself personally.

          This is something I’ve been meaning to do anyway, but I’ve been procrastinating because it’s so hard. Now that you’ve pointed out how useful this could be I’m more motivated than ever.

          Liked by 1 person

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          1. painkills2

            I wrote to my State Medical Board. Waste of time. They receive a lot of funds from the drug war, and now, from the opioid war. It helps them keep their jobs, but they’re also staunch believers in the drug war. Hope you have more luck.

            Liked by 1 person

            Reply
            1. Zyp Czyk Post author

              Sometimes I just have to try – we never know what the results of our actions might be.

              This is CA where I like to think we are a bit more progressive than NM.

              I don’t expect results, but for my own sake, I have to at least try. Otherwise, when they take my pain meds away I’ll feel like I “let” it happen without protest.

              Liked by 1 person

  2. Laura P. Schulman, MD, MA

    Suddenly these “guidelines” have been adopted into law, without any of the usual opportunity for discussion and debate prior to enacting a law. Big Brother has arrived. This is what my generation of physicians tried so hard to avoid: corporate medicine and the erosion of physician autonomy. The AMA sold us out when it endorsed the HMO model in the 1990’s, opening the door for the total corporate takeover we see today. Today’s doctors never knew a time when they didn’t get their orders from some business person in an office. The people who are being sacrificed, as in your example above, are the older generation who still practice according to their own judgement. You can bet that poor bastard pissed somebody off, so they made an “example” of him. Now everybody’s running scared, lest they also lose everything including their freedom. We probably won’t see doctors (and nurse practitioners and physician’s assistants) bailing out of medicine, but we will see a whole lot of abandoned patients (read: anyone on long term pain meds).

    Liked by 3 people

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    1. Zyp Czyk Post author

      I don’t understand how these guidelines became a general law, except through such DEA intimidation tactics. It’s all part of keeping the drug war going, finding new targets to expand its scope.

      The unrelenting flow of bad news for pain patients is getting to me, the fear of losing my pain meds, the complete disdain for logic exhibited by the government and other rule-makers that will ruin my life, it’s overwhelming and exhausting and depressing beyond what any antidepressants can help with. This is a true danger, not a fantasy, not catastrophizing, not a mood disorder, but a very real threat to my wellbeing and even survival.

      Liked by 4 people

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      1. Laura P. Schulman, MD, MA

        I was recently sent to see someone at a prominent “Spine Center” who turned out to be a “pain rehabilitation specialist.” This seems to be a new industry, spawned by the new guidelines. I’ll be writing a post about it soon, when I get less triggered about the whole thing.

        He tried to tell me I have fibro without even listening to my issues. I wasn’t there for pain medicine, simply wanting answers to my concerns about spine surgery, specifically because of my atrophic skin and blood vessels. When I managed to get a word in edgewise (he was lecturing me on the dangers of treating pain with drugs), I stood up and planted my palms on the floor and wrapped my arms around my legs. I can no longer stick my head between my knees because my lumbar spine has fused itself. I showed him my stretchy atrophic scarred skin.

        He began shouting, “EDS is not painful!” So I showed him my hands, which are knotted and deformed. That happens when you are hypermobile and get into your sixties. Whole body arthritis, plus my viscera and bone marrow are being taken over by hemangiomas. Oh yes, this is painful.

        Finally, I was treated to a harangue about the dangers of the medical marijuana that I’m prescribed, legally. I think he wrote that I’m a drug abuser in my chart. Just wait till I get hold of that!

        Yes, I am worried for your welfare. This thing is affecting lives, and I’m afraid many lives will be lost. I really don’t know what the point of the whole thing is, because insurance is for sure not going to pay for the fancy new designer drugs to treat pain.

        I’m trying to get myself in better shape so I can go back to practicing acupuncture. As it is, I can’t look down for very long because my cervical spine is so messed up. I miss helping other people to live better quality lives. I’m angry that I’m a prisoner to pain, with little hope for any improvement in quality of life.

        Liked by 3 people

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        1. Zyp Czyk Post author

          I don’t know how such people are allowed to practice medicine when they believe the media over science and uncritically swallow and regurgitate whatever nonsense comes into their ears. This guy is basically telling untruths and I thought doctors weren’t allowed to do that,

          When opioid patients have been deserted without tapering, that seems like a clear case of malpractice – but it seems anything goes if it supports the drug-war.

          Liked by 1 person

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          1. Laura P. Schulman, MD, MA

            Absolutely regurgitating word for word bs.

            Yes, a friend of mine was simply discontinued from a morphine patch…pitched right into withdrawal, total agony, definitely malpractice, but what’s an “addict” to do? Labeled as such, instant erasure of all credibility. Disgusting vacating of duty.

            Liked by 3 people

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    2. humanecare

      Good old HMO model of care. Whenever I see ” evidence based” it’s a” red flag”, no pun intended. It sounds good, but it’s usually “one size fits all” medicine, and not based on personalized medicine which includes the patient, and all the variables each individual presents.
      Kaiser HMO is based on this, and when I read that they we going to be the model for the ACA, I thought, Oh Oh …here we go…and here we are…!!! My husband and I had Kaiser for several years and it was horrible, basically “you’ll take what we give you and you’ll like it” no listening to the patient, and like a human mill. I read somewhere they call it Kaiserizing…basically you’re so traumatized that you stop trying to get help from them with medical issues, and have to go outside the system for good care. Except now it’s become THE CARE everyone is supposed to get..and it’s hard to go outside the system for good care because it’s almost gone.
      I see the guidelines like that (evidence based-one size fits all) and now all these patient advocacy groups hollering for alternative methods because decent care is disappearing.
      I never thought I’d be crying out for good medical care, but as we age our bodies change and now it’s going downhill fast.

      Liked by 4 people

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  3. painkills2

    There are no consequences to a doctor who abandons a patient. While withdrawal is torture, it usually doesn’t kill people. It can, but usually not. But there are plenty of consequences to a doctor who doesn’t follow the “standards of care.” Because standard treatments don’t work for everyone, there will always be a percentage of patients who don’t receive help and are harmed. The CDC’s new standards of care affect tens of millions of people, so the harm will be greater.

    “The guidelines were a response to a serious and growing problem: millions of pain patients became addicted to prescribed opioids, and hundreds of thousands died as a result.”

    I’m sorry, but this is bullshit. And anyone in the medical industry who believes this is not to be trusted. Millions of pain patients did not become addicted to opioids. Hundreds of thousands of pain patients did not die as a result. The majority of patients who are dying are those suffering from addiction, a patient population that is very small compared to the pain patient population.

    Liked by 2 people

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