Clampdown on Rx opioids is hurting pain patients

The clampdown on opioid prescriptions is hurting pain patients – by Kate M. Nicholson – Jan 2019

Here is another article by our great advocate, Kate Nicholson, that appeared in the Los Angeles Times – a very mainstream media outlet – where it could be seen by millions.

…at the age of 30, I was no longer able to sit or stand. I could barely walk short distances. These limitations, related to a surgical mishap, would continue for almost 20 years…

When medical advancements led to an improvement of my health, I went off opioids without incident.

I’ve heard from multiple people who are taking opioids that, if their pain lessens for some reason, they can sometimes dramatically reduce their own opioid doses without suffering significant withdrawal symptoms.

I have experienced this too. My daily opioid dose can vary by a factor of 2, depending on how severe my pain is, and I don’t suffer withdrawals on days I take substantially lower doses – at least not in the short term.

I was, as it turns out, incredibly lucky. A report released last month by Human Rights Watch paints a cautionary and at times harrowing picture of what pain patients are experiencing today.

Patients who rely on opioid analgesics are being forcibly weaned off the medication or seeing their prescriptions significantly reduced

Increasingly, the guidelines are treated not as recommendations, but as one-size-fits-all mandates. They are being misappliedby physicians, state legislatures, insurers and Medicaid programs.

Some physicians told Human Rights Watch researchers that they had taken patients off opioids, or reduced patients’ prescriptions, against their better clinical judgment.

“You set yourself up for a liability, even when you know they’re not addicted and they’re benefiting from opioids,” one physician said.

Other doctors said that they had stopped treating pain patients altogether — even patients who don’t use prescription opioids.

Even when their use is appropriate, opioids carry risks, and the risks increase at higher doses. The CDC was right to encourage judicious, responsible prescribing.

But chronic pain is a large umbrella category, encompassing a wide range of injuries and diseases, some of which are incurable.

A one-size-fits-all approach to treatment does not work.

No medically trained person could believe such a simplistic statement nowadays, when we know how incredibly complex and different our individual bodies are.

That such a ridiculous idea is being adopted as a rule or law shows how dangerous it is to allow medically untrained people like politicians and bureaucratic agencies to make decisions about our individual medical care.

The recent clampdown has had harmful consequences. Some patients told researchers that they were forced to quit working or go on disability when their medication was denied. Others are now homebound. Many mentioned the possibility of suicide.

Patients also said that they were turning to alcohol or illegal substances to treat their pain.

What began as an effort to protect patients may be morphing into one that is harming them. The CDC’s National Center for Health Statistics estimates that 50 million Americans have pain every day and nearly 20 million have pain that limits major life activities. If the experiences that patients described to Human Rights Watch are common, the harm to patients could be widespread.

The CDC’s own data show that fatal overdoses are driven largely by illegally produced fentanyl, its analogs and heroin — not by medically prescribed opioids.

It’s outrageous that the CDC promotes policies that are contradicted by its own data.

This federal agency has gone off the rails and needs a major leadership change and restructuring to prevent more disasters like they’ve created around opioids.

For all these reasons, the CDC should address the misapplication of its guidelines, as the American Medical Assn. recently did. The agency needs to revise its guidelines to recommend that physicians not abandon pain patients or engage in “forced tapering.”

The CDC should also study and address any unintended consequences of its 2016 guidelines, as it promised to do.

Since I don’t believe the consequences to legitimate pain patients were unintended, that would explain why they aren’t studying them as “unintended outcomes”.

Tackling the overdose crisis is a vital public policy goal. But chronic pain patients should not become casualties in that fight.

Kate M. Nicholson is a civil rights and health policy attorney. She served for 20 years in the Department of Justice’s civil rights division, where she drafted current regulations under the Americans With Disabilities Act. She gave a TEDx talk about chronic pain, “What We Lose When We Undertreat Pain.”

Here is Ms. Nicholson’s story in more detail:

In the summer of 1994, I was working at my desk at the Department of Justice when my back started to burn. Moments later, my body seized up, and I fell to the floor. Suddenly, at the age of 30, I was no longer able to sit or stand. I could barely walk short distances. These limitations, related to a surgical mishap, would continue for almost 20 years.

After dozens of failed treatments, I reluctantly tried prescription opioids. The pain medication enabled me to work despite my condition. I argued cases in federal court from a foldable reclining chair, negotiated settlements by video teleconference and, working remotely, managed litigation in U.S. attorney’s offices across the country.

Ms. Nicholson is one of our best advocates, as she’s a lawyer who was crippled by her own chronic pain for years. I’ve posted several other articles she has written:

• CDC’s opioid guideline is harming pain patients
• Wise words from Kate Nicholson
• Denying Treatment to People With Chronic Pain