The True Victims of the Opioid Crisis Are Starting to Rebel (after 3 years of silence) – Wired.com by Michelle Cohen Marill – May 2019
I find this word choice curious, “starting to rebel” when we’ve been screaming bloody murder for three years.
Twenty years ago, easing pain was the mission and opioids were the method.
Yes, because they worked. Everyone seems to forget that.
Pain became known as “the fifth vital sign,” as important as blood pressure, temperature, heart rate, and respiratory rate, and hospitals and clinics routinely asked patients to rate their pain.
And now, just asking about pain and treating it is suspected to be “peddling heroin pills”.
In 1999 the Oregon Board of Medicine even declared that “clearly documented undertreatment of pain” was “a violation equal to overtreatment.”
At pain clinics, the best results came from offering a range of treatments, including physical therapy and cognitive behavioral therapy. But insurance was more likely to pay for the simpler pharmaceutical path.
They should fix this issue with the insurance companies, requiring them to cover alternative treatments for those who find them effective, before taking away the pain relief patients have achieved with opioids.
Also, if people are to remain “abled” they will need to spend 8 hrs a day working. Even if insurance covers it, where are they supposed to find the time for repeated ongoing treatment sessions during business hours?
I’m lucky that I had flexible hours which gave me the time to try out chiropractors, acupuncturists, and physical therapist. But realistically, I could not have attended such sessions on an ongoing basis – my job would not tolerate it.
The drop in opioid prescriptions might be a sign that the crackdown on abusive use is working. It also might reflect the plight of chronic pain patients who suddenly find it hard to get the prescriptions they’ve been using to help them get through the day.
One in four cancer patients have had trouble getting their pain medication because a pharmacist refused to fill the prescription, even though the drug was in stock
Suicides are rising among people with chronic pain, according to a 2018 analysis of National Violent Death Reporting System data. Halting opioids suddenly also can lead to cardiovascular problems, including heart attacks, according to Michael Schatman, director of research and network development at Boston Pain Care and editor in chief of the Journal of Pain Research.
“Pain patients have been abused,” says Schatman, who advocates for a middle ground on the use of opioids. “I believe that it’s genocide of people with chronic pain.”
That’s the depressingly real truth.
It is a new civil-rights issue, says Claudia Merandi, a retired court reporter with severe Crohn’s disease. “When you take away a person’s right to live a humane life, what else would it be?”
Perhaps the most powerful support comes from pain experts.
But no one in charge is listening to them.
The public, government agencies, and law enforcement are only listening to the recovery community’s spokespeople, like A. Kolodny.
In March, a group called Health Professionals for Patients in Pain wrote to the Centers for Disease Control and Prevention, urging the agency to respond to the “widespread misapplication” of its 2016 Guideline for Prescribing Opioids for Chronic Pain.
Patients were [and still are] being forced to taper off opioids and were subjected to unnecessary suffering, they said. The letter was signed by more than 300 health professionals, including three former US drug czars.
On April 9, the Food and Drug Administration (FDA) warned that suddenly decreasing dosage or halting opioids in patients who are dependent on them could lead to “serious withdrawal symptoms, uncontrolled pain, psychological distress, and suicide.”
The next day, the CDC director clarified that the agency’s guideline, which recommends against high doses of opioids, applies to the initiation of opioid treatment and not to patients who have been stable in long-term treatment.
Yet chronic pain patients say many doctors have already stopped prescribing opioids. They fear scrutiny from the Drug Enforcement Administration, state medical boards, or even their own health institutions
Sean Mackey, chief of the Division of Pain Medicine at Stanford University, was initially reluctant to enter the fray over opioids. “I prefer to avoid this space because there is so much emotional rhetoric and anger and attacks flying both ways,” he says.
“I just want to focus on pain, the research and clinical care of people in pain.”
Well, too bad.
You can’t keep your head buried in “research” when patient welfare is threatened.
You can’t do proper “clinical care of people” when politicians are trying to force you to stop providing effective pain relief (which is almost the definition of “clinical care”).
But he felt compelled to speak out against what he calls “a social experiment on a large part of the most vulnerable population.”
I suppose it’s better late than never, though I’ll never understand those three years of silence from these folks.
Mackey wrote a letter warning that forced tapering poses significant harm without any evidence of safety or effectiveness. It was co-signed by more than 100 pain and addiction experts and patient advocates.
“People of good conscience need to step up and say ‘No, this is wrong,’” he says.
Really? What was he doing during the last three years? Did he just now develop the conscience that should have compelled him to protest immediately?
On May 16, after an independent review found little evidence to support the alternative treatments or the tapering, HERC backed off of the proposal. It stopped requiring people with back and neck pain to taper off opioids and decided to revisit that coverage issue next winter.
So they think this proper medical care needs revisiting next winter. They will never just admit they were wrong – that doesn’t happen in politics or, apparently, in medicine.
Johnna Magers of Indianapolis, organizer of the June protest outside CDC, wants people to think about the lives that are threatened by the loss of access to opioids. “The rest of America better wake up,” she says.
“Because you are one accident away from being a chronic pain patient.”
Ah, we can only hope…