When Patients Need Opioids to Ease the Pain

When Patients Need Opioids to Ease the Pain – The New York TimesBy Mikkael A. Sekeres, M.D.July 10, 2019

Here’s a doctor making a case for us:

Some patients genuinely need powerful painkillers to make their excruciating existence at least somewhat tolerable.

This statement by a medical doctor should carry some weight, but the rule-makers don’t want to hear anything but the popular story of evil opioids addicting the innocent. This may be quite rational if most of their supporters believe it to be true. 

My patient, a yoga instructor, had already received a week of chemotherapy, so he couldn’t be called a complete newcomer to the side effects of his treatment.  

He was in his 70s and had a rare variety of a rare cancer: acute lymphocytic leukemia. The drugs had hit the mark, as the leukemia had disappeared entirely from his blood stream.

The drugs had also inflamed and eroded the tissue lining the inside of his mouth and esophagus. The pain that resulted made it nearly impossible for him to consume even the thinnest of liquids. One patient told me that with this condition, called mucositis, drinking water was like trying to swallow glass.

On morning rounds, I asked the nurse practitioner caring for him what medicines he was taking to relieve his distress. She grimaced. “Not much. He can’t take pills anymore,” she said. “We gave him a mouthwash to help with the pain.”

“What about a P.C.A. pump?” I asked. Patient-controlled analgesia pumps allow a background rate of narcotics, often morphine or fentanyl; the patient can then administer extra doses, or boluses, as needed by pushing a button on the IV pump. It was our usual treatment for the unrelenting agony of mucositis, which wouldn’t get better until his immune system recovered from the chemotherapy, weeks from then

“He’s refused it,” she said, simply. “He doesn’t want to get addicted to the drugs.”

When I entered his room, my patient gave us a brave smile behind his bedside table. It held cups of water, ice, liquid medicines to numb his anguish, and sponge applicators he could use to gently apply the medicine to the fire that raged in his mouth. His lips were red and swollen, the inflammation made even more stark in contrast to the iridescence of his yellow skin. I sat at the edge of his bed.

“That looks like it really, really hurts,” I said softly. His eyes met mine briefly, then looked away. “It’s not fun,” he answered, his voice barely above a whisper.

“Will you let us help with the pain? The only way people get through this is with narcotics we can give you through your IV. The P.C.A. pump.”

He shook his head. “I’m managing O.K.” He held up one of the green sponges he used for his mouth to show me how he was managing, wearily. It was an effort for him to say even those few words.

“Are you worried you’ll get hooked on the pain medications?” I asked.

I felt so bad for him. It wasn’t the first time I had heard this from one of my patients.

But there are people with diagnoses like cancer who wouldn’t be able to withstand their conditions — or the aggressive therapies we administer to try to rid them of these diagnoses — without supportive medications like opiates.

What has gotten lost in a lot of reporting about the crisis, and the regulatory guardrails that have been put in place to limit opioid prescribing, are the patients who genuinely need the drugs to make their excruciating existence at least somewhat tolerable.

I told my patient that, when used appropriately for limited periods of time and with a proper tapering schedule, it was unlikely he would get hooked on painkillers.

One study even showed that death from opioids was 10 times less likely to occur in cancer patients versus the general population.

“You know, we don’t award a crown of thorns at the end of this for suffering,” I gently teased him.

“O.K. I’ll try it.” He closed his eyes and let his head drop back in his pillow, as if even the thought of a drug that would finally ameliorate his pain gave him relief.

We started the P.C.A. within the hour, and that night he slept soundly, his pain eased, for the first time in days

Author: Dr. Mikkael Sekeres (@MikkaelSekeres) is director of the leukemia program at the Cleveland Clinic.

3 thoughts on “When Patients Need Opioids to Ease the Pain

  1. Kathy C

    This is a really big problem that is under-reported. The Hysteria over opiates is endangering people lives, and casing even more suffering. I have seen people become really distressed because they had a painful surgery and found out they were given morphine. Due to the lies and misinformation, they believe that if they are given morphine it means they are going to die. Of course nurses and physician don’t bother to explain that they are not dying.

    Family members are told that opiates mean death and addiction, and providing an opiate to a near death family member means they are killing them. There is no one to tell them it is alright, or that all they are doing is relieving pain. People are so terrified and misinformed, like the Yoga guy in the article. Yoga practitioners have been Gas Lighted, they believe that Yoga protects them from cancer, and old age. The fact that it does not, comes as a shock to them. Many of them over the years have told sick people that Yoga will cure them, and callously judged people who got sick as having a “bad lifestyle.”

    I came across this interesting article today, https://www.gsb.stanford.edu/insights/why-hospitals-underreport-number-patients-they-infect The Center for Medicare Services claimed that they were going after hospital acquired infections, a major problem, and very expensive for Medicare. Hospitals have a financial incentive to under report or misreport the numbers, and reporting requirements are different in different states. In my community the local hospital, which under reports infections and even deaths, ran an article in the business section. They created a public relations piece, that included an advertorial for a large corporation, that sold them devices to sterilize hospital rooms. It is extremely unlikely that their infection rates went down, or that these devices were effective, yet a marketer/journalist presented this as if it was. The idea was to promote sales for this large corporation, provide both the hospital and the corporation a nice public relations boost, and mislead potential patients over their odds of getting a hospital acquired infection.

    Hospital acquired infections were a big deal, yet CMS did not tighten up reporting requirements, they allowed the hospitals to do it on the honor program. The same thing with opiates, no one was tracking their use either. In the US die to our profit driven healthcare system is was just easier to prescribe them, instead of diagnosing or tracking why people had pain in the first place. The pharma industry got insurers to pay for a 30 day supply, and most Americans do not have access to their physicians, if their pain increased. The news continues to misreport this. They mislead about complications and infections, which require more pain medications. They do not want to research any of the factors that caused any of this, they want to blame the patients, and physicians. It is really deceptive to compare American rates of prescribing to other developed nations where people do not wait for years to see a physician, have less stressful jobs, and access to healthier living.

    CNN is covering JUUL and their youth education program, where they presented vaping as safe and effective. https://scopeblog.stanford.edu/2019/07/19/flavored-e-cigs-appeal-to-new-nicotine-users-stanford-study-finds/ This is not exactly groundbreaking research, JUUL already has proprietary research, on their massive social media campaign that targeted teens. Of course that Stanford researcher is not allowed to mention marketing or the research that was already done. All that JUUL had to do was present their products as a a “Wellness” product. Vaping was considered safer for smokers than cigarettes and they did claim it could help wean people off of cigarettes. The CDC gives them a step by step way to market E-Cigs aor anything else.

    https://psmag.com/news/the-cdc-defends-its-new-anti-opioid-campaign Most of the deaths are due to illegal drugs and drugs stolen from medicine cabinets or the black market. The addicted do not make a distinction between stolen, or black market pills and prescribed medications, and neither do the journalists. People are dying from fentanyl laced pills made to look like pharmaceuticals, while the drug cartels give them band names like “Oxys.”
    All that marketers have to do is appear to be addressing a public health issue. https://npin.cdc.gov/pages/health-communication-strategies-methods They can peddle nearly anything as long as it appears to be in the public interest. The fact that none of it appears to be working has not slowed them down at all. They failed to look at the marketing that was promoting the anti vaxx movment, in content ads or advertorials about vitamins or alternative health products.

    One in content piece written by a local physician, she promoted alternative products, and pharma products for the flu, targeted to people who refuse vaccines. She implied that there was no need for the Flu vaccine, there are pharma products to treat the flue if they did get it, in spite of taking vitamins and herbs for their immune system. Healthcare is a market, and it is buyer beware. If a person is uninformed or misinformed enough to buy a product or treat themselves with alternative care, they deserve what happens to them. The regulatory agencies are no longer regulating, and our academic institutions are no longer doing actual research. Academia has been corrupted by corporate funded research, and their need to attract attention to get funded.

    The CDC continues to protect fast food, and processed food, while telling people to exercise.
    https://www.facebook.com/CDCEatWellBeActive/ The food, sugar and soft drink industries, came up with this narrative. https://www.npr.org/sections/thetwo-way/2016/09/13/493739074/50-years-ago-sugar-industry-quietly-paid-scientists-to-point-blame-at-fat

    Promoting “healthy” fast food on Facebook. , “https://www.fda.gov/food/nutrition-education-resources-materials/calories-menu It is no wonder the American lifespan is getting shorter.


  2. Kathy C

    The NYT ran a piece, written by a physician, that stated that opiates had no known medical use. They frequently run ” editorials” and in content marketing, written by industry insiders without divulging their funding.

    Liked by 1 person


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