Are chronic-pain patients victims of the war on opioids?
The opioid crisis has captured headlines and news broadcasts for the past few years. This is hardly surprising. Far too many people have died from narcotic overdoses.
There is a downside to demonizing these pain medicines, however. Many chronic-pain patients have been denied access to drugs such as hydrocodone and oxycodone. That’s because of pressure from the Centers for Disease Control and Prevention, the Drug Enforcement Administration and insurers to discourage prescribing or dispensing opioids. Many experts believe that overprescribing is behind opioid misuse and overdose deaths.
The message is that opioids should be used only for acute pain, such as after a serious accident or surgical procedure. Health professionals are being told that prescribing these drugs won’t help patients in chronic pain. But most patients are not being offered alternatives.
The Food and Drug Administration held hearings this month, and patients in chronic pain voiced their frustrations. Many complained that the medications that helped them function previously are being withheld, even if they took them precisely as prescribed.
One patient who testified at the FDA hearings was a disabled registered nurse with cervical scoliosis and ruptured disks that cause unremitting pain. She has been treated for a decade, going to the pain clinic each month and seeing her primary-care physician every three months. Although she never was identified as a problem patient, she is now unable to access the pain medicine that allows her to function.
Millions of patients are in a similar predicament. The decision by the Centers for Medicare and Medicaid Services not to cover opioids above a given dose next year might make the problem worse.
We have heard from hundreds of people who are desperate as a result of these restrictions. One person wrote: “I have more than I can handle just typing right now. The pain meds don’t make it so I can walk. At times, I even try not to drink anything for fear that I might have to go to the bathroom.
“If the restrictions get even tighter, I won’t be able to tolerate it. I only tolerate it now so I don’t leave my golden retriever alone. He’s the reason I haven’t killed myself already.”
Another man wrote: “I had back-fusion surgery involving multiple vertebrae. It left me worse than before. I’ve been on [opioid] pain meds for five years, with a drug test every month, and I have never caused any problems.
“Now the doctors are cutting my meds so much that my quality of life is zero. It was bad enough before. I am considering suicide and I wonder if that is what they want.”
Even cancer patients are not immune to the increasing restrictions: “My father attempted suicide last week because the director of his pain clinic abruptly cut all his pain meds. He suffers irreversible chronic cancer pain!”
Not every person in chronic pain is considering suicide. But they all deserve compassionate treatment to alleviate their agony.
Opioids have been used for more than 5,000 years. They are powerful analgesics. Until drug companies develop more effective and safer alternatives, decision makers need to recognize that people with intractable pain deserve relief. For some, that will require opioids.
Keeping illicit fentanyl and its derivatives out of the country might be a more productive way to control the opioid epidemic that is killing people.
Joe Graedon is a pharmacologist. Teresa Graedon has a doctorate in medical anthropology and is a nutrition expert. Their syndicated radio show can be heard on public radio. In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 628 Virginia Drive, Orlando, FL 32803, or email them via their website: www.PeoplesPharmacy.com.
2018 King Features Syndicate, Inc.