Opioid Crackdown Leaves Some Chronic Pain Sufferers Living in Fear
Posted May 2, 2018 11:20 a.m. EDT
Hampton Roads, VA — More than 42,000 people die from opioid drug overdoses each year according to the Centers for Disease Control. This has resulted in a crackdown on prescription opioids. Now, some chronic pain patients say they live in fear their quality of life will be taken away.
Every day there is a regimen of taking up to eight pills. First up is Percocet for breakthrough pain. Then, Nusenta, an extended-release painkiller which releases medicine over time. This is all to fight the chronic pain of constantly passing kidney stones.
"I would rather give birth every single hour of every single day instead of passing another stone," said Jessica Writesel.
Writesel is in her 30s and said she's in pain every single day. She was diagnosed with medullary sponge kidney disease after passing 20 kidney stones by the time she was 17. Thanks to prescription opioids, she said she can live a relatively normal life.
"I know that if I didn't have the medication in me right now, this [an interview with News 3] wouldn't be happening right now. I'd be in my bedroom curled up in a ball trying to deal with the pain," said Writesel.
How did America get to where it is now regarding opioids? In the 1990s, pain was under-treated and this spurred doctors becoming more willing to prescribe opioids. During this time, some opioids including oxycodone, morphine, fentanyl and hydromorphone were formulated to release their medicine over a period of time.
Doctors continued to prescribe opioids more often into the 2000s. Then, emergency room visits related to prescription opioids dramatically increased. Due to patients abusing opioids, starting in 2010, the FDA responded with formulas containing abuse-deterrents and asked for education when it comes to proper opioid prescribing and usage.
Fast forward to 2016 when more than 42,000 people died from opioid drug overdoses that year alone.
Now, there is a crackdown to try and reverse the epidemic. A CDC guideline says:
When opioids are started, clinicians should prescribe the lowest effective dosage. Clinicians should use caution when prescribing opioids at any dosage, should carefully reassess evidence of individual benefits and risks when considering increasing dosage to =50 morphine milligram equivalents (MME)/day, and should avoid increasing dosage to =90 MME/day or carefully justify a decision to titrate dosage to =90 MME/day
"The other opioid crisis is patients who legitimately need the medicine and they are legitimate medicines, not having access to them," said Dr. Robert Hansen, who currently practices in Virginia Beach.
Dr. Hansen, who has been treating pain patients for more than 30 years, said those guidelines are what started scaring doctors away from prescribing opioids to patients who need them.
"Once guidelines go out, that changes the game. Everybody became much more aware of the issues of opioid use. Primary care doctors became very frightened. Rules were…developed or enhanced surrounding the treatment of chronic pain," said Dr. Hansen. "Pain has become much more complicated. It's frightening for doctors and more and more are getting out of it, including pain doctors."
There are steps doctors take to make sure their patients don't abuse the system. Pain patients have frequent doctors appointments, get their urine checked first thing every visit and their pills counted among other ways of checking opioid use. Also, at Dr. Hansen's practice, patients fill out multiple forms ranking their pain level and function level. The goal is to improve function and lower pain, not just the latter.
"Reasonable doses, modest doses are not being prescribed because people are afraid to do so. Doctors are afraid of some kind of action being taken against them," said Dr. Hansen.
Writesel has dealt with this firsthand. As a Navy wife, constant moves equal constant fear of not being able to get the medications she needs to live with a quality of life she has a right to.
"It's hard because if you're moving to a new place and you're seeing a new doctor and they see your record and see you're on these meds, they're going to do one of two things: they're going to look at you funny and say I'm not giving you anything or they're going to send you to a pain specialist because they don't know how to deal with the situation," said Writesel.
Both Writesel and Dr. Hansen said this is a painful solution to the problem and the people hurting most are patients. Hansen believes there will be three groups. The first will be law-abiding patients who will suffer in pain. A second group will refuse to live in pain and turn to the street to illegally buy medication or heroin, which Dr. Hansen said will lead down a dark path.
"There is a third group and we're seeing more and more of this who say you know I can't do this anymore and they end their lives," said Dr. Hansen, who referenced someone he knew who put a gun to his head.
Writesel hopes by sharing her story, she can change the stigma surrounding opioids.
"We've got to as a country, come together and understand the problem isn't the medicine. It's the people who are taking the medicine. If they need the medicine that's fine. If they don't, there's no reason they should have it," said Writesel.