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Keep chronic-pain patients in mind when addressing opioid issues

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In an effort to curb illicit-opioid overdoses, our government has made it so people who truly need prescription opioids to manage real, unbearable pain are struggling to get them.

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Amber Bullington
As a chronic-pain patient myself, I proudly stood alongside other local chronic-pain patients last week at the Capitol in St. Paul for the Don’t Punish Pain rally. The Sept. 18 event was part of an international movement to draw attention to those suffering the unintended consequences of our country’s “opioid epidemic.”

In an effort to curb illicit-opioid overdoses, our government has made it so people who truly need prescription opioids to manage real, unbearable pain are struggling to get them. Doctors are afraid to not follow the Centers for Disease Control and Prevention’s guidelines because the Drug Enforcement Administration has been sending them threatening letters, shutting down pain clinics and trying to prosecute the doctors it feels aren’t prescribing pain medication properly. These guidelines don’t even apply to chronic-pain patients!

Dosages reduced or eliminated

Because of this, millions of chronic-pain patients have had their pain medications reduced or eliminated altogether. These are people who have been stable for years, even decades, and there is no medically sound reason to change their dosages. The result being that once-productive citizens are now unable to work, care for themselves and their families, or give back to their communities.

And it’s not just chronic-pain patients who are suffering. Patients who find themselves in the hospital for surgeries or treatments are finding there aren’t enough pain medications to treat all of the patients who need them. This is because fewer and fewer prescription opioids are being produced.

There is ample evidence that our country has an illicit-opioid problem, not a prescription-opioid problem. As fewer and fewer prescription opioids are produced and prescribed, overdose rates continue to rise. It’s frustrating that our leaders have stigmatized and punished legitimate and legal opioid use. It does nothing to decrease abuse or help street-drug users get the help they need.

I recognize the anguish that illicit opioid use has caused many in our communities. My heart breaks for the families who have had to bury their loved ones because they used illicit opioids or didn’t use their opioids properly. And I hope that we continue to find ways to help users of illicit opioids get the help they need to live productive lives.

Patients closely monitored

Did you know that patients who use prescription pain medications are closely monitored? They must submit to regular urine tests, sign pain contracts, always use the same pharmacy and agree to be tracked in a national database. And lately, many patients with legitimate opioid prescriptions are being turned away by pharmacists because they have their own biases against opioid use. If that pharmacist works at the pharmacy a pain patient has always used to fill their prescriptions, then the patient would be breaking their pain contract if they got the prescription filled at a different pharmacy. The consequence of breaking a pain contract is dismissal from a patient’s pain program, often without proper tapering, causing the patient to go into agonizing withdrawal.

Punishing proper and responsible pain management, such as the proposed opioid tax in Minnesota would have done, won’t end the opioid crisis. It could actually raise the cost of prescription opiates for legitimate patients and limit our access to life-saving care. It won’t address overprescribing or the number of dangerous and deadly illegal drugs flooding the black market. And as many states look at similar solutions, they’re not addressing the real problem: Our country has an illicit fentanyl and heroin problem.

People with cancer, arthritis, back problems and a host of other chronic-pain conditions are among the patients who rely on opioids most. For these patients, opioids are a last resort. I can guarantee you that the majority of prescription-opioid users have already tried every other conventional and nonconventional treatment available before they turned to pain medication. Patients who are dying are being denied proper pain control because, according to their doctors and our government, they may become addicted! Do you know how ridiculous that is? Elderly patients who have been taking a minimal amount of pain medication for decades to function are being forced to stop taking them.

Few chronic-pain patients become addicted

Statistics show that less than 5 percent of chronic-pain patients become addicted to prescription opioids [PDF]. Chronic-pain patients take opioids to live their lives, not to escape their lives, as addicts do. They don’t take opioids for pleasure; they take opioids to help reduce their pain and gain functionality. Chronic-pain patients are not the problem, so why are we treating them as such?

As lawmakers continue to seek solutions to the opioid epidemic, the needs of the chronic-pain community must be considered. The Don’t Punish Pain rally was a good start at getting the voices of chronic-pain patients heard. I hope legislators keep the needs of chronic-pain patients in mind as they return to St. Paul and look for solutions to the real problem facing communities across America.

Amber Bullington is a Minnetonka mother of two who has been a chronic-pain patient for 17 years due to fibromyalgia and early-onset osteoarthritis.

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Comments (6)

  1. Submitted by Paul Brandon on 09/28/2018 - 12:25 pm.

    A couple of comments….
    First, recent research has shown that opioids are not an effective treatment for chronic pain — in double blind studies acetaminophen (Tylenol) is just as effective as the commonly prescribed opioid/ acetaminophen combinations such as Percocet.
    Second — the last link provided is to an advocacy group, not to a refereed medical journal. I agree that the rate of addiction to prescribed opioids is low; the problem is that the main source of street opioids is diverted prescriptions.
    I sympathize with Ms. Bullington’s situation (I have my own chronic pain problems and have used opioids), but unlimited access to opioids is not the solution. I wonder if she has tried non-medical approaches such as Cognitive Behavioral Therapy?

    • Submitted by James Ewing on 09/29/2018 - 11:03 am.

      Evidently you have not had to watch a loved one suffer. I am currently watching a loved one suffer. She’s a senior citizen who’s been disabled for 20 years. The last ten have been made bearable, barely, by legal and monitored opioids. Her dosage has been cut by 2/3 and is still being cut by her long term doctor who has been bullied and threatened.

      That loved one, my mother, wants to die now.

      Chronic pain patients are being shoved to the side by knee jerk reactions.

    • Submitted by Holly Mathews on 10/01/2018 - 07:10 am.

      I have an adult daughter that has 2 beautiful children,and a hard-working husband with decent insurance she has been bedridden due to severe chronic spinal pain and has not been officially diagnosed but a condition called Arachnoiditis is highly suspected and she is wasting away in bed with all pain medicine taken from her because the DEA has scared the doctors away from prescribing opioids to anyone and the chronic pain victims are literally committing suicide because they cannot endure the pain anymore.my daughter is only alive because of her belief in God,she seriously prays that He will take her out of her body.She feels helpless and wretched as a mother,wife and human ..In desperation I reached out to Mayo in Rochester as a last resort and hope that they would indeed help her,had a 30 minute discussion with a very nice lady that sounded understanding and compassionate well my precious daughter just received a letter from mayo saying that they cannot help her. No appointment,no nothing,just like to that..How does this happen??

    • Submitted by Reese Tyrell on 10/02/2018 - 08:56 pm.

      The research you refer to involves mostly patients with knee pain, not lifelong genetic disease. Many (if not most) patients on long-term opioid medication have already failed every non-opioid therapy.

      I have a rare genetic disease called IC/BPS (non-healing open wounds in the bladder). I have been through diet, dozens of non-opioid medications, electrical stimulation, weeks in an integrated multidisciplinary pain clinic, physical therapy, meditation/hypnosis/mindfulness, ACT/CBT, alternative medicine, pouring various medications into my own bladder through a catheter multiple times daily, and every other treatment known to science.

      None of these therapies were able to restore normal activities of daily living. Pain medication has allowed me twenty years of earning a Ph.D., teaching college, and raising my child. Without it, I would have had twenty years literally trapped in a bathroom.

      Patients like me can’t sign up for research studies. If I signed up for a study to test the effectiveness of pain medication, and I got placed in the placebo or Tylenol group, I’d be unable to leave a bathroom for months.

      No one is advocating for “unlimited access to opioids.” We advocate for availability of opioid medication for last-resort patients, when benefits outweigh potential harms. Pain medication can be a mobility aid (much like a wheelchair), allowing people with disabilities to access normal life.

  2. Submitted by Amber Bullington on 09/28/2018 - 03:59 pm.

    Thank you for taking the time to read my opinion piece and comment. For the record (not that I think it’s relevant), I currently take only Ibuprofen for pain. I’ve also tried just about every conventional and non-conventional treatment available over the past 17 years. I have not done CBT, but I’m currently doing Dialectical Behavior Therapy (DBT). While I find DBT hugely beneficial, it currently has not reduced my pain. I also am not advocating for unlimited access to opioids. I’m advocating for the government and insurance companies to get out of the doctor/patient relationship. Doctors have the training to know when it’s appropriate to prescribe opioids and the training to assess a patient’s risk for addiction. Routine drug testing and pill counts (standard practices in pain management) help control opioid diversion. My doctor knows me and my needs; the government and my insurance company do not. This is not my personal fight at this point, but I am standing up for others for whom opioids have enabled them to be productive citizens when other treatments have failed. I personally don’t know a chronic-pain patient on opioids who hasn’t tried a wide variety of other (often damaging and painful) treatments before turning to opioids as a last resort. Limiting the production and prescribing of opioids is not decreasing opioid overdose deaths. So why are we letting people with legitimate needs for opioids to suffer?

  3. Submitted by Paul Brandon on 09/28/2018 - 09:57 pm.

    Points taken.
    DBT is a variety of CBT.
    Unfortunately, studies have shown that physicians’ prescribing is controlled more by pharm company detail people and literature than it is by material published in the medical journal, which most physicians don’t have time to read.
    I’m not arguing for eliminating the use of opioids, but currently they are manufactured in far larger quantities than is justified by the medical need.

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