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Julie Anne Feinstein overcame a life of adversity when she began taking daily pain medications 10 years ago, at age 68, prescriptions that would put her at the center of the opioid crisis of Country
Polio to become a teenage ski and mountaineer near her home in Oregon. When the post-polio syndrome struck at age 36, causing muscle weakness, fatigue and pain, and making it difficult to teach, the mother of four had a degree in Special Education to work with visually impaired students. could do by sitting. When she was 62, a blind student accidentally knocked her down, an injury that led to a spinal fusion – the second – and ended her career. Unable to handle daily chores, Feinstein moved to an badisted living center in Portland and began using an electric wheelchair.
Opioids entered her life while she was undergoing chemotherapy and radiation therapy for stage 3 lymphoma. Feinstein was suffering so much that she was unable to get out of bed.
His doctor had prescribed oral morphine three times a day and oxycodone "as needed".
For seven years, Feinstein took the same dose. This helped her lead a robust life in the badisted living center, she said. She organized a knitting group, learned Hebrew and studied for her Bat Mitzvah, which she celebrated at 75 years old.
Reluctance to prescribe
For decades, the medical community considered opioids cautiously in the treatment of chronic pain. The country's first opioid crisis more than a century ago – when doctors prescribe morphine, laudanum and heroin freely to relieve pain – had left the country. According to the Presidential Commission on Drug Abuse and the Crisis of Opioids, 1 in 200 Americans is addicted. This eventually resulted in a negative reaction and reluctance to prescribe opioids – a reluctance that persisted until about 30 years ago, the commission reported last year.
Then several factors, including poor characterization of the addictive nature of opioids in painful patients, the influence of the pharmaceutical industry, the pressure on doctors to fight the pain and the lack of Medical education and patients have brought back the pendulum to drugs, said the commission.
Towards the end of the 1990s, opioid prescriptions difficult to find care
The nation now struggling to reverse a drug epidemic fueled by prescription opioids, policies to reduce their consumption and the use of opioids Sourcing come from multiple sources. New prescribing guidelines for centers for disease control and prevention, state legislation, medical advisory sanctions and policy changes through management-intake and prescription plans were promulgated to curb the Opioid abuse. But patients like Feinstein say they feel that the changes have ignored the treatment of their pain and made the management more difficult for many.
The first sign that Feinstein's treatment was in danger appeared three years ago. The doctor told her that she could no longer prescribe opioids for chronic pain because of a change in clinical policy. She would need to find a pain specialist.
It took six months of "hell" – pain, anxiety and several rejections – Feinstein said, before finding a specialist 20 miles from Portland that would take her as a patient and maintain her prescription. Now, she says, she is sitting on a time bomb.
"I could receive 30 days' notice of the closure of this clinic at any time," she said.
His doctor, Gregory Gullo, said he is not worried about his ability to run his office. He said that he follows the recommended protocols such as random urine checks to ensure that patients do not abuse drugs.
And there are advantages to stricter rules on prescribing opioids because it is now able to focus rather than on pills. "
But he understands the anxiety of patients with serious diseases that depend on medications.Some primary care doctors limit opioid prescriptions to five days of pills," he said, and said. Others refuse to prescribe them at all
Patients with multiple sclerosis or post-polio syndrome, such as Feinstein, "" If I … give up, who is left? "
A Pennsylvania Rehabilitation Specialist, who has been practicing for 25 years, said he stopped taking new patients and may abandon current patients because of fewer treatment options, a longer Keeping electronic records and more difficult to understand what is "in the book"
"If I'm fed up who left?" "she said under cover of anonymity for fear of being audited.
The opioid epidemic" picks up and confuses the lives of people who have a real need for this drug with those who abuse, and that is tragic and that, "said Feinstein's daughter, Amanda Feinstein.
" She has a degenerative disease, "she said about the post-polio syndrome of His mother Without pain medications, "everything stops."
Jim Shames says that when he evaluates credit or blame for tighter control by the Oregon Medical Board, who authorizes the doctors, many people point to him.Shames trained Oregon Pain Guidance in 2011 in response to the high rate of overdose deaths that he examined as the medical director of Jackson County Health and Human Services [19659002] People were taking large amounts of opioid medications, sometimes several medications for d pain Specifiers. "
His group held monthly meetings with hospitals, insurance companies, mental health professionals, and chronic pain experts to push" As a Health Person. " public, we must reduce morbidity and mortality, and there will undoubtedly be people who will struggle to deal with this problem, "he said.
But the situation has turned out to be complex, Shames admits. In January, his group held a meeting with 50 health care providers and the director of the state medical board. The goal was to address the frustrations of physicians treating patients who they had inherited from other doctors or for whom they could not reduce a high dose or switch to other drugs, partly because Patients feared weaning
Patients need a medical home, Shames said. If doctors have a safety plan and continually evaluate the patient, "the advice is not going to get you into trouble," he said. But even patients who are suffering from high dose opioids "are really not immune" from an overdose, he said. They would do better on buprenorphine, he says, which can treat pain and withdrawal symptoms, but that presents a lower risk of abuse because it does not create the same level of euphoria and depression respiratory.
Specialist, Feinstein's family turned to Myra Christopher, recently retired from the Center for Practical Bioethics, a nonprofit organization based in Kansas City, Missouri. Christopher also led the Bread Action Alliance to implement a national strategy. She is "agnostic" about the use of opioids for chronic pain, but concerned that patients like Feinstein are "collateral damage" in the effort. to fight against the opioid crisis.
"I wish that people with chronic pain have access to comprehensive care for chronic pain, which include opioids or not, interventions, surgery Acupuncture, physiotherapy, mbadage, Biofeedback and Behavioral Health, "she explains
For four years, PAINS members, including patients and their families, have been trying to change what Christopher calls unfair treatment. The Academy of Integrated Pain Management, an advocacy group for integrated pain management, will resume the PAINS website and continue its program, said Bob Twillman, executive director of the Academy. 19659006] Finding a Ground of Understanding
But some advocates for patient rights and organizations are viewed with skepticism or mistrust because a number have received 39, money from pharmaceutical companies. A report from the Senate Committee on Homeland Security and Government revealed that opioid manufacturers Purdue, Janssen, Mylan, Depomed and Insys paid at least $ 8,856,333.13 to 14 outside groups working on the project. chronic pain and other opioid-related problems between January 2012 and March 2017. "
The Center for Practical Bioethics and the Academy of Integrated Pain Management, with the US Pain Foundation and the American Academy of Pain Medicine, were part of the named organizations.
Twillman says the Senate report is Andrew Kolodny, co-founder of Physicians for Responsible Opioid Prescription, said policymakers misunderstood the opioid crisis for decades. years because advocates of chronic pain told them, "Do not, in your effort to stop drug addicts, penalize patients with pain Do not take s measures that involve less prescription of opioids, because that would t The problem of untreated chronic pain is worse. "
The argument that there were two separate populations caught in the opioid crisis was" wrong, "he said. "Thousands of people suffering from pain have died from an overdose."
Doctors are in the middle of a bend, said Matthew Wynia, director of the Center for Bioethics and Humanities at the Anschutz Medical Campus of the University of Colorado. For 20 years, doctors, often through bioethicists and patient empowerment groups, have been told to believe patients when they say they suffer and do what patients want.
Now, he said, bioethicists and other role: help "from one side to understand where the other party comes from, that the opposing force does not". is not bad, but come to that with a set of values and preferences and priorities that must be understood to find some kind of common ground. "
New methods of treating chronic pain are under study." Paul Chelminski, a professor at the University of North Carolina's School of Medicine, is part of the research team at the University of North Carolina. a $ 9-million study to determine how cognitive-behavioral therapy and motivational interviewing – helping patients figure out how to achieve their goals – could reduce the use of opioids.
The goal, said Chelminski, is "to retrofit the management of chronic pain to what it should have been 20 years ago."
It will take more than five years to get the results.
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