Patients with chronic pain experience an opioid suppression puncture

Marty Mioni knows what she would do if her pain medications were removed.

"I would go get a gun," said the resident of Port Orchard, 63 years old.

Mioni is not dramatic. For some patients with chronic pain, who fear losing access to opioid medications under the evolving prescribing guidelines aimed at countering the opioid crisis nationwide, suicide is a realistic alternative to a life of grinding pain.

Mioni has been taking opioids for 15 years to deal with the pain caused by a broken disc in an occupational lesion and persistent nerve damage resulting from a surgical procedure. She says that she has tried all other forms of therapy available, even volunteering for trials of experimental treatments.

"It's the only thing that works for me," says Mioni of opioid medications.

But this year, Mioni says its provider has begun to gradually reduce its prescription of Oxycodone in response to the new guidelines. Her doses, which she takes several times a day, no longer mask her pain. The simple fact of cooking this summer has become a "little struggle", she said. She is worried that more restrictions are coming.

"If they fail to solve this problem, I am very afraid that we will completely lose our pain medication," Mioni said.

Marta Mioni, a suffering patient, is with her husband, James, in her home in Port Orchard. She has been taking opioids for 15 years to manage the pain of a broken disc. (Photo: Larry Steagall / Kitsap Sun)

Another patient, 52-year-old Gretchen Lont, attempted suicide some 10 years ago after suffering from back pain from several falls. . An opioid prescription was the only thing that allowed her to lead a normal life, she said.

Like Mioni, the doses of Lont are tapered and the pain recedes.

"I'm not doing anything now," she says. "When you're in pain twenty-four hours a day, and it never goes away, it's gnawing at you."

The rights of patients with chronic pain are trampled as lawmakers and rulers rush to respond to the opioid crisis

"We are treated as addicts, but without compbadion", she says.

Mioni and Lont joined other chronic pain patients who came together to share their stories. "Do not Punish Pain" rallies on Facebook are scheduled across the country on September 18, including one in Olympia.

A tendency to tapering

Patient protests come at a time of rapid change in the field of pain management.

Guidelines published by the Federal Centers for Disease Prevention and Control encourage non-opioid treatments for chronic pain and discourage high doses of opioids (more than 90 morphine milligram equivalents as per CDC guidelines and 120 morphine milligram). The Ministry of Health is refining a set of rules for prescribing, monitoring and tracking opioids under the legislation pbaded in 2017. These rules could be finalized later in the year .

Locally, a project is underway in Kitsap, Clallam and Jefferson counties to help practices better manage opioids with the help of a "Six Building Blocks" method developed by the United States. University of Washington.

The reform efforts respond to a wave of opioid abuse and overdose deaths – partially fueled by over-prescription – and a better understanding of the health risks badociated with high doses of drugs. 39; opioids.

"What is the appropriate cap for opioids?" Said Dr. Nathan Schlicher with CHI Franciscan Health, which is part of a working group of the Washington State Medical Association and Washington State Hospital Association to a safe opioid. practices.

Existing guidelines and prescribing rules proposed by the state do not specifically recommend to providers to reduce doses for patients with chronic pain unless they do not comply with the agreement strict pain management signed with their provider. , or meet other criteria.

Dr. Jon Hillyer of Bremerton's Peninsula Pain Clinic, which prescribes opioids alongside other pain treatments, said the decision to reduce consumption is made on a case-by-case basis. One consideration is increasingly proving that high doses of opioids do not provide greater benefits than moderate doses and increase the risk of harm to patients, he said. Another consideration is that patients with prescribed pain at high doses of opioids may not be able to find treatment in the future if prescribing guidelines become stricter or they have to change supplier.

"We are trying to reduce the dose for some patients," said Hillyer, noting that most patients respond well to change. "We can reduce some side effects and improve their quality of life."

Marta Mioni, a patient suffering from pain, fears that patients suffering from chronic pain will commit suicide if they are impaired have helped to preserve their quality of life . (Photo: Larry Steagall / Kitsap Sun)

Hillyer acknowledges that there is a subset of patients with chronic pain whose quality of life could be reduced by narrowing. These patients have for years been using high doses and consistent opioids to manage their pain successfully and have followed all the rules.

"They have well established diagnoses and long-term compliance," Hillyer said.

These patients have tried other forms of pain treatment and find relief only with opioids.

"They have no alternative," Hillyer said.

Feeling Pain

A shoulder operation in 2005 left Candyce Smith with incessant pain

The procedure damaged the nerves in her neck that never regenerated. Later, her back was extinguished and she was diagnosed with degenerative disc disease – a condition that was superimposed on even more nerve pain.

An opioid prescription allowed him to continue working at his office. Smith has been on the same dose for more than a decade, she said.

"What he was doing was taking care of my pain to the point that I could work," said the 65-year-old resident of Bremerton about the pills.

Smith said that her dose is now diminished due to prescribing guidelines, and her pain has risen to the point that she can no longer sit or stand comfortably for a while. She had to quit her job and apply for disability benefits.

"I did not expect that at all," she says.

Smith is afraid of having to go on living in pain.

"I do not know what to do for me," she says. "I really do not do it, something has to change here."

Smith, Mioni, and Lont – all patients of the Peninsula Pain Clinic – agree that restrictions are needed to prevent opioid abuse. But they believe that the new prescribing guidelines are reactionary and have created a unique policy that does not fit their situation as law-abiding patients with chronic pain.

"The only thing I'm addicted to is my quality of life," says Smith, "and I'm losing it."

Mioni fears that some patients choose to commit suicide rather than live with chronic pain and feels that more patients whose doses are decreased will be more likely to buy drugs illegally and self-medicate. treatment.

"Do not they know that if they take people out of their medicine, they will look for it somewhere else?" she says.

Patients want to ensure that the rules adopted allow providers to continue to prescribe high doses of opioids to patients with chronic pain who depend on the drug to manage their pain and do not respond to d & # 39; Other treatments

. most of us there are no alternatives, "Smith said.

Oscillating pendulum on opioids

A reform effort that has frustrated some patients is also a challenge for health care providers.

"It's a pendulum that's swayed," said Hillyer at Peninsula Pain.

In practice for more than 20 years, Hillyer remembers when the pendulum swung in the opposite direction

In the mid-1990s, increasing doses of opioid medications were an accepted treatment for chronic pain. According to Hillyer, opioids have become increasingly used foods in the culture of health care.

Daily regimens of more than 300 morphine equivalents – three times the new limit recommended by the Centers for Disease Control – were not suitable. rare.

"Opiates, in a way, became one of the first-line treatments because they were considered safe," Schlicher said with CHI Franciscan Health.

The ensuing national health crisis forced a re-evaluation of these practices. According to the Centers for Disease Control, more than 350,000 people in the United States have died from prescription-related overdoses or illegal opioids between 2009 and 2016. More than 300 Kitsap residents have died from overdose. Opioid between 2000 and 2016, according to the Ministry of Health. While the pendulum is moving toward stricter regulation, Hillyer said it has become harder for practitioners to care for patients with pain. New opioid prescriptions are being reviewed by insurance companies, pharmacies and agencies that oversee workers' compensation claims.

"There are so many other areas that become so restrictive that it becomes difficult to practice".

The threat of discipline also hangs over the industry. In 2016, state regulators cracked down on Seattle Pain Centers clinics, suspended the medical license of its director and launched investigations of providers who worked in clinics "due to concerns about bad practices". The company shut down abruptly, closing its eight offices, including one in Poulsbo, and leaving thousands of patients scrambling to find new suppliers.

In June, the Board of Medicine and Osteopathic Surgery accused Beno Kuharich, a pain specialist in Silverdale, of unprofessional conduct for what he termed dangerous prescribing practices. Kuharich, a former Seattle Pain Centers provider who currently practices with The Doctors Clinic, vehemently denies the charges.

Hillyer stated that disciplinary cases had the unintended consequence of making circumspect practitioners prescribe opioids, thereby reducing access to care. Schlicher and Hillyer said the global regulatory burden imposed on opioid prescriptions has prompted many primary care providers to stop using drugs, shifting the burden to specialized clinics like Peninsula Pain.

"We observe this change nationwide. I said.

Schlicher, a former state senator, said that policymakers need to create a set of rules to counter the opioid crisis, create clear guidelines for providers who insist on education rather than on the punishment. The rules should allow opioids to be a tool in the prescriber 's toolbox, alongside a host of other therapies.

"We are working to deal with this epidemic on both sides, and we want to be respectful to patients," he said.

Hillyer believes that the balance will eventually be found, even though the transition may be painful.

"It's a time when things are changing and change is difficult for providers and patients," he said. "But it's necessary."

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