Other victims of the opioid epidemic: Patients in pain who can not find relief

Andrew Auell says he is open to anything that could make his pain bearable – opioids, opioids or not, physical therapy or combination of approaches.

The Fayette County man has Ehlers-Danlos syndrome, a condition that weakens the tissues that hold his bones and joints, causing painful dislocations and buckling. He also has lasting injuries due to a car accident and a physical assault.

Still, he says his doctor is willing to only prescribe a small dose of opioid, to use at night.

He says it leaves him in such pain that he could not sleep for three consecutive nights. "Right now, I'm running out of drugs," says Auell, research director for the Chronic Disease Advocacy and Awareness Group, Inc., which advocates on behalf of patients with pain. "Right now, I'm having trouble walking my dogs. It's hard for me to get ready to eat. "

Auell is among those suffering from chronic pain who claim to be victims of the repression of painkillers such as Oxycodone and Vicodin, occurring as a result of the national addiction crisis and overdoses caused by opioids.

"We are trying so hard to deal with one tragedy that we have created another," he says.

In the United States, opioid sales more than tripled between 1999 and 2010. Opioid deaths more than quadrupled over this period, according to the US Center for Disease Control and Prevention.

Much of the crisis is attributed to aggressive marketing, over-prescription of drugs and the unnecessary use of opioid painkillers, which can lead to heavy dependence. In response, health insurers have limited durations of opioid prescriptions and require special authorization for the most powerful versions. States have laws governing opioids. The doctors are monitored and, in some cases, prosecuted.

Pain sufferers and their lawyers say that doctors are less and less willing to prescribe opioids, sometimes for fear of being charged with crimes.

"There are patients whose lives depend on pain relief. Now, doctors are even scared to have these patients, "said Twila Brase, a graduate nurse from Minnesota and head of a patient advocacy organization.

Some have been abandoned by their doctors. Some have turned to illegal street drugs out of desperation. Some committed suicide, say Brase and others.

This month, 300 health care experts told the US Centers for Disease Control and Prevention that the recently published opioid guidelines were affecting some patients. "Taken together, these actions have led many health professionals to perceive a significant category of vulnerable patients as institutional and professional liabilities to contain or eliminate, rather than as people in need of care," experts said in a statement. letter to the CDC.

Doctors became nervous following acts such as those of David Freed, the Harrisburg-based US lawyer, who wrote this month to 300 Pennsylvania doctors to inform them that they prescribed amounts of opioids that did not meet the standard.

Freed said the main goal is to encourage doctors to take a closer look at their prescribing habits. It does not exclude the possibility that some of the doctors end up being prosecuted.

In 2017, 47,600 deaths in the United States were attributed to opioids, compared to 8,048 in 1999, according to the federal government. However, pain sufferers and their advocates point out that the majority, about 30,000, involved illegal opioids such as heroin or prescription opioids illegally obtained.

Efforts to cope with the crisis unfairly penalize people who use opioids as prescribed, they say.

Bill Gregory, a resident of the Harrisburg area, says the situation has caused "seven and a half months of hell" to his family. He is particularly worried that his relative may turn into a street heroine or commit suicide.

Gregory says the parent, who does not want to be identified, has been prescribed opioids for years to relieve the pain caused by multiple medical problems, including lasting injuries from a car accident.

Last year, his relative's doctor said, "He was no longer comfortable and [the relative] should find someone else, "according to Gregory, 64.

After receiving a final one – month order, the family contacted a dozen doctors and forwarded medical records, but none of them was willing to take a patient who was taking such a dose. of opioids, said Gregory.

Her parent experienced opioid withdrawal and severe pain and sometimes could not get out of bed The parent resorted to the illicit manufacture of suboxone, which can delay weaning, and went to the drug rooms. Urgency to advocate for opioids. A doctor, after providing treatment for a short time, asked his parent to immediately enter a drug rehabilitation center, which he would not have done for reasons such as the fact that his dependence was not due to illegal drugs.

Gregory says he missed several days of work by contacting doctors and patient advocates. Finally, they met at the Penn S. Health Milton S. Hershey Medical Center, where a physician reviewed the medical situation as a whole, called on a variety of specialists, including a physical therapist, and initiated a management process. pain while reducing opioids.

"It was inhuman," says Gregory about the ordeal.

In 2016, the CDC issued guidelines to inform physicians that opioids should not be the first choice for short-term pain management. In particular, the guidelines recommend that physicians carefully review patients' drug history prior to prescribing opioids and prefer a range of non-opioid analgesics, ranging from medication to physical therapy and acupuncture.

In general, the guidelines indicate that most people should not take opioids for more than seven days.

The guidelines clearly indicate that they are intended for patients with acute short-term pain, such as an injury or an operation, and not for people with cancer or terminal illness.

Yet advocates such as Brase argue that the CDC guidelines have taken the weight of the law. They have led to the promulgation of laws restricting the use of opioids, and have made sure that doctors who prescribe outside guidelines are considered criminals, she said.

Brase says it's a "global attempt to tell the doctor how to practice medicine or deal with the consequences, and those who are going to give the consequences are not in the examination room."

In Pennsylvania, legislators have passed a law prohibiting doctors from prescribing more than seven days of opioids to minors, although there are exceptions for situations such as children with cancer. They passed another law prohibiting emergency room doctors from prescribing more than seven days of medication.

Dr. Vitaly Gordin, head of pain management at the Milton S. Hershey Medical Center at Penn State Health, says he supports the CDC guidelines as a necessary response to a crisis. However, he believes that they do not leave enough leeway for patients who have long taken high doses of opioids and can not be interrupted abruptly.

According to Gordin, about 20 years ago, doctors subscribed to the push to prescribe more opioids, despite the lack of data and medical data to support.

As a result of injuries or surgeries, including minor ones, doctors usually prescribed opioids for weeks, advising patients to take them as needed. Now, years later, the danger of doing so is obvious. "If the patient takes it four to six times a day for four to six weeks, he will become addicted," he says.

Doctors also increased the dose as the patient developed tolerance – another disastrous approach. According to Gordin, when people exceed the equivalent of about 90 milligrams of opioids a day, they run a high risk of serious medical problems, including respiratory failure.

At present, the death toll for opioid-related deaths in 2017 includes 17,029 deaths attributed to prescription opioids, compared with 3,442 in 1999.

Gordin views CDC guidelines as a necessary way to inform physicians about the safest ways to relieve their patient's pain.

But he also believes that the CDC needs to understand what doctors are doing with patients who, after years of counseling, take dangerously high doses of opioids.

These patients can not be cut short, Gordin says. They are at risk of contracting withdrawal sickness and turning to illegal drugs and suicide.

"The doctors are between the hammer and the anvil," he says. "We want the government and the authorities to understand that this can not be applied in the same way as the criminal law. This must be done in a very careful and patient-oriented way. "

The situation may leave doctors, especially pain specialists with a high concentration of patients legitimately needing opioids, for fear of being prosecuted. "It's very disturbing for a doctor to get a letter from the American lawyer," he says.

According to Gordin, the best approach for patients with chronic pain is often a combination of treatments, such as physical therapy, lifestyle changes, non-opioid analgesics, and relaxation techniques to manage pain while reducing the use of opioids.

It is a complex process that may require the participation of multiple specialists and take considerable time – more time and money than taking a pill. And that points to another riddle.

Two decades ago, before the surge in prescription opioids, there were many pain clinics designed to help people use various tactics, including physical therapy and fashion changes. of life, to manage chronic pain with the least possible medication.

But as author Sam Quinones explained in "Dreamland: The True Tale of the Opioid Epidemic in America", these clinics have virtually disappeared from the market due to the rise of opioids.

These clinics are showing signs of resurgence. The approach they offer, while more expensive and more demanding than just opioids, can provide the healthiest path for people with chronic pain.

"We need to help people become more proactive and more responsible for their health," said Gordin.