Garrett Greene takes opioids to relieve pain and has trouble finding an effective treatment.
Crystal Vander Weit and Jasper Colt, USA Today
David Lackey spent 40 years running his machine repair business, despite arthritic lesions, degenerative disc disease, bone spurs on the shoulders, and back and spine fractures.
After the Drug Enforcement Administration raided her pain doctor's office in January, seized medical records and banned opioid prescriptions, Lackey only lived 34 days.
The man from Odessa, Texas, died of a heart attack in March, after a month of weaning that left him shaking in bed or in the bathroom, vomiting and suffering from diarrhea, said his daughter, Gina Bruton.
Wanda and David Lackey. David died 34 days after having to abruptly stop his pain medications after a search at his doctor's office. Family photo (Photo: Courtesy of the Lackey family)
Federal health authorities are rethinking the policies that have led to brutal cuts by those who legitimately need these painkillers to function.
Federal measures have made a widespread effort to reduce the prescription of opioids and slow down an overdose epidemic that kills tens of thousands of Americans each year. However, the Centers for Disaster Control and Prevention the officials recognize that the organization's influential guideline for chronic pain in 2016 has been misused to justify harmful practices such as the rapid reduction in the number of pain-relieving tablets or the patient's abandonment by a physician
The CDC plans to update and expand the guideline with new research and is working with public safety officials to ensure that patients such as Lackey are not sidelined during the search or closure of the office. of a doctor.
In April, the Food and Drug Administrationcautioned against reports of serious injuries resulting from the reduction or discontinuation of drug treatment in opioid-dependent patients, including withdrawal, pain, psychological distress and suicide.
This fall, the FDA is expected to finalize its plan to add warning labels to opioid drugs regarding the abrupt cessation of these drugs. The FDA also proposed in May to require drug manufacturers to offer patients a limited number of blister packs. These packs can be low, medium or high dose packs or be adapted to different procedures, such as hernia operations or appendicectomies.
And one Department of Health and Social Services In May, the advisory working group explained how to balance the needs of 50 million people with chronic pain while tightening prescriptions to prevent opioid addiction. The Interagency Working Group on Best Practices in Pain Management has recommended ways for people with pain to function and improve their quality of life.
The total number of opioid prescriptions in the United States has decreased each year since 2012, a trend that has accelerated after the CDC directive issued in March 2016. Nevertheless, the number of overdose deaths has continued to increase, pharmacies distributing less pain medication, mainly motivated by illegal drugs such as heroin and fentanyl.
Vanila Singh, who chaired the HHS task force, said medical advice, doctors and other state authorities may take time to qualify prescription for opioids.
"I do not advocate going and prescribing without thinking," said Singh, chief medical officer of the office of the deputy secretary of health at HHS. "It must be where the stigma of being the patient or the prescribing physician or clinician is mitigated – it's still a difficult boat to turn."
"Doctors are afraid of DEA"
Bruton thinks pain patients and doctors have been unfairly targeted.
"Of course, the warning labels should be there," says Bruton. "But in my opinion, they are leading the bad war."
The CDC says its guideline was for primary care physicians, who are sending more and more patients with pain.
"Doctors are afraid of DEA and are worried about losing their livelihood. So they try to protect themselves, "explains Bruton.
Like his father, Bruton's husband, Vernon, works in heavy machinery repair and was a patient of Carl D 'Agostino, a physician specializing in the treatment of pain, sanctioned by the Texas Medical Board in June 2018 for failing to keep records showing that he was monitoring patients in the urine. medication screens, number of pills and medical history. D'Agostino did not call back calls from the United States today.
Vernon Bruton now has to travel 700 km to a new pain doctor in San Antonio, Texas. She says there are only four or five doctors in pain management in an area of about 200,000 people.
He takes a small dose of opioids to treat his degenerative disc disease and his neuropathy, some of which result from a car accident while he was young and crossed a bridge to land in a creek bed. in his truck. He was found six hours later.
"Every day, he's afraid he'll be the next doctor at home," says Bruton.
Because he could not get copies of his FBI medical records, no new doctor would take Lackey as a patient. At age 74, Mr. Bruton was still working part time for his business and needed 60 mg of hydrocodone a day to be "functional".
"He has never been completely relieved," says Bruton. "He just wanted to be able to participate in life."
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The CDC acknowledged that the 2016 guidelines may have had unintended consequences. Officials pointed out that the CDC is not a regulator and that its guidelines are voluntary. Nevertheless, state health ministries, insurers, and others have cited the guideline as a reason for implementing limits for opioids.
A common restriction: Limit the daily consumption of opioids to 90 milligram equivalents of morphine per day, which equates to two 30 milligram oxycodone tablets.
"Many groups took this number and said," We have to either gradually reduce [patients] up to that amount or we have to stop them, "says Sharon Tsay, a doctor in the CDC's Unintentional Injury Prevention Division." That was not the intention. Some people need higher levels. they are addicts. It is therefore very dangerous. "
In collaboration with the Federal Agency for Research and Quality Health Care, the CDC is collecting new data to update and expand its pain guidelines. The agency described the research as a priority, but did not say when it planned to publish the information.
41% refuse new patients with pain
Other research shows that one of the consequences of the prescribed repression is that doctors are reluctant to take in new pain patients. A University of Michigan study released Friday in the Journal of the American Medical Association found that 41% of the 194 primary clinics surveyed refused to take in new patients with pain.
Rebecca Leonard knows the difficulty of finding a doctor who specializes in pain. A bulging disc, nerve damage and back surgery have been hurting Reidville's wife in South Carolina since the late 1980s.
She says that a cutaneous patch with fentanyl provides constant relief for years. But when his primary health care physician retired five years ago, it took six months to find a pain specialist who put him on a strict and tapered diet. When Leonard failed to remove a patch of pain before putting on another, the pain doctor refused to continue treating her, she said.
It's been more than three years since she does not take pain medication and she spends 23 hours a day on her bed or couch. She rarely leaves the house.
"I'm at the end of my rope," says Leonard. "There are a lot of people in this situation, you do not look for solutions, after a while you do not have the energy for that anymore."
From Vicodin to kratom
Jacqui Gerschefske, a resident of Tucson, Arizona, still suffers from back pain caused by a car accident six years ago by a drunk driver. His primary care physician prescribed him 5 mg of Vicodin and Oxycodone, which allowed him to stand for 8 hours as a convenience store employee.
"She knew I was stable and knew I was not abusing her," Gerschefske said.
His doctor retired and his new doctor refused to prescribe the same treatment plan. Gerschefske started taking a herbal product, kratom. The FDA has warned consumers to avoid kratom because of the risk of addiction, abuse, and addiction.
The CDC said that kratom, an herbal supplement, caused the deaths of 91 fatal overdoses in the United States from July 2016 to December 2017.
UNITED STATES TODAY & # 39; HUI
The FDA has tested 30 kratom-based products and discovered that it has found "significant levels of lead and nickel" that are dangerous.
Ms. Gerschefske said that she would no longer be in contact with a doctor wishing to prescribe opioids, she would stay with the kratom despite warnings from the FDA.
"My new doctor does not prescribe medicine for pain," says Gerschefske. "It was my solution, and I'm grateful to have it."
The federal government wants to prevent new cases of dependency
Public comments on the FDA proposal for blister packs have been largely negative so far, with suggestions for regulators to focus on illegal drugs and looking for solutions that do not make it more difficult to open platelets. of pills by people suffering from painful conditions.
Dr. Yngvild Olsen, a drug addiction specialist in Baltimore, notes that the proposed rules for blisters are for patients with acute pain, such as after an injury or surgery. She does not think it will help or hurt many patients with chronic pain. But this could help prevent some addictions.
"Of course, there is a percentage of people who start taking opiods for acute pain, who continue to take it and can abuse it," she says.
Olsen, co-author of "The Epidemic of Opioids: What Everyone Needs to Know"" stated that the CDC guideline had been applied in a way that was never intended.
This "has never been done for people already on opioids," she said. "Unfortunately, that's what happened."
Dr. Douglas Throckmorton, Deputy Director of Regulatory Programs at the FDA's Center for Drug Evaluation and Research, said the agency had "never lost sight of the needs of patients with pain."
"We know that every action we take can have a big impact," he said.
Although doctors still routinely prescribe opioid 30-day prescriptions for procedures rarely requiring more than a few days, Throckmorton believes that it can "change depending on conditions and education."
"The goals that the CDC has adopted reflect its goals – education and the reduction of inappropriate prescription of opioids," said Throckmorton. "As we work to educate prescribers, we will continue to keep the patient suffering from pain in mind."
More: Patients suffering from pain are anxious by doctors "terrified" by opioid addiction, despite the change in CDC
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