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CLEVELAND, Ohio – While the epidemic of opioids has worsened across the country and as legislators, public health officials and physician groups have restricted access to opioid medications, patients with chronic pain claim to have been abandoned by the health system.
Many of these "legacy patients" have been using pain medications safely and responsibly for at least ten years and have often been treated by their primary care physician. Over the past five years, everything has changed: in order to receive drugs, they are tried and suspected by their doctors, nurses and pharmacists, are forced to sign humiliating and coercive contracts and submit to random checks. drug test. Without warning, some doctors are dumped and are forced to withdraw dangerous drugs themselves.
Over the past year, I have spoken to dozens of patients with chronic pain and heard their horrifying stories about weaning, abuse and daily suffering. More than one doctor told me, "It's a very bad time to be a pain patient in America."
So why are doctors relieving patients with pain and should they completely eliminate opioids for pain? Why are there so few doctors comfortable with managing chronic pain? And what can patients and physicians do to improve the care of people with daily pain?
The Lakewood Public Library and the Greater Cleveland Chapter of the League of Women Voters will be hosting a discussion on the subject on Thursday from 6:30 pm to 8:00 pm in a free public forum at the main branch of the Lakewood Library, 15425 Detroit Road. The discussion is co-sponsored by the Siegan Continuing Learning Program of Case Western Reserve University and First Interstate Ltd.
Who speaks
Speakers include Dr. Adam Hedaya, founder of Cleveland Pain Care; chronic pain patient Larry Harbert from Sagamore Hills; Dr. Ted Parran, Medical Co-Director and Educator at Rosary Hall, St. Vincent Charity Medical Center, is an addiction expert.
I will moderate the discussion and answer your questions.
What does it feel like to be a pain patient today?
"They treat us like land … like a number and a drug addict," Jean Karchefsky told me when I met her at home in Willoughby earlier this year. The bus driver who retired from Mentor Schools had been suffering for months after her general doctor in Chardon refused to continue managing her pain with opioid medications.
"I do not even want to go to a doctor," she says. Karchefsky endured the brutal weaning of her cold turkey opioid medications when she was unable to find a new doctor and was short on pills.
Many other pain patients in northeastern Ohio have experienced similar problems over the past five years.
Larry Harbert, whose Beachwood pain management physician has been suspended for drug use over the past year, has been managing his multiple back and leg problems without a doctor for nearly a year.
Herbert, who had to stop taking morphine and oxycodone after the departure of his doctor, said he had tried unsuccessfully to find a lawyer to sue for malpractice. He believes that a lawsuit is justified because the sudden departure of his doctor left him, as well as other patients, with no other solution than the withdrawal of their drugs, he says.
"Everything was wrong," said Harbert. "It was totally wrong, as it was managed, no one should be forced to withdraw. [Withdrawal] was horrible. Every bone in your body hurts. Every joint in your body hurts. I have a toothache. "
How did we come here?
The number of opioid prescriptions in the country has steadily increased during the 2000s, at a time when pharmaceutical companies aggressively marketed drugs for uses other than terminal cancer and where more patients were screened for pain. Dosages have also increased over time.
Prescriptions and dosing began to decline after a peak in 2010 after two events: the publication of two national recommendations on chronic pain establishing for the first time what constitutes a "high dose" for prescribing and shortly thereafter , studies correlate between increased doses of opioids and an increasing risk of overdose.
In 2013, the Government of Ohio Governor's Opiate Action Team (GCOAT) recommended that physicians "squeeze the break" and re-evaluate when prescribing opioid doses greater than a certain threshold for patients with chronic pain. The Ohio threshold was set at a level even lower than the "high dose" established by national guidelines. In 2016, Centers for Disease Control and Prevention issued guidelines urging physicians not to prescribe high doses of opioids where possible.
The message was sent to the doctors:
· Since their peak in 2010, the highest dose opioid prescriptions have dropped 41% over the next five years, according to a CDC analysis.
· In Ohio, the number of prescription pain medications issued has decreased by 28% over the past five years, according to the state pharmacy board.
· In some institutions, the fall has been even more drastic. The opioid prescription decreased by 66% in some VA medical centers between 2012 and 2016, and by 41% at the Cleveland VA Medical Center, according to the institution's opioid safety initiative.
Do the restrictions work?
If the current overdose crisis goes back to the liberal prescription wave that began with the introduction of Oxycontin in the mid-1990s, most overdose deaths today concern the world. use of illicit drugs such as heroin or fentanyl.
In 2016, nearly 60% of unintentional overdose deaths in Ohio, about 2,300 dead, were due to fentanyl and its powerful parents. About 14%, or about 500 unintentional overdose deaths, were due to prescription opioids, the lowest proportion since 2009.
Yet, the number of deaths due to an opioid overdose in the state, which has one of the country's most aggressive prescription monitoring programs, continues to climb: it has increased by 32 % to 4,050 deaths compared to 2015.
We will discuss the pain of chronic pain patients in Ohio and what can be done to improve their care on Thursday night. If you are a patient with chronic pain or are treating patients with pain, we would love to hear your stories and answer your questions, so join us. If you can not participate and you want to talk about the issue, you can leave a note in the comments here, comment on facebook at facebook.com/brie.zeltner, call me at 216-538-6140 or leave me a message. note to [email protected].
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