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LONGVIEW, Wash. (AP) – For over 10 years, Shannon Greenwood has taken 16 opioid tablets a day for her chronic pain. But over the past eight years, the 59-year-old resident of Longview has reduced the daily dose to two.
"It was a long and difficult road," Greenwood said. "I went up and down like a roller coaster, and it ruins your life, you do not have the ability to do what you did and you do not want to miss feeling good before doing anything." your homework for the day. "
Resident of Onalaska and suffering from chronic pain, Ramona Poppe, also reduced her dose of opioids. Poppe was born with a congenital malformation and had more than 20 operations since childhood. About four years ago, the 56-year-old increased his daily dose from seven tablets to five over several months.
Poppe said the pills did not take away all his pain, but they kept him cool. But if his dose goes down, Poppe said that she would lose her ability to function.
Until now, state regulations allowed opioid users to slowly wean themselves off addictive medications, and Poppe and Greenwood both acted with the help of Dr. Richview. from Longview. But new state regulations in force may force patients and their doctors to withdraw drugs faster, which could be bad news for people with chronic pain. Many of them live in fear of losing their prescriptions and their ability to manage pain.
The new rules could have special significance for Cowlitz County, which had the highest opioid-related overdose deaths from 2011 to 2015. The death rate for chronic opioids in the counties was 33% above the average Department of Health.
Last year, the Legislature passed a bill requiring five health professional boards and commissions to adopt new opioid prescription rules by January 1. the final rules will do that.
According to the American Academy of Pain Medicine, 100 million people in the United States suffer from chronic pain. Kirkpatrick and former Longview doctor, Anne Dubosky, now practicing in central Washington, fear that the changes will target a group that does not have a high rate of overdose deaths.
"The state is creating new regulations in response to the increased deaths from opioid overdose," Dubosky said. "But there is no evidence that patients with chronic pain are dying from these overdoses."
Kirkpatrick said many patients with chronic pain were feeling guilty, having done something to contribute to the overall increase in overdose deaths. The potential threat of new regulations only adds to this concern, he said.
"Patients with chronic pain are anxious because they do not think they can survive if they are without drugs," Kirkpatrick said.
Poppe said that his ability to function would suffer if his dose of opioids was too low. The 56-year-old has walked on crutches since she's nine years old. Despite persistent pain, Poppe did not start taking regular opioids until he was in his 30s. Her current prescription allows her to take care of her 86-year-old mother.
"It's difficult, but if I did not take opioids, she would be in a retirement home and I would be alone," Poppe said.
According to the 2016 Centers for Disease Control guidelines on the prescription of opioids for chronic pain, few studies have been done to evaluate the long-term benefits of opioids for chronic pain. However, it is reported that the use of opioid analgesics is associated with serious risks, including overdoses and opioid-related disorders. Patients may also experience tolerance and loss of effectiveness over time.
Nevertheless, an increasing number of people with chronic pain are starting to push back the calls to limit them.
Martha Mioni, of Port Orchard, in Washington State, organized a rally entitled "Do not Punish Pain" at the State Capitol in Olympia. The 64-year-old patient is taking opioids for chronic back pain caused by an injury. She organized the rally to draw attention to how the opioid crisis affects people with chronic pain. Mioni said his dose had already been forcibly narrowed. She fears that the rules will lower her further.
"Every time I go to the doctor, I wonder how much it will go down this month," Mioni said Friday. "I'll be bedridden if they continue as they are."
Mioni said the change in his dose had nothing to do with his health and that the doctors felt pressure from the CDC at lower doses.
The CDC's 2016 guidelines on opioid prescription for chronic pain suggest that physicians limit patients to a dose of 90 mg of morphine equivalent per day. (Milligram equivalents of morphine are used to compare the relative potency of different opioids.) Mr. Dubosky said that this number is only an indication, but states take it as a rule to follow.
"My concern is the speed with which we are instituting rules that are not evidence-based," Dubosky said. "I think that as a physician, my ability to treat patients as individuals and to use my judgment is disappearing."
The proposed state regulation would require a mandatory consultation threshold of 120 equivalents in milligrams of morphine. This means that patients who need more powerful prescription medications will need to see a specialist in pain management. Kirkpatrick said that one problem with this proposal is the lack of pain specialists.
Mioni said it may take more than a year to see a pain specialist. The health department lists 62 pain treatment clinics throughout the state, but he notes that clinics may not take new patients.
Health Ministry spokesperson Julie Graham said the department knows that patients are concerned about change, but wants people to have a clear idea of what the rules do and do not do. She said the regulation would not require providers to change care as long as they follow the rules.
Boards of health involved in drafting the rules will apply the new rules separately, said Graham. Health officials are finalizing the regulations based on feedback from the relevant boards. It is difficult to know what the changes will be until the rules are finalized.
New national regulations are the latest change in the evolutionary approach to opioids.
Dubosky said that there was a "pendulum movement" in the prescription of opioids. Before the 1990s, doctors did not prescribe narcotics for anything other than cancer, end-of-life and acute pain, she said. After trying to treat chronic pain, doctors began prescribing opioids to a larger number of patients and at higher doses. Now, the pendulum has come back since the increase in deaths due to drug addiction and overdoses, Dubosky said.
"I have never agreed to use higher-than-normal doses of narcotics," Dubosky said. "But a lot of suppliers have done, and now we all carry the burden."
Kirkpatrick said regulators must separate people who use illegal drugs for pain and leisure patients by using narcotics to function normally. Poppe echoed this feeling.
"Why should I be grouped with this group of people who have addictive personalities, when all I want to do is have a decent life?" Poppe said.
Patients wishing to start or continue an opioid prescription for chronic pain go through a prior process, said Kirkpatrick. They must first try other treatments before starting opioids, he said. Patients would then complete a questionnaire to find out if they were addicted to depression and would be screened, he added. But Kirkpatrick does not accept new patients with chronic pain.
Kirkpatrick said his firm has seven full-time and four-time service providers. In total, they see about 200 patients with chronic pain. He said that they no longer thought they had room for them and they refused about four people a day calling for pain management.
According to Kirkpatrick, there is a shortage of doctors willing to prescribe opioids in the state and country. The hesitation stems from the concern to be monitored by law enforcement and public agencies, as well as the amount of work needed to cure patients with chronic pain, Dubosky said.
"It's exciting to talk to people who are reducing their medications to new guidelines," Dubosky said. "Those who take the regulations have forgotten how difficult it is."
Surveillance is not a bad thing and some doctors have contributed to the problem by prescribing opioids to patients knowing that they were selling or giving pills, Dubosky said. This problem is not going anywhere, but there are better ways to lower opioid doses than a general regulation prohibiting doses at a certain level, Dubosky said.
"It's important to build relationships with patients," Dubosky said. "The most effective way to do that is to have patients on board and accept the plan."
That's what Kirkpatrick could do with Poppe and Greenwood. The doctor helped Greenwood switch to methadone, which stays in his system longer and allowed him to drop his dose of hydrocodone, she said.
Greenwood said the weaning process was difficult, but Kirkpatrick listened to his concerns and took them into account. She is now able to leave home without worrying about the loss of her medication.
"I'm so grateful to him for hearing and working with me," Greenwood said. "I could not have done that with other drugs."
Doctors should not have any difficulty prescribing opioids, Greenwood said. Regulation is important, but patients can take opioids to manage the pain without doing too much.
"I believe that there will always be drug abuse," Greenwood said. "But it comes from people trying to reach a high level, no people like me trying to spend the day."
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Information from: The Daily News, http://www.tdn.com
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