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In the midst of an epidemic, efforts to reduce the number of opioid prescriptions by changing the standards for doctors seem to work. Prescriptions in New Hampshire and elsewhere are down.
But people suffering from chronic pain, caused by long-term conditions, often long-term, say that success comes at their expense.
A dozen patients and advocates of chronic pain gathered Tuesday at the State House, urging doctors to better consider the needs of patients like them. According to them, the recent change in opioid prescribing practices has tied the hands of doctors and created difficulties for patients who request drugs, they said.
"It's not a one size fits all," said Edie Allyn-Page of Marlow, who has been suffering from fibromyalgia and arthritis since 1982. "I know some of us are panicking because we're going to lose our medications for pain. It's the perception.
Now advocates urge New Hampshire officials to consider legislation to protect doctors from existing prescription rules and put decision-making back in their hands.
"We are not against the fight against addiction," said Jim Murphy, co-organizer of the event. "We support it 150%. But we are also for the compassionate care and treatment of the patient suffering from intractable chronic pain, even if it requires a certain level of opioid analgesics. Because, in this case, it is what is appropriate.
The immediate problem for Murphy and other advocates is a set of guidelines unveiled by the Federal Centers for Disease Control in March 2016, which aimed to reduce irresponsible prescribing practices for opioids. These guidelines were neither mandatory nor laid down by federal law, but prompted several states to implement them, including New Hampshire.
Among the 12 recommendations of the CDC: the prioritization of non-opioid versus opioid treatment, the creation of detailed treatment plans between physicians and patients that indicate when opioids can be cut; physicians' preference for short-acting painkillers over long-acting alternatives; and a host of new surveillance mechanisms, including random screening tests and monthly visits.
New Hampshire adopted the recommendations in 2016 through a radical change to its own prescribing rules through the Board of Pharmacy. But protesters said on Tuesday that the new rules added unjust and sometimes prohibitive barriers to chronic pain patients who are not at risk of addiction. And they accused the CDC of relying on "erroneous and exaggerated data" that overestimated the role of prescription drugs in the opioid epidemic to justify its recommendations.
For example, Murphy said, recent data from the New Hampshire Medical Examiner indicates that fentanyl is the leading contributor to opioid-related deaths, not prescription drugs. This, he said, was an indication that the focus on the drugs had been unfairly placed.
"Patients with chronic pain are not the problem," said Jim Murphy, who co-hosted the event. "Patients with chronic pain need these medications to provide quality of life and daily living. They keep their medication with their lives.
The rally was one of 82 across the country, organized by a national group, "Do not punish pain". In Concord, he brought together a small group of enthusiasts.
Allyn-Page, like many others at the rally, followed the growing bureaucracy needed to track and maintain her painkillers. It's part of a daily fight, she says.
"I arrived at a time when I had to make a choice," she said. "You can choose to sit on the couch and watch life go by, or you can choose to participate in life."
"And it's hard to do," she added. "It's very difficult to do. You make a choice every day. Am I in bed today or am I getting up?
For Murphy, the legislative solution is simple. A bill should be introduced to protect physicians from federal guidelines and give them more freedom in the way they prescribe. "We can do anything we want for patients with chronic pain," he said. "If the providers are afraid to prescribe this medicine, it will not help us at all."
But as overdoses continue to accumulate, a proposal to relax standards for doctors is proving difficult to sell. Murphy contacted all senators and representatives of major population centers, including Concord, he said.
Few people added his calls.
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