Unintended consequences of opioid suppression in patients with pain

AUSTIN (KXAN) – Some Texans living with chronic pain and illness say that the ongoing crackdown on misuse of opioids has unintended consequences for their community. They feel that their voices are neglected when policies and guidelines for opioid prescriptions are developed.

"One thing does not work for everyone," said Nancy Wheeler.

Wheeler attended a "Do not Punish Pain" rally in downtown Austin organized by several patients suffering from chronic pain on Tuesday. According to her, the 2016 guidelines for prescription of opioids for chronic pain published by the Centers for Disease Control and Prevention had good intentions, but patients should be evaluated on a case-by-case basis.

"People who manage chronic pain are not an easy solution for us," she said. "Personally, I have eight procedures a year to manage my pain. I use other drugs. I have actually received three holes in the stomach while taking ibuprofen.

The CDC has published its guidelines in response to the overdose death epidemic. It suggests that when opioids are used, clinicians should prescribe the lowest effective dose, such as no more than 90 milligrams of morphine equivalent per day.

"We tried all the other modalities," she continued. "We try all the other modalities. We need the CDC and people in the United States to treat us as human beings.

Good days exist, but they are rare.

"I have days in bed," she said. "However, it is not a solution for me either."
Sonya Gibson says that since the publication of the CDC guidelines, her meds have been reduced and she has ended up getting out of it. Gibson lives with lung lesions, spinal deterioration, pelvic floor dysfunction, foot pain and arthritis.

"Unfortunately, opiates are what gives me the best quality of life and allows me to have the highest level of functioning," she said. "Removing my medications or any of these medications will not stop anyone who is determined to go out and climb. Our goal is not to become high. Our goal is to do our laundry, mop our floors, take care of our kids, go to work if we can again.

Several members of the gathering acknowledged the need to address substance abuse and drug abuse, but took note of the way they want policymakers to clearly define the distinction between prescription drugs and illicit drugs. The state of Texas has taken several steps to resolve opioid-related issues and has its own prescription monitoring program to help track drug abuse.

The CDC guidelines are not intended for the treatment of patients undergoing active cancer treatment, palliative or end-of-life care. However, some palliative care communities feel that by focusing on reducing the opioid epidemic, they have also impacted patient care.

"Sometimes people have less access to drugs," said Kimberly Galusha, a doctor at the Austin Hospice – Christopher House. "Either their doctor, their insurance company or their pharmacy will limit the amount they will give out each time they enter it."

This week, US Senate legislators passed a bill requiring special packaging for prescription opioids. It also encourages the increased use of non-addictive analgesics.