For many people, the face of the opioid crisis in this country is the scene of a drugged-out mother and father passed out on a couch with a little child forlornly looking at them. It is a heartbreaking image of a family being destroyed by addiction, and of young lives being shattered.
But the opioid crisis has another face, too, as we were reminded this week on the front page of this newspaper. That is the face of a woman who could be your friend, your neighbor or a family member, sitting calmly on a couch and talking about being cut off from the pain medications that make her life tolerable. Another heartbreaking image.
Opioids are a scourge. They have ensnared millions of people into addiction, and 64,000 Americans lost their lives to overdoses in 2016 alone. Greedy drugmakers and clueless doctors flooded our nation with poison.
Opioids are a salvation as well. For millions more, the drugs offer relief from chronic, incapacitating pain, and have given many people a chance at a better life.
This country has such a tangled, twisted relationship with drugs and drug abuse. We seem to lurch from one overreaction to another as we grapple with our drug problems.
Drugs go from miraculous to the epitome of evil, one after another. Marijuana, cocaine, morphine, heroin: all hailed, all condemned, most outlawed as dangerous. The opioids were just a continuation of this process.
In 1996, a drug manufacturer called Purdue Pharma introduced OxyContin. Mother Jones magazine said it debuted with the most aggressive marketing campaign in pharmaceutical history, downplaying its potential addictiveness.
At the same time, doctors were being pushed by pain management specialists to assess the pain of every patient they saw, and to treat pain more readily.
The American Journal of Public Health, in a 2016 article tracing the origins of the opioid epidemic, reported:
“The dimensions of the problem were and are immense. An estimated 25 million adult Americans, according to the most recent data, suffer daily from pain, and 23 million others suffer from severe recurrent pain, resulting in disability, loss of work productivity, loss of quality of life, and reduced overall health status.”
Researchers were telling doctors that pain management was an important aspect of patient care. Drug companies were promoting new opioids as a safe method of pain management. It is no wonder that the number of opioid prescriptions exploded.
But everything started to go wrong in short order. Again, from the Journal of Public Health:
“Purdue advertised Oxycontin as nonaddictive because the drug was released within the body over 12 hours; recreational users quickly learned to get high by crushing or dissolving the pills, or simply taking very high doses. Overstressed and well-intentioned general practitioners, and a number of unscrupulous ‘pill mill’ operators, wrote liberal prescriptions for the new analgesic. The ready supply of Oxycontin made diversion and sale, particularly by low-income patients on Medicaid or Medicare, attractive and easy; but when pill addicts found their drug too expensive, they sought an alternative.”
That alternative was heroin. As one addict said, Oxycontin cost $40 a pill, but he could get the same effect for $10 from heroin.
Drug overdose deaths increased 137 percent from 200 to 2014, and non-fatal overdose went up 200 percent. States in the West, Midwest and Appalachia were hit especially hard.
As the extent and depth of the problem began to sink in, the opioid backlash was underway.
In 2016, the federal Centers for Disease Control and Prevention issued new guidelines for prescribing opioids “as part of the urgent response to the epidemic of overdose deaths.” The guidelines urged primary care providers not to consider opioids as a “first-line or routine therapy” for chronic pain.
Terrified by the ways in which opioids had come to be abused and by the resulting wave of death, doctors, pharmacies and insurance companies quickly began changing their accepted practices.
A seven-day supply for new prescriptions, limits on daily dosage and other restrictions are now the industry standard for many pharmacies and health insurance companies. Patients are required to renew prescriptions within weeks instead of months.
But where does that leave the patients with chronic pain?
According to local patients interviewed by News-Post reporter Kate Masters, it is leaving them in limbo, and worried about what the future might hold.
They are finding it increasingly difficult to get the medicine they need and are encountering more hassles and roadblocks.
Terri Boettcher, of Middletown, said she and many others feel stigmatized. Restrictions by insurance companies and pharmacies are hurting patients’ ability to receive customized care.
After being injured in 2000, she tried several medications, surgery, steroid injections, physical therapy, acupuncture and more, all trying to manage the pain from a herniated disc.
Eventually, she and her doctor settled on a daily dose of oxycodone. However, under the new rules, her prescription has been reduced from a 60-day supply to a 20-day supply.
“I’ve had less pain relief because I’m trying to take less medication to make it last longer,” she told our reporter.
Her fear is that even more restrictions might result in her being denied continuous use of opioids completely.
Pain management specialists and their patients are groping for a way forward that does not endanger their health while helping to battle the huge societal problems caused by abuse of the drugs.
Dr. Paul Christo, a pain specialist and associate professor at the Johns Hopkins University School of Medicine, told our reporter that long-term pain management patients are not among those who are likely to abuse narcotic painkillers. Most have extremely high levels of discomfort and are too worried about being cut off from their medication to abuse or divert it, he said.
These specialists need the support of the insurance companies and national pharmacies to continue treating patients with chronic pain in the ways that are most effective. They need to be heard at the CDC as the rules on pain management evolve.
The broad-brush rules deployed to fight the opioid crisis in 2016 might have to be revised and narrowed so that doctors specializing in the treatment of pain have more freedom than primary care doctors do.
This is the only fair way to help those patients devastated by chronic pain.