CLEVELAND, Ohio—As the opioid epidemic has worsened across the country and legislators, public health officials and doctor's groups have responded by restricting access to opioid prescriptions, chronic pain patients say they've been abandoned by the healthcare system.

Many of these “legacy patients” have been safely and responsibly using pain medications for a decade or more, and were often managed by their primary care doctors. Over the past five years, they say, everything has changed: In order to receive medication, they say they're subjected to judgment and suspicion by their doctors, nurses and pharmacists, are forced to sign humiliating and coercive contracts, and submit to random drug testing. With little warning, some are being dumped by their doctors and left to withdraw from the dangerous drugs on their own.

Over the past year, I’ve spoken with dozens of chronic pain patients, and heard their horror stories about withdrawal, poor treatment, and daily suffering. More than one doctor has told me: “It’s just a really bad time to be a pain patient in America.”

So why are pain patients being dropped by their doctors, and should opioids for pain be eliminated completely? Why are there now so few doctors comfortable managing chronic pain? And what can patients and doctors do to improve the care of those coping with everyday pain?

The Lakewood Public Library and the Greater Cleveland chapter of the League of Women Voters will host a discussion on the topic Thursday from 6:30 to 8 p.m. in a free public forum at the Lakewood main library branch, 15425 Detroit Road. The discussion is co-sponsored by Case Western Reserve University Siegal Lifelong Learning Program and First Interstate Ltd.

Who’s speaking

Panelists include Dr. Adam Hedaya, founder of Cleveland Pain Care; chronic pain patient Larry Harbert of Sagamore Hills; Dr. Ted Parran, co-medical director and educator at St. Vincent Charity Medical Center’s Rosary Hall, and an expert on addiction.

I will moderate the discussion and field your questions.

What’s it like being a pain patient today?

"They treat us like dirt... like a number and a drug addict," Jean Karchefsky told me when I met her at her home in Willoughby earlier this year. The retired Mentor Schools bus driver had been suffering for months after her Chardon primary care doctor refused to continue managing her pain with opioid medications.

"I don't even want to go to a doctor anymore," she said. Karchefsky endured cold-turkey withdrawal from her opioid medications when she couldn’t find a new doctor to take on her care and ran out of pills.

Many other Northeast Ohio pain patients have experienced similar problems over the past five years.

Larry Harbert, whose Beachwood pain management doctor was suspended for admitted drug use last year, has been managing his multiple back and leg issues without a physician for nearly a year.

Harbert, who suffered withdrawal from morphine and oxycodone after his doctor left, said he tried unsuccessfully to find a lawyer to sue for malpractice. He believes there are grounds for a suit because his doctor’s sudden departure left him and other patients with no alternatives but withdrawal from their medications, he says.

"The whole thing was wrong," Harbert said. "It was totally wrong the way it was handled. Nobody should be forced to go through withdrawals. [Withdrawal] was horrible. Every bone in your body hurts. Every joint in your body hurts. My teeth hurt."

How did we get here?

The number of prescriptions nationwide for opioids rose steadily throughout the 2000s during a period when pharmaceutical companies were aggressively marketing the drugs for uses outside terminal cancer, and when more patients were being screened for pain. Dosages rose over time as well.

Both prescriptions and dosages began to fall after a peak in 2010 following two events: publication of two national chronic pain guidelines that established for the first time what qualified as a "high-dose" for prescribing, and, shortly after, studies that showed a correlation between escalating opioid doses and a progressively increasing risk of overdose.

In 2013, the Ohio Governor's Cabinet Opiate Action Team (GCOAT) advised doctors to "press pause" and re-evaluate when prescribing doses of opioids above a certain threshold for chronic pain patients. Ohio's threshold was set even lower than the "high dose" established by national guidelines. In 2016, the Centers for Disease Control and Prevention issued guidelines warning doctors to avoid prescribing high doses of opioids when possible.

The message came through to doctors:

· Since peaking in 2010, prescriptions for higher-dose opioids dropped 41 percent over the next five years, according to a CDC analysis.

· In Ohio, the number of prescription painkillers dispensed has fallen by 28 percent over the past five years, according to the state Pharmacy Board.

· At some institutions the drop has been even more drastic. Opioid prescribing fell by as much as 66 percent at some VA medical centers from 2012 to 2016, and by 41 percent at the Cleveland VA Medical Center, according to the institution's Opioid Safety Initiative.

Are the restrictions working?

While the current overdose crisis can be traced back to the wave of liberal prescribing that began with the introduction of Oxycontin in the mid 1990's, today most overdose deaths involve the use of illegally-obtained street drugs such as heroin or fentanyl.

In 2016, almost 60 percent of unintentional overdose deaths in Ohio, about 2,300 deaths, were due to fentanyl and its potent relatives. About 14 percent, or about 500 unintentional overdose deaths, were due to prescription opioids, the lowest proportion since 2009.

Yet opioid overdose deaths in the state, which has one of the most aggressive prescription monitoring programs in the country, continue to climb: up 32 percent to 4,050 deaths from 2015.

We’ll discuss what chronic pain patients here in Ohio are facing, and what, if anything, can be done to improve their care on Thursday evening. If you’re a chronic pain patient, or if you treat patients with pain, we’d love to hear your stories and answer your questions, so please join us. If you can’t make it and would like 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 drop me a note at bzeltner@plaind.com.