opinion

Forced opiate reduction a most dangerous game

In February 2018, Sens. Rob Portman, R-Ohio, Sheldon Whitehouse, D-R.I., Shelley Moore Capito, R-W.Va., Amy Klobuchar, D-Minn., Dan Sullivan, R-Alaska, Maggie Hassan, D-N.H., Bill Cassidy, R-La., and Maria Cantwell, D-Wash., introduced the Comprehensive Addiction Recovery Act, dubbed CARA 2.0. The senators will decide how many pills should be prescribed when you are discharged from the hospital.

The magic number: A 3-day supply.

The extensive hospital stay renders you bedbound, unable to get to a pharmacy to personally pick up that opioid with the triplicate prescription from the hospital. The pharmacist will not release the prescription to a caregiver. Across the country, primary care physicians are declining to refill that post-hospital prescription.

You have legitimate chronic or intractable pain. Now you are told to come off your opioids; asked to sign extensive contracts with a promise to not sell your opioids; do not lose or drop them as a refill will not be given; if your urine test shows cannabis, no pain meds at all will be renewed.

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In a doctor’s office, emergency room, or urgent care center you will now be treated like an addict. You may have a clean record, adequately controlled with opioids for years, gainfully employed, mentally alert, yet you are now an addict, obligated to see a new physician. Physicians are now treated like drug dealers who push opioids.

Dr. Forest Tennant, a renowned pain specialist, said forced reduction or cessation of daily opioids in stabilized patients has reached the point of unscientific and inhumane hysteria.

As each physician refuses to treat your pain, it leaves fewer physicians who are willing to prescribe. The remaining physicians will write more prescriptions since patients are now concentrated under the care of pain specialists. They, too, are told to reduce your daily dose of opiates.

Washington State triggers a prescribing physician’s conduct if he orders over 120mg/day morphine equivalent dose. In some states this regulation is mandated; in others, it is suggested. Insurance companies are the most dangerous forcers arbitrarily demanding you reduce your daily dose by 30 percent to 70 percent. Some insurances no longer cover brand name opioids, injections, patches, or compounded formulations. There are no studies to show that daily doses above 120 mg are unsafe. Per Dr. Tennant, the last straw-dog is the diagnoses of hyperalgesia in a patient who has been well maintained on a stable dose. There are no studies to develop criteria for a diagnosis of hyperalgesia.

Intractable pain from head concussions, spinal cord injuries, rare autoimmune diseases means the person is always in pain. The forced reduction is instead creating a crisis of untreated pain, lack of access to pain killers and an increase in abuse.

There are many botanical herbs like cannabis and kratom that can replace opioids. The regulators force patients to have either or. This is not based on science, as tapering off opioids requires the opioid and the herb be taken together to achieve reduction.

The above examples are not outliers. The Pain News Network conducted a survey in 2017 that showed 71 percent of patients are no longer being prescribed opioids. Eighty four percent say they have more pain. Fifty nine percent find it harder to find a physician or do not have a physician. Ninety five percent state the CDC guidelines have not reduced the opioid abuse and are harmful to patients in pain. Opioids are very effective pain killers. Who will rise to demand a halt to this insanity?

Ruth Hill, RN, of Palm Desert, educates on medical cannabis. Email her at hilruth@gmail.com.