How Stigma Against Addiction Devastates Pain Patients – by Elizabeth Brico @elizabethbrico – Feb 2019

Here’s yet another story of what would qualify as malpractice if it were any other drug than opioids. A doctor suddenly stops prescribing opioids necessary for the “activities of daily living” and sends their patient into the agony of physical withdrawal and an unnecessarily limited life without medical care.

There’s no concern for Quality of Life when politicians responding to media-hype and PROPagandists are controlling our pain care.

First it was a hip replacement. Then it became complicated by a MRSA infection. Eventually, Dee Giles, formerly an ER nurse, had to endure amputation of her right leg and the right half of her pelvis. She also lives with osteoarthritis, a degenerative joint disease that causes immense pain over time. Her arthritis and phantom limb pain were so severe that she required ongoing prescriptions for morphine and oxycodone. Giles, who is 49 and lives in the tiny city of Powell, Wyoming, was seeing the same doctor consistently for six years, she had to submit to regular urine drug tests and “pill counts,” in order to ensure she was not taking more than prescribed. All of her tests came back fine, and she says she was never under suspicion of misusing her medication. Cut Off From Medical Care But at one of her appointments in 2016, her doctor told her he would give her one more month of medication and then she would need to find a new prescriber. He confessed that he would no longer be prescribing opioids out of fear of being reprimanded for over-prescribing. Because Giles had already tried non-pharmacological approaches to pain management to no effect, he was discharging her as a patient. Her doctor also did not taper her from her medication, even though prolonged use of opioids results in physical dependency.

This is malpractice.

Such a sudden stoppage of a medication that is known to create physical dependency is only tolerated for opioids. If it were any other dependency-inducing drug, like antidepressants, a doctor would never be permitted to do this.

But doctors are allowed to simply stop prescribing opioids, guaranteeing that the patient will be suffering from miserable withdrawals without any further medical care.

Physical dependency is different from addiction. The latter is a psychological condition of compulsively using drugs despite negative outcomes; dependency occurs with a range of medications—not just opioids—and simply means that a person’s body has become so adjusted to the use of the drug that it will go through withdrawal if the medication is suddenly withheld. “I not only had a severe increase in pain,” says Giles of her withdrawal, “I had almost a month of constant vomiting. I ended up in the emergency room twice just to get IV fluids because I wouldn’t keep anything down. I couldn’t sleep. I had muscle twitches and restless leg syndrome type symptoms … slowly, after a month, the withdrawal symptoms got better, but the pain has gotten worse ever since.”

It’s absolutely clear that this is not the proper practice of medicine, yet the AMA remains silent without a peep of protest since they merely added their voice to the FDA and CDC warnings last year not to do exactly this.

In the year prior, Giles had had a near-fatal reaction to an NSAID (anti-inflammatory drug). Without opioids or NSAIDs, she was left with only acetaminophen, the active ingredient in Tylenol, which comes with its own set of health concerns when overused, to manage her pain. She found it completely inadequate. Now Giles says she spends most of her time on the couch, unable to even move much around her house. Opioid Prescribers Scapegoated by the DEA In 2016 the Centers for Disease Control released a set of guidelines meant to help physicians engage in better opioid prescriptions practices.

The guidelines do not forbid opioid prescribing, they only suggest more caution and possibly referral to a pain specialist when prescribing higher doses, nothing else.

The guidelines themselves are not inherently unreasonable.

The problem, however, has been the response.

Because the guideline mentioned two numbers (50 and 90 MME) above which to exercise increased caution politicians, medically ignorant and lacking all nuance. are using those numbers to create hard limits

The DEA has begun using these guidelines as a basis for identifying “over-prescribers.” These types of responses often don’t take into account the fact that certain kinds of doctors—such as those who specialize in the treatment of pain, or treat more people from certain populations or professions—will be inherently required to prescribe more opioids than others.

This is the problem with “standards” when taken literally. No one wants to think about the implications of such standards because they become far more complicated in “real life”.

Americans want simple solutions, not nuanced suggestions.

Now, at least 26 states have enacted laws limiting the dispensing of opioids to three-to-seven days at a time for non-cancer pain. These changes are directly linked to the same misinformation and stigma that keep hundreds of thousands of opioid use disorder patients from accessing the most effective medicines for their disorder Fearmongering surrounding the safety and efficacy of opioids has driven people to equate their use with addiction and death.

We can thank PROP for that. They have waged a PROPaganda war against all opioids users, not just those that abuse them or buy them illicitly, but legitimate pain patients as well.

But the numbers don’t back up these claims. Even the CDC admits that most long-term opioid patients will not become addicted to their medication.

I don’t understand how this fact can be acknowledged by the very agency that first proposed more careful and limited use of opioids, yet they continue to allow all kinds of self-proclaimed “experts” to spew fearmongering PROPaganda that pushes politicians to prove the “drug-warrior” commitment and pass scientifically unsupported laws regulating the practice of medicine.

Drug overdose deaths have risen rapidly over the past several years. That includes opioid-related deaths. But the prescribing of opioids has actually dropped in that period. by prescribing fewer opioids than people need, doctors are driving patients to the streets, where unregulated illicit supplies are fickle and dangerous. The data back this: Most opioid-related deaths are related to illicit supplies of drugs like heroin and fentanyl. Pain Patient Suicides “Abandonment of care; we are certainly seeing a lot of that right now because of the regulatory oversight physicians are under,” says Kate Nicholson Nicholson, who herself lives with chronic pain and experienced physician abandonment in 2014, believes that pain patients’ rights will be the next big ADA litigation dispute. “One of the biggest issues in the policy department is the conflation of dependency and addiction. Non-compulsive, appropriate use with life-restoring effects—that’s the polar opposite of addiction. I think in order to get people to understand, you have to draw that distinction first.” Chronic pain patients, meanwhile, are being labeled as “addicts” and treated with suspicion simply because they require a type of medicine to which only a tiny minority of patients will become addicted. As Anna Fuqua, a pain patient and former nurse, has written in the Washington Post, some abandoned patients have become so overwhelmed by their pain that they have resorted to suicide. In a blog post on NationalPainReport.com, Dr. Geralyn Datz described the shattering experience of learning one of her patients had taken his own life after losing access to his medication for financial reasons. One Twitter user recently shared, “My 27 year old son had chronic severe pain from scoliosis surgery 4 yrs ago. Because he was young no one wanted to prescribe typical opioids. He was on tramadol. He committed suicide last saturday.” And on Medium, doctors Erin O. LeBlanc and Thomas F. Kline published a heartbreaking litany of stories about pain patients who killed themselves after being denied access to the drugs that most effectively managed their pain.

It’s hard to believe that medical authorities cannot fight back against this blatant takeover of the practice of medicine that’s having such dire consequences for pain patients.

It is the misunderstanding of addiction, its causes, and the efficacy of opioid-based medication that is hurting addiction patients and chronic pain patients alike. Author: Elizabeth Brico @elizabethbrico

Elizabeth is a journalist from the Pacific Northwest. Her work has appeared in publications including Vox , Tonic / Vice , TalkPoverty , HealthyPlace and The Establishment . She has an MFA in Writing and Poetics from Naropa University. She also writes about trauma, addiction and recovery on her blog, Betty’s Battleground.