The opioid abuse (and overdose) epidemic isn’t fueled by chronic pain patients. Most of the abuse problem involves the use of illicit drugs by addicts, and then to a lesser extent the selling of drugs left over from short-term prescriptions to deal with acute pain. There are also patients who fake pain in order to obtain drugs.

Many people who truly suffer from chronic pain of a serious type often need to be on opiates in order to have any quality of life at all.

The government is trying to deal with and control opioid abuse, but somewhere along the line the message got garbled and some chronic pain patients have been the ones to suffer, while the abuse statistics continue to climb in the rest of the population.

It’s the worst of both worlds:

Political leaders and government officials often failed to note the bulk — at least 60 percent, according to the U.S. Department of Health and Human Services — of the overdose epidemic was caused by illicit drugs, not prescription painkillers. And when officials did address the portion of deaths due to prescriptions, advocates of safe opioid use argue, they often lumped together pain patients and people with addiction who illegally obtained someone else’s prescribed opioids. That made for a perfect storm, which formed the basis for a slew of hardline state and federal policies, including a Trump administration vow to slash prescriptions by 30 percent over the next three years. Either in response to the CDC guidelines or as proactive measure to deal with the opioid crisis on their own, at least 33 states have enacted some type of legislation related to prescription limits, according to the National Conference of State Legislators. Health care providers and pain patients who have Medicare prescription plans are bracing for January, when the federal insurance program will give its insurers and pharmacists the authority to reject prescriptions that deviate from CDC recommended dosage. “The CDC guidelines were geared to primary care doctors, but they have been hijacked and weaponized as an excuse for draconian legislation,” said Michael Schatman, a clinical psychologist and director of research and development at Boston Pain Care, a multi-disciplinary pain clinic, and editor-in-chief of the Journal of Pain Research. “Illicit opioids, not prescription opioids, are driving overdose deaths.”

The article describes some chronic pain patients who are committing suicide as a result of doctors cutting back even now in anticipation of later cutbacks. It’s a sad and terrible situation.

I was a chronic pain patient for close to 13 years, beginning in my early 40s. For much of that time my pain was fairly severe and sometimes very severe, and it was neuropathic pain, a type that’s particularly difficult to control even with narcotics (I’ve written about it here and here). I wouldn’t wish that degree of chronic pain on a dog or my worst enemy.

I never took narcotics, but that was because I was literally terrified of them, plus I was told that opioids wouldn’t even help with my condition. This was a long time ago, and perhaps the medical point of view on that has changed in the intervening years, but I remember one of the first doctors who treated me saying to me, “Nothing will touch this pain, not even morphine.” That made me understand why people with chronic pain sometimes kill themselves.

But it’s been my impression that a lot of people who’ve never faced chronic pain do not understand the phenomenon at all. They imagine a type of pain that’s not as severe as chronic pain can be. But perhaps more importantly, they imagine a type of pain that’s time-limited and that improves on a daily or weekly basis. The thing that distinguishes chronic pain is the fact that it does not improve and the patient sees no end in sight, which saps the two basic ingredients patients require to carry on: energy and hope.

What states have passed these laws limiting chronic pain patients to the CDC prescribing guidelines? How strict are these laws? How many insurance companies will deny drug coverage if a patient exceeds those guidelines? This could be a real disaster for people who are already suffering more than enough.