Category Archives: chronic pain
***Bob Aronson is a 2007 heart transplant recipient. He has also suffered from Chronic pain for several years and doepends on opioids to provide some comfort. He has tried several alternatives, some have been beneficial but he still needs opioids in order to live a somewhat normal life.
Yes, there is an opioid crisis. Yes, the number of deaths from opioid overdoses is a tragedy, and yes, something must be done to stop the addiction and the dying, but denying pain relief to legitimate chronic pain sufferers is not the way to do it. There are millions of Americans who suffer daily from chronic pain and need the relief provided by opioids. Everyone is subject to becoming a chronic pain sufferer including transplant recipients.
I have always thought the federal government approach to stopping the opioid addiction/overdose/death epidemic was wrong-headed, but I also thought that the denial of pain relief to legitimate chronic pain patients was accidental, a result of overzealous federal agencies. I thought that if we protested they would see the light and make the appropriate changes. I’ve never been so wrong. The Federal Government didn’t mistakenly create a problem for chronic pain patients, THEY DID IT ON PURPOSE. WE ARE NOT ACCIDENTAL VICTIMS, WE ARE THE TARGETED GROUP AND WE MUST FIGHT BACK.
Lest you think my claim is just the paranoia of a crazed junkie, let me offer proof in two forms; one personal the other by exposing government policy. First a quick personal experience. I have osteoarthritis and some pinched nerves. The proof of that claim can be seen on my MRIs.
My primary doc has often commented about the pressure applied by the feds to get him to stop prescribing opioids. He suggested I go to a pain clinic where the physicians are pain specialists and allowed more leeway, but even they are closely monitored by the drug cops. The clinic prescribed 15 milligrams of Oxycontin twice a day and 10 milligrams of Hydrocodone once a day for breakthrough pain. That was the regimen for quite some time and while not totally controlled, the pain was manageable. At the same time I was getting steroid injections in my neck and back as alternatives to more opioids. Then, one day without warning the pain doc said they could no longer offer the Hydrocodone. They said that the best they could do for breakthrough pain was Tylenol 4 which contains codeine, a totally ineffective drug for my condition and much less powerful than the Hydrocodone. Now, my pain is not under control but the doc says this is the best he can do under current federal guidelines. I expect that soon I will hear that Oxycontin is no longer available.
The federal agencies involve;d in the opioids issue seem to think that anyone who takes any narcotic pain reliever is an addict, their policies ignore evidence to the contrary. For example; I have never shown signs of addiction, I have never asked for an increase in milligrams or for stronger drugs, I have never Doctor shopped, and have always passed the random urine tests they give and when I go to the pain clinic I always have the correct number of pills left in the containers. So, why was I denied relief? Because the feds blanket policy wants all opioids use stopped regardless of who is hurt in the process. Not only that, but if you read on you will quickly see that the feds believe that chronic pain patients are liars and addicts and have therefore Targeted us. Then, they turned the torture screws even tighter by specifically targeting Medicare Part D patients. Those are the people who have prescription coverage under Medicare. What follows goes far beyond personal experience, it exposes a broad government policy that targets those who legitimately need the pain relief offered by opioids.
On April 2, 2018, CMS (Centers for Medicare and Medicaid Services) issued updated regulations for Medicare Advantage Plans (MAP) and Medicare Part D programs. The focus of the updates is to provide additional guidelines and tools to target the nation’s growing opioid epidemic. I should note that most, perhaps 90 percent of those affected are older Americans. The Government has targeted chronic pain patients many of whom are senior citizens. Here’s proof. CDC’s Guideline for Prescribing Opioids for chronic pain makes it clear that pain patients should be using alternative therapies that do not include narcotics regardless of the level of pain and effectiveness of the alternative treatment. The Guidelines ignore the fact that many patients cannot afford alternatives, are disabled and unable to get to alternative therapy and that many are uninsured and cannot afford it. https://www.cdc.gov/drugoverdose/pdf/Guidelines_Factsheet-a.pdf As I did the research, I could not believe what I found, but here’s more of the story.
These new regulations expand Medicare’s ability to identify medication misuse and establish controls at the pharmacy. Already some pharmacies are limiting opioid prescriptions to a 3 or 7-day supply. They are doing it arbitrarily as a blanket program, totally ignoring individual patient histories and medical conditions. Why? Because they believe it is good public relations. This is a business decision, not one to benefit patients. They think their tough stance on opioids will bring them more respect, more customers and greater profits. They are using our misery to make more money. They are gambling that most Americans will praise them for their efforts, when in fact they should be soundly condemned and shamed. The 3 or 7-day prescription limit means the patient with chronic pain will have to see a physician every three or seven days to get a refill prescription (Narcotic prescriptions never allow refills and in most cases cannot be called or faxed in to the Pharmacy.. The Patient must posses the prescription and physically hand it to the pharmacist. At the same time, he or she will also be asked for ID). Everyone knows that it is nearly impossible to get a doctor’s appointment every three to seven days, so it is obvious that pharmacies like CVS and Walmart in their quest to be more profitable have joined the Government in calling chronic pain sufferers liars and addicts.
Always remember, these are business decisions. They are made to determine the effect on the business, not for the betterment of humankind. When corporate executives or their boards of directors make decisions like these, their first concern is the bottom line. They do not make decisions based on what’s right or what’s compassionate. When things like 3-day prescriptions are proposed, the first question asked is, “How will that affect the bottom line?” If the answer is negative, acceptance is very unlikely. Don’t be fooled by their advertising or PR efforts. If an effort can’t make money, they don’t do it and, if they decide to do it and it fails to make money they will quietly withdraw it.
The same is true of Insurance companies. From January 1, 2019 on, those companies that offer Part D plans will have the authority to arbitrarily establish drug management programs for patients they believe are at risk of abusing medications (a good excuse to quit paying for certain drugs, an action that will increase insurance company profitability). They can then determine misuse without ever talking to the patient. That means insurance companies can designate an individual as “at risk” and limit the patient’s access to their list of frequently abused drugs with no patient or physician input. (CDC guidelines for prescribing opioids) https://www.cdc.gov/drugoverdose/pdf/Guidelines_Factsheet-a.pdf
You can be assured that if Insurance companies see that disallowing Part D payments for pain-relieving drugs will strengthen their bottom line, they will do it. This war on opioids then becomes a profit center for Part D. Insurance companies. CMS (Centers for Medicare and Medicaid Services) says it will designate all opioids, except Buprenorphine (a drug used to treat opioid dependence) and Benzodiazepines (an addictive drug used to treat anxiety, nervousness, panic disorders, muscle spasms, seizures, and more). Benzos will also be designated as a frequently abused drugs but will be excluded from the new guidelines, for a while). You can read more here — CMS proposes Part D Opioid Limits, Pharmacy reacts. http://www.drugtopics.com/drug-topics/news/cms-proposes-part-d-opioid-limits-pharmacy-reacts
There are an estimated 25 million Americans that suffer from Chronic pain, and this new attack will only make the suffering worse. Read what follows, and you’ll have the full story.
The U.S. Government’s war on opioids is led by the DEA (Drug Enforcement Administration), the FDA (Food and Drug Administration) and the CDC (Centers for Disease Control). CDC reports that opioids were involved in 42,249 deaths in 2016, and opioid overdose deaths were five times higher in 2016 than 1 999.
I do not doubt that there is a crisis of major proportions and that something must be done to stop the abuse of these drugs and the mounting death toll. The government approach, though, is over-broad, arbitrary and just plain wrong. They would make opiates unavailable to everyone. That goal fails to recognize that millions of chronic pain sufferers legitimately need to use opioids, and to take them off the market will cause irreparable physical and mental health damage. The government insists there are alternatives to opiates; they ignore the fact that the alternatives don’t work on everyone, that some patients can’t afford them because insurance does not cover them and that many patients are uninsured. The Government program is more likely to force chronic pain sufferers into the street to buy cheaper illegal drugs than to alternative programs that only extend the pain.
Among the targets of the above-mentioned federal agencies are 1) the companies that make opioids, 2) the physicians who prescribe them, 3) the pharmacies that fill the prescriptions and 4) the patients who need them. CDC says that each year, over 200 million opioid prescriptions are written and filled in the United States. In 2012 the number of prescriptions peaked at 255 million. No doubt, that’s a hell of a lot of opioid prescriptions, and the number raises the question, “How many of them are really necessary for pain control and how many do nothing more than satisfy an addiction?” That’s the question the Feds should be asking. Instead, they are acting as though they have the answer and it is, “All of those prescriptions are life-threatening, especially those written for patients who claim to have chronic pain.” Patients, on the other hand, are getting this message, “All of you so-called chronic pain sufferers are liars. You don’t need opioids.”
The feds message to the medical profession is, “We’re watching you and want you to know that we strongly discourage prescribing opioids for repeat patients. If you continue to do that you are placing your license at risk.”” So, who is a repeat patient? That’s me and thousands if not millions like me who must see a physician each month to get a new opioid prescription. There is far less pressure on docs who write a scrip for one or two-time use. That’s someone who broke an arm, and in a few weeks, the pain is gone on its own as opposed to Chronic Pain patients who need on-going relief.
The issue that the feds refuse to address is this; while you are seeking out and trying the alternatives, how do you control the pain? Several pain management specialists have told me that to determine which alternative will work, you must quit using opioids and it may take months to find one that works, or you may never find it. All that time you are experiencing pain so intense as to cause you to have suicidal thoughts or at least thoughts of how death would provide relief. When pain is so bad, it prevents you from doing anything, even those things you used to love, and the feds don’t allow any relief, they are violating this age-old admonition, “First, do no harm.”
As a chronic pain sufferer, I would much prefer to get pain relief from something other than a narcotic. I don’t like the feeling I get from using the drugs. As an intelligent, functioning human being, I much prefer a clear head to one muddled by narcotics. While I am nearly 80 years old, narcotics allow me to be a functioning, productive member of society. I do woodwork, write blogs, just published a science fiction book, engage in discussions in the social media and do the grocery shopping and even some cooking. Without opioid relief I would be reduced to a weeping, grumpy old man who is unable to do anything for himself.
Most politicians are on the anti-opioid bandwagon, they don’t know about chronic pain so we have to tell them. we have to be isiIbecause they’ve only heard a small part of the story. Now it is time to tell our story because if we don’t’ all of us may exit this world in excruciating pain. This time we can’t wait for someone else to fix the problem, we must fix it ourselves by telling our stories to those who can stop this nonsense. Here are some addresses you can write to or call.
House of representatives members and contact info. https://www.house.gov/representatives
U.S. Senate members and contact info. https://www.senate.gov/general/contact_information/senators_cfm.cfm
CMS Contact info https://www.cms.gov/Medicare/Coverage/InfoExchange/contactus.html
DEA contact info https://www.dea.gov/contact.shtml
FDA contact information. https://www.fda.gov/AboutFDA/ContactFDA/default.htm
The White House contact information. https://www.whitehouse.gov/get-involved/write-or-call/
American Pharmacists Association contact information. https://www.pharmacist.com/contact-us
Finally, be in touch with your local media. Suggest stories on chronic pain with this angle, “The feds, physicians, and pharmacies, aren’t telling the whole story. Here’s the chronic pain patient’s perspective.”
Only you can change this wrong-headed, harmful approach to ending addiction to opioids. Tell your story, let the bureaucrats and elected officials know your feelings and your suffering. There are 25 million of us, if we all act, we will be a force that cannot be ignored.