When Pain Kills

[As seen in National Pain Report 8.18 Written by Liza Zoellick and Janet Zureki]

Pain has a profound impact on the quality of life and can have physical, psychological

and social consequences. It can lead to reduced mobility and a consequent loss of strength,

compromise the immune system and interfere with a person’s ability to eat, concentrate, sleep,

or interact with others. According to international human rights law, countries have to provide

pain treatment medications as part of their core obligations under the right to health: failure to

take reasonable steps to ensure that people who suffer pain have access to adequate pain

treatment may result in the violation of the obligation to protect against cruel, inhuman and

degrading treatment. [1] According to a World Health Organization(WHO) study, people who

live in chronic pain are four times more likely to suffer from anxiety and depression. Because of

this, WHO has stated that for mild to moderate pain it recommends a combination of basic pain

relievers and a weak opioid. For moderate to severe pain, the WHO has recognized that strong

opioids, such as morphine are absolutely necessary.[2] Medical abuse of patients in chronic

pain and suffering is a violation of basic human rights. Humans in pain placed in cages.[3]

Although the 1961 Single Convention on Narcotic Drugs lays out some minimum criteria for the

handling of opioids, governments may, under the convention, impose additional requirements

if deemed necessary.[4]

 

In 2016, The CDC came out with its voluntary guideline for prescribing opioids for

chronic pain. This guideline provides recommendations for the prescribing of an opioid pain

medication by primary care physicians for chronic pain. According to this guideline:

When opioids are started, clinicians should prescribe the lowest effective dosage.

Clinicians should use caution when prescribing opioids at any dosage, should carefully

reassess evidence of individual benefits and risks when considering increasing dosage to

>= 50 MME/day, and should avoid increasing to >=90 MME/day or carefully justify a

decision to titrate dosage to >=90 MME/day.[5]

MME stands for the morphine milligram equivalent and according to the CDC, 90 MME breaks

down to 90 mg of hydrocodone daily, 60 mg of oxycodone daily, or 20 mg of methadone

daily.[6] Dr. Lesly Pompy, states “This standard is unconstitutionally vague and does not

promote scientific patient care”. Even though a Doctor can justify patients receiving more than

90 MME per day, most are reluctant to and some have started force tapering their patients

down to the 90 MME limit. Tolerance is patient specific because the scientific laws of

pharmacodynamics and pharmacokinetics is patient specific.[7] When it comes to tapering

down patients, the CDC states that for patients that agree to taper opioids to lower dosages,

clinicians should collaborate with the patient a tapering plan. [8] Although the guideline is clear

that the patient needs to agree to the tapering, many patients are being forced tapered instead

and are being left without proper pain control. This forced tapering has many patients have

turning to alcohol or illegal drugs to cope with their pain, unfortunately, some with devastating

consequences. This practice of forced tapering has also lead to pain patients committing

suicide.

 

The question has been raised, are CDC guidelines are causing more suicides? That

answer is not clear because experts believe many suicides go unreported or are misclassified as

accidental, often covered up by grieving family members or accommodating medical

examiners.[9] Suicides related to pain often get classified as something else like depression,

or families are too embarrassed to admit that it was the pain that caused their loved one to

commit suicide. Dr. Thomas Kline has been keeping track of patients that have committed suicide on a

pinned post on his Twitter page of patients that took their lives after being forced to taper

down or completely off of their medicine and shares their stories.

According to the CDC, Suicide rates in the US rose from 1999-2016 by

25.4%.[10] One fact does remain true, pain patients are indeed committing suicide due to their

pain.

Some of the strictest laws regarding opioids dispersal is in Florida and Kentucky which limit initial opioid prescriptions to a 3-day supply.[11] I spoke to an incredible pain warrior recently, Trina Vaughn, who lives in Kentucky but is currently making a journey to Colorado because of the changes to opioid laws. Trina is 60 years old and suffers from fibromyalgia, severe osteoarthritis and tinnitus among some other chronic illnesses. She has been medically retired and on disability since 2007. In her town of Bowling Green, Kentucky, she had the same pharmacy and same doctor for 20 years, until doctors were forced to stop writing pain prescriptions and patients were forced into two pain clinics, IPS: Interventional Pain Specialist or CPS: Comprehensive Pain Specialist. Her first encounter was with IPS, an experience I would not wish on anyone, began with being admonished for using the bathroom prior to them giving her a drug test to a doctor who was dismissive of several of her conditions yet after she disclosed five back surgeries became more receptive to pain medication, even giving her a choice of oxycontin and hydrocodone until she expressed that she preferred hydrocodone so she could break pills in half to adjust dosing. When this was revealed he told her that she would take the pills three times a day as prescribed or be dismissed and never allowed to return to the clinic. After reporting the incident, her next encounter was with CPS where she did not fare much better. Though the initial visit with the doctor went well, the next visits did not. Though she made attempt to explain ahead of time what her urine sample would show the doctor interpreted her as “non-compliant” and without an attempt at listening dismissed her as a patient and sent her packing. No prescription to tide her over and no explanation other than “non-compliant.”

This is happening everywhere and because she was left with no where to turn, Ms. Vaughn was left with an excruciating decision to make. Leave Kentucky; leave her husband and move alone to Colorado where she has better prospect of treatment. Most of my conversation with Ms. Vaughn was exchanged via email as she travels to Colorado. I could not help but worry about her on such a long trip, though she seemed very well prepared for it. This is the reality and the effect of the opioid war on patients. I chose to focus on Ms. Vaughn’s struggle because there are many more going through the same thing but without the recourse of traveling to another state to get the help they need. It is inhumane to force a pain patient to travel cross country just so they can get the help they need. It is inhumane to allow the suffering of pain patients who cannot travel and therefore cannot get the help they need. This is where patients become desperate to end the pain. These are the faces of the opioid war.

 

 

 

 

 

 

 

References

1. Access to pain treatment as a human right. Diederik Lohman, Rebecca Schiefer, and

Joseph Anon Source: ncbi.nlm.nih.gov

2. World Health Organization. Achieving Balance in National Opioid Control Policy.

Geneva. WHO. 2000 Source: ncbi.nlm.gov

3. Dr. Lesly Pompy, text message interview 7/9/18

4. United Nations Single Convention on Narcotic Drugs. UN 1961 Source: ncbi.nlm.gov

5. Foley KM. Ideas for an Open Society: Pain Management 2002 Source: ncbi.nlm.nih.gov

6. CDC Guideline for Prescribing Opioids for Chronic Pain- United States 2016 Source:

CDC.Gov

7. CDC Guideline for Prescribing Opioids for Chronic Pain- United States 2016 Source:

CDC.Gov

8. Dr. Lesly Pompy text message interview 7/9/18

9. CDC Guideline for Prescribing Opioids for Chronic Pain- United States 2016 Source:

CDC.Gov

10. Balletpedia.com

11. Opioid epidemic: New laws restricting prescriptions go into effect in these states.

Source: Usatoday.com 7/1/18

 

 

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