Post by Joanna on Dec 11, 2018 2:56:22 GMT -5
Opioid Crackdown Leads to Despair, Suicide
By 2006, Jay Lawrence, a Navy veteran and native of Tennessee was experiencing numbness in his arms and legs and the pain was so excruciating it reduced him to tears. Multiple surgeries, chiropractic adjustments and physical therapy didn’t work. He finally found solace in prescription painkillers – 120 milligrams a day of morphine. A high dose, but it dulled the pain enough for him to take walks with his wife, shop for groceries, even take in a few movies.
But last February, the doctor at the pain clinic delivered some jarring news: He was cutting Lawrence’s daily dosage, first to 90 milligrams then, in short stages, down to 30 milligrams. The doctor said the reduced dosage was in response to the Centers for Disease Control and Prevention (CDC) prescribing guidelines released in 2016 as part of a national anti-opioid push, according to Lawrence’s wife, Meredith. “The doctor said: ‘You know these guidelines are going to become a law eventually. So we’ve decided as a group that we’re going to take all of our patients down,’” Mrs. Lawrence told Fox News in an interview.
Following the reduction in pain relievers, Lawrence’s pain returned with a vengeance. He could barely move or sleep. He soiled his pants, unable to make it to the bathroom in time, his spouse recalled. “It feels like every nerve in my body is on fire,” he told his wife.
Meredith said she and her husband went to their primary care physician and asked for a referral to another pain clinic and were advised it would take a minimum of six weeks. This was too much for Lawrence. In March, on the day of his next medical appointment, when his painkiller dosage was to be reduced again, he instead went to a nearby park with his wife. And on the very spot where they renewed their wedding vows just two years earlier, they held hands and he raised a gun to his chest and killed himself.
Lawrence, who was 58, became one of an undetermined number among the nation’s 20 million chronic pain sufferers who chose suicide after being cut back or denied prescriptions for opioids. The suicides have motivated many of those who continue to suffer pain – and family members and advocates of those who took their lives – to call for a re-evaluation of the rush to reduce opioid dosages for those who most need them. “We have a terrible problem. We have people committing suicide for no other reason than being forced to stop opioids, pain medication, for chronic pain,” said Thomas Kline, a North Carolina family doctor and former Harvard Medical School program administrator. “It’s mass hysteria, a witch hunt. It’s one of the worst health care crises in our history,” added Kline, who has 26,000 Twitter followers and a website where he publishes the names of those who he said committed suicide after having their opioids prescriptions cut back or eliminated. “There are five to seven million people being tortured on purpose.”
The CDC doesn’t have numbers on those who commit suicide after having their pain medications cut. But most of the doctors who spoke to Fox News said they knew of between one and six patients who had committed suicide after losing access to opioid treatment and being turned away by other doctors who now see prescription painkillers as a hassle.
Several prominent doctors and pain patient advocacy organizations said they have heard from hundreds who say they have been left in debilitating pain and are considering suicide. The issue earlier this year came to the attention of Human Rights Watch, which launched an investigation. “Clearly, there are patients now who feel like life is not worth living if they return to living in pain,” said Diederik Lohman, director of Health and Human Rights for Human Rights Watch. “Many of the patients we spoke to are very law-abiding and would turn to suicide before going to the street to get illicit drugs. The government has a duty to respond to the overdose crisis, but to do so in a way that is harming people who have a legitimate medical issue is a human rights issue.”
Many pain patients say they understand the urgent need of political leaders and government agencies to fight the drug overdose epidemic. But targeting the millions who legitimately suffer chronic pain is grasping for a solution that doesn’t address the preponderance of illegal drugs, they argue – or the rate of overdoses caused by them.
The CDC released a report Nov. 30 showing that despite a drop in painkiller prescriptions over the years, the drug overdose rate continues to soar, with the growth driven by the illicit opioid fentanyl and its cousins. It is a trend that has held for several years.
“People with pain shouldn’t have to suffer because people without pain are abusing opioids,” said Cynthia Toussaint, a former ballerina from California, who has Complex Regional Pain Syndrome (CRPS), which left her bedridden for 10 years, and unable to speak for five. “Pain patients don’t want to take opioids any more than cancer patients want to use chemotherapy. However, many people with pain need opioids to function physically and pursue the joyful aspects of life.”
At a recent American Medical Association (AMA) meeting, the group’s president, Dr. Barbara McAneny, spoke of how an advanced prostate cancer patient of hers attempted suicide after he was denied opioids by an insurer. “The pendulum swung too far when pain was designated a vital sign and now we are in danger of it swinging back so far that patients are being harmed,” she said, according to published reports.
Issues with CDC Guidelines. Federal officials have said the CDC guidelines weren’t intended to disrupt the proper prescribing and use of opioids. “We’re not telling any doctor that they can’t make a legitimate prescription,” then-U.S. Attorney General Jeff Sessions told Fox News, in an interview before he left office. “Maybe some doctors are getting too cautious. We don’t know.” Sessions acknowledged “opioid prescribing can be essential for people,” and added, “it’s very clear that people with serious pain problems are in need of real significant pain relief and sometimes [opioids] are the only thing that will provide relief, and it is absolutely legitimate to prescribe it.”
We have heard about the suicides ... It’s tragic that anyone takes their life for any reason, including that they had their opioids unilaterally stopped, Dr. Debbie Dowell, lead author of the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain, said. CDC officials added they are also aware chronic pain sufferers have committed suicide in their struggle to get by with fewer or no opioids. Dowell continued, saying the scope of suicides caused by under-treatment of chronic pain “isn’t something that’s easy to measure. We’ve looked at how we might measure this. Sometimes patients or their families don’t report it.”
The CDC guidelines focused on primary care physicians and recommended extreme caution in prescribing opioids. It also suggested a maximum daily dosage of 90 morphine milligram equivalents for first-time painkiller patients. But the guidelines also warned against forcibly tapering or abruptly cutting off severe pain sufferers who have responsibly taken opioids, noting a drastic change could lead to withdrawal and serious illness.
Untreated pain, many health experts say, can also lead to hypertension, more serious pain conditions and other problems. Health practitioners say this is a plight that could affect anyone – all it takes is a slip, a fall, or a botched surgery that could bring on intense and perhaps long-term pain.
Dowell indicated patients should be prescribed on a case-by-case basis. “We believe everyone deserves effective pain management,” she claimed. “The CDC guidelines are not a regulation or a law – it’s guidance for providers. It never made a recommendation to take people off medication involuntarily, or to taper down involuntary,” she continued. “It was meant to provide updated guidance about the benefits and risks of opioids for chronic pain so that the provider and the patient – together – could make decisions.”
Guidelines Become Enforcement Tools. The CDC disclaimer was apparently lost among the headlines concerning the staggering number of deaths due to opioids. 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 a proactive measure to deal with the opioid crisis on their own, at least 33 states have enacted some type 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 disproportionate focus on prescription painkillers by officials responding to the overdose epidemic, pain specialists and public health researchers say, is in great part why the drug-related death rate continues to climb while legal opioids becomes less available to pain patients.
“We’re targeting the most vulnerable and sickest people who have been on opioids a long time,” insisted Dr. Stefan Kertesz, an addiction specialist and professor at the University of Alabama at Birmingham School of Medicine. “Insurers are issuing rules that say we won’t cover long-term opioids for anyone over 90 milligrams. Well, five percent of people who receive opioids account for 60 percent of the milligrams prescribed. With so many milligrams going to a tiny group of very sick people, if you can knock a few people off these opioids, you can show a big numeric reduction. What we’re really doing is dragging down the dose on the most disabled people,” said Kertesz, who sits on several state opioid safety committees. “Prescription control seems an easy answer to the epidemic, but that’s not stopping addiction.”
Cries for Help and Giving Up. On social media, comments sections on news sites and in emails to Fox News, numerous pain sufferers say they have made suicide plans because their health care provider has forcibly reduced their dose to a deficient level, or cut them off entirely. They speak of being treated like drug abusers, submitting to frequent urine tests and pill counts. “I have been on pain management since 2006,” said a man from Tampa in a Facebook message. “Have a crippling disease that there is no cure for, and can no longer get the medications I need. A few months ago I was researching death with dignity and other options for assisted suicide if I wasn’t able to get the help needed down the road.”
Some posted comments about a loved one who died by suicide after losing access to a long-term treatment for pain and found the suffering unbearable. Others said their spouse’s suffering, together with the frustration and anguish of being turned away or under-treated by doctors, was the reason they came around to accepting their loved one’s suicide plan.
In her new home in Georgia, its walls covered with pictures of her late husband, Meredith Lawrence recalled the helplessness she felt watching him suffer, as the pain worsened, and the drugs were tapered down. “He said ‘I have three choices,’” Meredith Lawrence recalled. “He said ‘I could do illegal drugs, I could suffer the rest of my life in pain, or I can end my life. I’m not going to do the first two.’” Lawrence’s doctor did not respond to email and phone requests to comment for this story.
Meanwhile, hashtags on Twitter like #SuicideDue2Pain, #DontPunishPain, #PatientsNotAddicts have become common. “I think about suicide every day,” said Dawn Anderson, a former trauma nurse from Indiana, whose doctor cut her opioid dosage after his office was raided by the DEA. “I recently wrote a suicide note to my family,” said the woman, a diabetic whose legs were both amputated below the knee. “They have seen all I have gone through. I want to live. But not like this.” Anderson, 53, now finds it too painful to stand on prosthetics because of what she says is undertreated pain, and is confined to a wheelchair. “The pain feels like an electrical shock that happens every 30 seconds in some parts of my body,” she explained, “and in the back it’s a stabbing pain, like a hot poker that is stuck and never coming out. The pain I endure on a daily basis is taking my will to live.” Anderson’s doctor did not respond to requests for comment.
Anne Fuqua, a former nurse in Alabama who herself suffers from chronic pain, has logged records of 167 suicides since 2014 that she maintained were directly a result of patients who had their opioids reduced or cut and suffered uncontrolled pain. Fuqua said she is in the midst of verifying more suicides that have been reported to her.
Caylee Cresta, a 26-year-old Massachusetts woman, has Stiff Person’s Syndrome, a rare disease, that causes muscle spasms and rapid convulsions that fracture her bones and often leave her stuck in an unnatural position for days. She has had the condition since age 19. “You’re in fear that your doctor will say that your next prescription is your last,” she said, adding that when she has “a bad day,” it means “I stop being a mother, a wife, a daughter.” Ending the pain by ending it all has seemed, at times, like the way out, she admitted.
Though pain management experts indicated they share the concern and alarm over the terribly high percentage of drug overdoses, they are more concerned about their patients. “I share the nation’s concern that more than 100 people a day die of an overdose. But my patient nearly died of an under-dose,” said McAneny, president of the AMA. “My patient suffered, in part, because of the crackdown on opioids … When I visited my patient in the hospital as he was recovering from his suicide attempt, I apologized for not knowing his medication was denied,” McAneny continued. “I felt I had failed him.”
Sources: Elizabeth Llorente, Fox News, December 10, 2018, and Centers for Disease Control.