Everyone knows we are in the middle of an opioid epidemic. Hardly a day goes by without a headline or a TV news story about a tragic overdose death. There is no question that far too many people have died from opioids during the last few years. Unfortunately, however, the crackdown on prescription medications like hydrocodone and oxycodone has had an unanticipated outcome. Many people in severe pain have been cut off from access to relief. The lack of opioids has some chronic pain patients turning to street drugs to ease their pain. Others may consider suicide as the only way out of excruciating agony.

Opioid Prescribing Has Changed:

For many years, the best-selling drug in America was hydrocodone with acetaminophen (APAP). A decade ago more than 120 million prescriptions of this combination pain reliever were dispensed in the US. Three years ago that number had fallen to 43 million.

Some physicians were doubtless too promiscuous in their prescribing of opioids. But many doctors were sincerely trying to ease the suffering of people who had no other way to overcome severe or chronic pain. The DEA reclassification of hydrocodone from a Schedule III to a Schedule II drug made it much harder for doctors to prescribe this opioid to patients.

You can read about consequences of this policy at this link:

Patients in Pain Are Outraged about New Hydrocodone Rules

Is a Lack of Opioids Leading to Suicide?

An intriguing “News and Analysis” article in JAMA (April 29, 2019) is titled

“Limits on Opioid Prescribing Leave Patients With Chronic Pain Vulnerable”

The author, Rita Rubin, describes a doctor who has been swimming against the tide of opioid emotion. Thomas Kline, MD, PhD, treats “pain refugees.”

These are chronic pain patients who have been cut off from opioids.

“Kline accepts these patients that no one wants because he’s trying to keep them off another list, one he has helped compile: a list of US residents believed to have committed suicide because their physicians would no longer prescribe adequate doses of opioids to treat their chronic pain.

“As of late April, the list was 40 people long, but it is not inclusive, Kline said. ‘The problem is a lot of families don’t want this public. I have to respect that.’”

Has the Pendulum Swung Too Far?

We have heard from hundreds of patients suffering from chronic, intractable pain. Most never abused opioids. They took their prescribed medication exactly as directed, never increasing the dose. They are now suffering the consequences of a lack of opioids. That means withdrawal symptoms and excruciating pain. Here are just a few stories from readers.

Bill is himself a health professional:

“If anyone decides to write their Congressman, please check your spelling and grammar so you don’t come across as someone whose brain is foggy from too much pain medication.

“Maybe my own brain is fried from two Vicodin plus 4 Ultram a day, but I don’t think so. I have been on it for 10 years. I’ve never taken more than that and never used more than one doc. Still, CVS, Walgreens and Walmart are refusing to fill my prescriptions unless the doctor agrees to taper. My doctor bent over backwards with multiple calls to clarify my diagnosis, alternative treatment plan and other medications and modalities tried. It doesn’t matter. I can’t get any more Vicodin. No one cares if we jump from a bridge. If we go to street drugs, that is further justification that prescribed medication leads to criminal behavior. If we are on disability, we are a liability. We are not contributing through taxes.

“Use your pain and channel it to fight if you can. Make your voice heard somehow. Take responsibility. I too must learn to live without anything for my severe pain. I am not sure how I will continue to be productive consistently without medication.

“As a health care provider, I can tell you that nobody is going to buy that someone has 10/10 pain but can still sit at a computer and type. I have worked in ERs and Orthopedic floors and not one of those 10/10 patients in 25 years were interested in their computer or their phone. If this makes people angry, then good. To everyone struggling with this issue, including myself, breathe and learn to live with it, for this is the lot we have been given. No one cares if I commit suicide and the government won’t care about you, either.”

Nick is a veteran who has suffered severe pain for ten years:

“I am a 100 percent disabled veteran and have been a pain patient for 10 years. The VA cut my oxycodone dose from 120 mg a day to 60 mg cold turkey. I found a civilian pain management clinic and was doing OK until the CDC/DEA came out with their bogus long-term (6 weeks) study by anti-opiate doctors.

“Suicides among pain patients are up 38%. Two friends, both vets, took their own lives after their pain meds were cut off. I was desperate to find something to hold me over until my next prescription. Kratom in capsules worked for me, though it is certainly not for everyone.. It is not a miracle, but it does take the edge off withdrawal symptoms, restless leg syndrome, etc. You must stay hydrated, eat plenty and rest. Kratom saved my life a few times when I wanted to check out. I hope the new rules will let doctors put us back on our original doses.”

Jaylene is incensed by her experience:

“The war on drugs doesn’t do anything but come between doctors and patients. My doctor says I have legitimate reasons for pain medication and he wished he could give me what I need. But instead, he is forced to cut patients off their medicines. I’ve gone from 60 pills a month to 50 which means I can no longer can have two a day. When I told my doc how much this affects me, he said he would not cut my prescription any further, but he added, ‘Life is pain and you cannot take a pill every time you feel it!’ He said I just need to learn to deal with it! I couldn’t believe he said this knowing how much legitimately documented pain I’m in.

“Until recently, I was getting Xanax for severe panic disorder and anxiety. I’ve been so upset because yesterday my doctor informed me that no longer is a patient allowed to be prescribed both opioids AND benzos. He told me I have to make a choice: one OR the other, not both.

“The sister of a friend of mine committed suicide four months ago. It was because of a lack of opioids. She could no longer get her meds because of these new rules.”

Where Do We Go From Here?

Everyone understands that far too many people are dying of opioid overdoses. What seems to have been lost in translation is that many of those deaths have been caused by fentanyl, carfentanil and other potent synthetic opioids made in China. They are smuggled into the U.S. using the United States Postal Service and other shipping strategies. A small amount can kill hundreds or even thousands of people. So far, US law enforcement hasn’t figured out how to stop the flow of these killers.

The CDC has asked doctors to clamp down on opioid prescribing as a way to control the epidemic of opioid overdose deaths. In many cases, patients in pain have been abruptly cut off from their pain medicines. Not only are they suffering from the pain, they are experiencing withdrawal symptoms from lack of opioids.

Perhaps regulators will one day realize that people in severe pain are not the cause of the opioid epidemic. Cutting them off from their pain medicine is not likely to solve the crisis, though it may be create its own epidemic of suicides. They should not have to suffer from a lack of opioids.

JAMA, April 29, 2019

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