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How the Opioid Crackdown Is Backfiring
Written by <a href="index.php?option=com_comprofiler&task=userProfile&user=46536"><span class="small">Brianna Ehley, Politico</span></a>   
Tuesday, 28 August 2018 08:08

Ehley writes: "Hundreds of chronic pain patients responding to a POLITICO survey describe being refused opioid prescriptions they had relied on for years with sometimes devastating consequences."

Many people with chronic, disabling pain describe being tapered off narcotics too quickly, or worse, turned away by doctors and left to navigate on their own. (photo: Kevin D. Liles/NYT)
Many people with chronic, disabling pain describe being tapered off narcotics too quickly, or worse, turned away by doctors and left to navigate on their own. (photo: Kevin D. Liles/NYT)

How the Opioid Crackdown Is Backfiring

By Brianna Ehley, Politico

28 August 18

Hundreds of chronic pain patients responding to a POLITICO survey describe being refused opioid prescriptions they had relied on for years with sometimes devastating consequences.

ast August, Jon Fowlkes told his wife he planned to kill himself.

The former law enforcement officer was in constant pain after his doctor had abruptly cut off the twice-a-day OxyContin that had helped him endure excruciating back pain from a motorcycle crash almost two decades ago that had left him nearly paralyzed despite multiple surgeries.

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“I came into the office one day and he said, ‘You have to find another doctor. You can’t come here anymore,’” Fowlkes, 58, recalled. The doctor gave him one last prescription and sent him away.

Like many Americans with chronic, disabling pain, Fowlkes felt angry and betrayed as state and federal regulators, starting in the Obama years and intensifying under President Donald Trump, cracked down on opioid prescribing to reduce the toll of overdose deaths. Hundreds of patients responding to a POLITICO reader survey told similar stories of being suddenly refused prescriptions for medications they’d relied on for years — sometimes just to get out of bed in the morning — and left to suffer untreated pain on top of withdrawal symptoms like vomiting and insomnia.

“I was pretty much thrown to the curb,” said Denise Pascal, 65, who had taken pain meds for decades after six back surgeries. Then her pain doctor cut her off and closed her practice without connecting her with another specialist.

Many of POLITICO’s respondents described being tapered off narcotics too quickly, or worse, turned away by doctors and left to navigate on their own. Some said they coped by using medical marijuana or CBD oil, an extract from marijuana or hemp plants; others turned to illicit street drugs despite the fear of buying fentanyl-laced heroin linked to soaring overdose death numbers. A few, like Fowlkes, contemplated suicide.

“I sat my wife down and told her life wasn’t worth it,” Fowlkes said after he had gone more than a month without pain relief while also suffering opioid withdrawal symptoms. “My pain exceeded my ability to handle it. We had a very frank discussion. … We even discussed what gun I would use.”

Fowlkes found another doctor willing to continue prescribe his medication. But he worries what will happen if the pills stop coming.

“Now there’s this ticking time bomb,” he said. “I don’t know when it’s going to go off again.”

That’s not an idle fear. Trump, who vowed during his campaign to combat the opioid crisis, has set a goal of cutting prescriptions by one-third over the next three years. He has also boasted of stepped-up prosecutions of doctors who prescribe inappropriately and sought tougher sentences for those who sell drugs illegally. While Trump has stressed a law enforcement approach — including broader use of the death penalty for traffickers — his administration has also invested billions in prevention, treatment and research, and last week authorized a respected science group to develop better guidelines for doctors about how to safely treat patients with severe pain.

Certainly, stories like Fowlkes’ and Pascal’s illustrate the unintended consequences of efforts to suddenly reverse years of loose prescribing practices that fueled an addiction crisis — and why so many of the estimated 25 million Americans suffering from chronic pain feel angry and forsaken. While studies suggest that other therapies are safer and more effective for many chronic conditions, large numbers of these patients are now hooked on the narcotics and on the relief they say they get from constant, grinding pain.

“I have a lot of anger, because I think there were a lot of things done wrong to all of us,” Pascal said.

Have you been treated for opioid abuse recently? Tell us your story.

Many doctors and pharmacists responding to POLITICO’s survey acknowledged such patients’ predicament. But they said they feel under enormous pressure to limit the powerful painkillers and fearful of consequences, such as losing their licenses or even prison time, for inappropriate prescribing.

The Justice Department has aggressively prosecuted doctors for improper prescribing or fraud — charging nearly 200 doctors and another 220 medical personnel for opioid-related crimes since January 2017, the DOJ said in a June press release.

Nonetheless, the toll of overdoses keeps mounting. Almost 70,000 people died of drug overdoses last year, according to the latest government numbers. About 49,000 were opioid-related, including legal and illegal painkillers, as well as street heroin and fentanyl.

“I will no longer treat chronic pain. Period,” said Sue Lewis, a primary care doctor who works in an urgent care clinic in Portland, Oregon. “There is too much risk involved,” she said, adding that if a patient doesn’t take the medications as she prescribes them, they could jeopardize her license.

Steven Henson, an emergency room doctor in Wichita, Kansas, described how his license was suspended after six patients illegally sold the medications he prescribed, without his knowledge.

“The DEA should be working with doctors when this happens,” as opposed to punishing them, Henson said.

Jianguo Cheng, president of the board for the American Academy of Pain Medicine, said that besides being scared, many doctors are also fed up with time-consuming requirements, including pill counting, where a patient brings her prescribed medication to the clinic so the doctor can make sure they aren’t being misused. Doctors also have to order regular urine tests to detect abuse.

And few are trained how to safely wean someone off opioids. Some patients told POLITICO their doctors failed to treat their withdrawal symptoms, and they were sick for weeks after being tapered off their painkillers.

Any doctor can prescribe a powerful painkiller like Oxycodone, but a physician has to go through special training and licensing to prescribe some drugs used to treat addiction. Only about 5 percent of U.S. physicians have been certified to prescribe buprenorphine, one of the main treatments for addiction, according to an NIH study published last fall.


Few saw the approaching wave. The effort to overhaul opioid prescribing began with little fanfare in March 2016, when President Barack Obama’s CDC issued controversial, first-of-their-kind guidelines, advising primary care doctors to prescribe opioids only as a last resort for pain, and then, in the lowest effective dose.

The guidance suggested a three-day limit for initial prescriptions for acute pain and recommended avoiding prescribing increasing large doses for those complaining of chronic pain. It was aimed at primary care doctors in an outpatient setting, not at specialists treating people with complex, chronic conditions, or those with advanced cancer. The CDC specifically excluded active cancer treatment, palliative care and end-of-life care, as well as the use of opioids in surgical and trauma settings.

Nonetheless, groups including the American Medical Association and the American Cancer Society Action Network raised concerns about unintended consequences for certain chronic pain patients, including cancer survivors who often deal with lifelong pain. AMA also raised concerns about the evidence underlying the guidelines.

Since then, at least 32 states have enacted laws related to limiting opioid prescriptions with exceptions for cancer and palliative care patients, according to the National Conference of State Legislatures. Most center on acute pain, but Oregon is considering a 90-day prescribing limit on many chronic pain patients in Medicaid. Those patients would have to go off the drugs within a year.

The guidelines have also served as a template for insurers like Anthem and pharmacy chains including CVS Caremark, that have capped initial opioid prescriptions. The Trump administration has also finalized opioid prescribing limits for initial prescriptions in Medicare Part D to take effect next year.

Sally Satel, a psychiatrist, Yale University School of Medicine lecturer and resident scholar at the conservative American Enterprise Institute, said the guidelines have been “systematically misinterpreted” as a blanket ban on opioids.

“Policies are being written as if to be in compliance with some mandate that we don’t have,” she said.

That misinterpretation, coupled with the crackdown on doctors and pharmacists under Trump’s Justice Department and growing alarm about opioid overdose deaths, has caused some doctors to stop prescribing opioids entirely.

Now, though, some patients are beginning to fight back.

“We thought we should be the ones being consulted because you’re talking about taking our medicine,” said Lauren DeLuca, president of the Boston-based Chronic Illness Advocacy Awareness Group, formed last November by DeLuca and another chronic pain patient to lobby state and federal lawmakers on behalf of those with chronic pain.

Some doctors are also questioning guidelines that they say tie their hands when it comes to chronically ill patients.

Thomas Kline, a general practitioner in North Carolina specializing in chronic and rare diseases who has garnered a large social media following for opposing the guidelines, argued the CDC shouldn’t tell doctors how to treat their patients. “It dawned on me that the CDC was going to sit in my office and try to tell me how to prescribe pain medicines, instead of tracking Zika,” he said.

Kline said he has not tapered any of his patients off opioids because he doesn’t believe that’s the right approach. He wants Congress to create an independent board to review the prescribing guidelines to prevent further unintended consequences.

Such efforts may be having an effect.

The Trump administration stands by the CDC guidelines, but officials say they are in early discussions about “expanding” upon them by providing specific examples of what doctors should prescribe for certain procedures. The FDA recently awarded a contract to the National Academies of Sciences, Engineering, and Medicine to develop new guidelines for treating acute pain that build on the CDC’s guidance, but lay out treatment recommendations for specific conditions and procedures.

“The goal is to strike a balance,” Vanila Singh, chief medical officer at HHS’ office of the Assistant Secretary for Health and the chair of an interagency Pain Management Task Force, said during a public meeting earlier this summer to discuss how to treat pain amid the opioid crisis. “We know there is a drug epidemic, and we know there are overdose fatalities happening all the time. But that has to be balanced against the issue of treating acute and chronic pain.”

Some doctors say they are also seeking better training in pain management. “Medical school certainly did not provide a solid basis for pain management or addictions,” said Henson, the Kansas emergency room doctor who said he has sought that out.

Many say one of their biggest problems is the dearth of good alternatives to opioids. Congress is working on legislation that includes provisions to encourage development of non-addictive pain treatments, but that won’t help the millions currently suffering from chronic pain.

Non-opioid pain therapies like acupuncture, which helps some conditions, can be expensive, and not all insurance plans cover them. Some people use medical marijuana, but insurance doesn’t cover that either. And some medical professionals caution against marijuana because there’s not a lot of research about its effectiveness and long-term safety for pain control.

Pascal, the Virginia back patient, says she has spent more than $5,000 in the past year treating her pain and withdrawal symptoms with alternatives such as acupuncture and CBD oil. She chose to go that route instead of medication-assisted treatment with a milder opioid called Suboxone (the brand name for buprenorphine). Although the treatment is considered the gold standard by doctors, she said she worried about remaining addicted.

Others say going off opioids entirely isn’t an option.

“The medication controls my pain to the point that I can function independently,” said Drew Pavilonis, 56, from Durham, North Carolina, who has relied on methadone to address chronic pain that developed following surgery to remove a brain tumor that left him wheelchair-bound. “Without it, I’m bedridden and pray for death.”

He blames “opioid hysteria” for the barriers at certain pharmacies.

“The longest I had to go without medication was four days,” Pavilonis said, blaming pharmacy issues for the gap. “I bought a pill splitter, and I started to split my methadone pills in half so I would at least have some medication for the four days. I suffered a great deal of pain during that time.”

Stigma around painkiller use is also an issue.

“You go in to fill your prescription and you’re treated like a second-class citizen … like you’re a drug addict,” said Melissa Brown of Helotes, Texas, who takes daily doses of OxyContin to cope with rheumatoid arthritis. “It’s like, wait a minute, I don’t abuse my drugs. I’m 51 and I’ve never had so much as a speeding ticket.”

Brown, and other chronic pain patients who responded to POLITICO’s survey, say they feel as if they’ve been pushed to the side in the larger response to the opioid crisis.

“President Trump in 2016 made it his mantra to represent the forgotten men and women,” Brown said. “I speak for a lot of chronic pain folks when I say we are now feeling like those forgotten men and women.” your social media marketing partner


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-5 # RLF 2018-08-28 10:00
The huge increase since 1980 of "chronic pain" sufferers is hiding obesity and stupidity problems in our society. People want their pain meds so that they continue to live in exactly the same way doing the same stupid things. Most of these people are junkies that would have better luck doing some other forms of pain relief...but that would mean they have to change they way they live...and not only do they not have the stomach for it, there is no support for doing this from our glorious government. These drugs lose efficacy with long term use...leaving these folks with a habit and still with pain. It is our entire drug filled approach and people's demand for a pill to fix everything without any sacrifice that needs to change.
+4 # USADUDE 2018-08-28 12:15
We are losing people unnecessarily to overdose who are living in constant excruciating pain that is made tolerable by extended release drugs like OxyContin. I’m sure there are people selling their pills to supplement their meager disability benefits. When a person suffering with chronic pain is cut off by his doctor or her insurance company or pharmacy what are they supposed to do? Many seek out street drugs like heroin and die from overdose. We have too many stupid counterproducti ve laws or regulations. Why do we hurt so many of our fellow Americans while claiming to be helping? Let Doctors treat their patients and please don’t treat us as medical experiments. We suffer enough just dealing with our day to pain. We don’t need the added uncertainty of not knowing if we will be able to get our medication or if we are going to be forced to go through the added pain and suffering associated with withdrawal symptoms. This is no way to treat law abiding citizens who happen to suffer from chronic pain. Nobody chooses to suffer from chronic pain Nobody! Without proper medication the probability for a bad outcome seems unavoidable this is entirely avoidable if we let those who need strong pain relief get it.
+6 # they said what? 2018-08-28 12:40
RLF, I think you don't know people with serious illnesses, like rheumatoid arthritis or chronic back pain. If you did, you might be more sympathetic to their plight. There may be a class of abusers, but there are also people with serious chronic problems that involve daily pain. For those people there is a point at which pain renders living impossible, and at that point if people don't take something, they can't function, as people in this article testify.

The problem with Trump's dealing with the opioid crisis is that, as usual, he doesn't know much about what it is and how to deal with it. He chooses a simple attack, which causes as much or more damage than it fixes. The tough guy stance may be appealing to some, but it lacks the critical thinking to find solutions that work.
+4 # lorenbliss 2018-08-28 13:51
With the Christians using their Trump/Pence Regime as a weapon to tyrannize the nation, what is really happening here is that the Christian belief in suffering as divine punishment has become the cornerstone of USian drug policy.

In other words, from the perspective of our JesuNazi overlords, it's ok to cut off people's pain meds because they wouldn't be hurting if they weren't sinners, accursed by the sadistically hateful Abrahamic god.

Again, and how many times must it be said: read Jeff Sharlet's "The Family: the Secret Fundamentalism at the Heart of American Power" (Harper: 2008). There's also Chris Hedges “American Fascists: the Christian Right and the War on America” (Free Press: 2006) and “American Theocracy: the Peril and Politics of Radical Religion, Oil and Borrowed Money in the 21st Century” (Viking/Penguin : 2006).

Read these works and you'll see the U.S. was irrevocably hell-bound for Christian theocracy long before the Trump/Pence victory gave the JesuNazis the apocalyptic powers they had long sought to destroy our Mother Earth, whom they regard as a "Satanic" throw-away world useful only as a stepladder to their god's imaginary "heaven."
+5 # lfeuille 2018-08-28 20:18
I don't know how "Christian" this is. It seems to me to be more stupidity and impatience. Trump just doesn't have the attention span to deal with complex situations and doesn't want to be bothered.

This goes in cycles. Chronic pain patients made big strides in the '90's in getting the medical establishment to recognize that their need for opiates was much higher than the average person and were for a while able to get the drugs they needed, But, of course Big Pharma took advantage of the loosened controls to flood the market and sell to those without chronic pain. Now they are cracking down again without making allowances for the legitimate pain patients. There should be a way to exempt therom the rules if policy makers weren't so simple minded.

Of course, the whole opioid crisis is a symtom of economic inequality crisis in the first place and can't be solved without addressing that crisis. Alcoholism and suicide are also "in crisis" for the some reason.
+4 # DongiC 2018-08-29 04:10
lorenbliss, you won't be invited to teach at Sunday school if you don't straighten up and fly correctly. Thanks for the book citations. I'll order them shortly. I don't know why God or Goddess allows such unremitting pain that people seek out heroin or suicide to end the torment. I don't agree with RLF that they are just stupid or too stubborn to change. That is way too insensitive. They are just too unlucky to have this condition of chronic pain in a society where the Christian right exercises such control over the political process. Rather than availability of drugs like heroin, under close government regulation, we have no heroin at all unless you get it illegally on the street. This is nuts. The Christian community demonstrates its lack of reason and true care for those who are suffering. And, they call us evil and tools of Satan. How does one educate them to be really human and kind? That is the key question.

Hopefully, we will find the answer before the species destroys itself through environmental pollution or nuclear war, I don't think we have much time left. Perhaps, the young, progressive female politicians of the day will show us the way.
0 # Matty 2018-10-07 09:17
I think it's sad what's being done to people who have a legitimate reason to be on pain medication..suc h as myself..I suffer with chronic headaches.neck pain and back pain...No therapy,or injections helped been there done that!! So finally I was proscribed a pain medication that finally gave me minimal relief to where I could function with every day task..the pain I suffered before taking pain medication was horrific.kept me bed ridden for day's or I spent most of the time in the's sad what's being done to us chronic pain patients..I've never abused or over taken my medication..and they want to through people to the wolfs and stop do you cope with pain!! Don't make the honest ones suffer..such as my self and millions of others..I 100% agree with every comment on here..people aren't going to suffer with severe pain..some will turn to street drugs and who will be the blame!! It's just a catch 22 and not to mention I was tossed from my doctors office two weeks ago and told to get pain management after being on pain medication for 12 year's..didn't care about withdrawal symptoms I would be going through ..that is so unfair.I heard horror stories about withdrawal not everyone handles them the same as someone else..
If there gonna cut people off then do the humane way..they'll be less drug addicts on the street!!! Withdrawal is no could be dangerous in some cases.