FROM THE LAWHERN FILES:
NORMAN J CLEMENT RPH., DDS, NORMAN L.CLEMENT PHARM-TECH, MALACHI F. MACKANDAL PHARMD, BELINDA BROWN-PARKER, JOSEPH SOLVO ESQ., REV. C.T. VIVIAN, JELANI ZIMBABWE CLEMENT, BS., MBA., WILLIE GUINYARD BS., JOSEPH WEBSTER MD., MBA, SHELLEY HIGHTOWER, BS., PHARMD., LEROY BAYLOR, ADRIENNE EDMUNDSON, JAY K.JOSHI. MD., MBA., NATASHA DUVALL PHARMD., WALTER L. SMITH BS., LEROY BAYLOR, BS., MS., MS., BRAHM FISHER ESQ., MICHELE ALEXANDER, CUDJOE WILDING BS, DEBRA LYNN SHEPHERD, BERES E. MUSCHETT, STRATEGIC ADVISORS
Sally Satel is a psychiatrist, a resident scholar at the American Enterprise Institute, and a visiting professor in the Department of Psychiatry at Columbia University’s Vagelos College of Physicians and Surgeons.
DOCTORS PRESSURED, PATIENTS SUFFER
The consequences of this new opiophobia have fallen on the shoulders of patients experiencing acute or chronic pain, many of whom have found themselves abandoned by healthcare providers in the name of preventing opioid abuse and addiction.
Dose tapering of chronic-pain patients with commercial health insurance and Medicare Advantage has increased substantially in recent years, and a quarter of those patients have had their doses tapered more quickly than medically recommended, according to a 2019 study by researchers at the University of California, Davis. In 2017, a survey of 3,100 chronic-pain patients by the non-profit Pain News Network revealed that 71% could no longer obtain necessary opioid medication from a doctor or had to settle for a lower dose.
“Suicide is perhaps the most devastating consequence of the crackdown on opioid prescriptions.”
Eight out of 10 said their pain and quality of life had worsened, and more than 40% said they had considered suicide as a way to end their suffering. Even some patients with sickle cell disease and terminal cancer — subgroups that the CDC explicitly excluded from the reach of the guideline — were not immune from painful dose reductions or complete cutoffs.
Many of these abandoned patients have become “pain refugees,” a tragic cadre of individuals who chase the dwindling numbers of physicians still willing to prescribe even modest doses of opioids. Traveling hundreds of miles every few months to obtain care in another city or state, they often drain their limited incomes on the odyssey.
Those who remain with their local physicians often try to supplement their reduced doses by adding alcohol or benzodiazepines for pain relief, thereby inadvertently enhancing the odds of an overdose. (In fact, the lethality of such combinations has created an exaggerated sense of the inherent lethality of opioid pain relievers which, on a population level, are rarely the sole cause of a fatal overdose.)
Other pain patients who’ve had their doses tapered or cut off have replaced opioids with large amounts of non-steroidal anti-inflammatory agents such as Advil, acetaminophen, or aspirin, which puts them at increased risk of liver injury, renal damage, and bleeding from the upper gastrointestinal tract. Still others report being required to undergo invasive procedures, such as implantation of medication pumps, in order to manage their pain.
Some patients have become so desperate for relief that they’ve moved to inherently riskier drugs after losing access to prescription opioids. “The VA cut my pain meds cold turkey after over 25 years,” a veteran told Fox News. “I now buy heroin on the street.”
Though the percentage of such patients is small (perhaps 5% over five years, according to estimates from SAMHSA), turning to street pills has proven dangerous. The Drug Enforcement Administration warns that sales of counterfeit pills — consisting of fentanyl pressed into pill shapes with familiar tablet markings — have been linked to overdose deaths nationwide.
Suicide is perhaps the most devastating consequence of the crackdown on opioid prescriptions. Case studies documented by physicians and personal tragedies memorialized on social media give the strong impression that poorly treated pain has pushed some patients into taking their own lives. Since 2011 Anne Fuqua, a retired nurse and chronic-pain patient, and Terri Lewis, a doctor of rehabilitation medicine with Southern Illinois University, have maintained a registry of people who took their own lives following physician-initiated changes or cuts in their doses.
To date, they have confirmed 584 suicides, the majority of which included people under age 59. About half were women, and almost all were white. Self-inflicted gunshot wounds were the most common cause of death, followed by hanging, carbon-monoxide poisoning, and jumping off a bridge. One veteran in New Jersey set himself on fire.
UNSCIENTIFIC BOGUS DEA-DOJ GUIDELINES HAVE SENT HIGHLY TRAINED MEDICAL DOCTORS AND PHARMACIST TO PRISON
After 2016, advocacy organizations such as Human Rights Watch and the American Cancer Society called on the CDC to revise its recommendations. To the agency’s credit, it responded. In 2019, the centers issued a press release and published an article in the New England Journal of Medicine stating that their guideline had been sorely misinterpreted as a federal mandate to reduce patients to 90 MME. (listen to podcast Jefferey Singers MD)
The Food and Drug Administration followed suit. Citing reports of “serious withdrawal symptoms, uncontrolled pain, psychological distress, and suicide” among patients inappropriately cut off from pain relievers, the agency issued a memo requiring changes to opioid labels so that they specifically warn of the risks of sudden and involuntary dose tapering. HHS also produced a guide on careful tapering practices.
Unfortunately, the corrected record has not had much impact. “The clarification did not filter down,” observes Kate Nicholson, a Denver-based civil-rights attorney.
“Patients are still being forced to have doses reduced or discontinued, and are experiencing outright abandonment by their clinicians. And doctors still fear law enforcement.”
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