Opioids: Pain patients, doctors say they’re unfairly targeted
Feds rethinking policies that led to crackdown
David Lackey spent 40 years running his machine repair business, despite having a body wracked by arthritis, degenerative disc disease, bone spurs in his shoulders and fractures in his back and spine.
After the Drug Enforcement Administration raided his pain doctor’s offices in January, seized medical records and prohibited any more opioid prescribing, Lackey lived only 34 more days.
The Odessa, Texas, man died of a heart attack in March, after a monthlong withdrawal that left him in bed shaking or in the bathroom vomiting and with diarrhea, his daughter, Gina Bruton, said.
Facing a backlash from chronic pain sufferers nationwide, federal health officials are rethinking policies that led to abrupt cutbacks to those who legitimately need these painkillers to function.
Federal measures made a broadbased effort to cut opioid prescribing and slow an overdose epidemic that kills tens of thousands of Americans each year. However, Centers for Disease Control and Prevention officials acknowledge the agency’s influential 2016 chronic pain guideline has been used incorrectly to justify harmful practices such as rapidly reducing pain pills or doctors abandoning patients.
The CDC plans to update and expand the guideline with new research and is coordinating with public safety officials to ensure patients such as Lackey aren’t discarded when a doctor’s office is raided or closed.
In April, the Food and Drug Administration warned about reports of serious harm from slashing or discontinuing medication for opioid-dependent patients, including withdrawal, pain, psychological distress and suicide.
This fall, the FDA is expected to finalize plans to add warning labels to opioid medications about the risks of abruptly stopping the drugs. The FDA also proposed in May that drugmakers be required to offer limited-count blister packs of pills as an option to patients. These packs could be in low, medium or high-dose packs or be tailored to different procedures, such as hernia operations or appendectomies.
And a Department of Health and Human Services advisory task force in May reported on how to weigh the needs of 50 million chronic pain sufferers while tightening prescribing to prevent opioid addiction. The Pain Management Best Practices Inter-Agency Task Force recommended ways to allow pain sufferers to function and improve their quality of life.
Total U.S. opioid prescriptions have declined each year since 2012, a trend that accelerated after the CDC guideline issued in March 2016. Still, overdose deaths have continued to climb as pharmacies dispensed fewer pain pills, largely driven by illegal drugs such as heroin and fentanyl.
Vanila Singh, who chaired the HHS task force, says it could take time for state medical boards, doctors and others to bring nuance to prescribing opioids.
‘Doctors are afraid of the DEA’
Bruton believes pain patients and doctors have been unfairly targeted.
“Sure, the warning labels should be there,” says Bruton. “But in my opinion, they are fighting the wrong war.”
The CDC’s clarification is that its guideline was intended for primary care doctors, who increasingly are turning away pain patients.
“Doctors are afraid of the DEA and worry their livelihood will be lost, so they are trying to protect themselves,” says Bruton.
‘At the end of my rope’
Other research shows one consequence of the prescribing crackdown is that doctors are reluctant to take on new pain patients. A University of Michigan study published in the Journal of the American Medical Association found that 41% of 194 primary clinics surveyed refused to take new pain patients.
Rebekah Leonard knows the difficulty of finding a pain doctor. A bulging disc, nerve damage and a botched back surgery have put the Reidville, South Carolina, woman in constant pain since the late 1980s.
She says a fentanyl skin patch provided steady relief for years. But when her primary-care doctor retired five years ago, it took six months to find a pain specialist who put her on a strict, tapering regimen. When Leonard failed to take off one pain patch before putting on another, the pain doctor refused to continue to treat her, she said.
She’s been without pain medication for more than three years and spends 23 hours a day on her bed or sofa. She rarely leaves the house.
“I’m at the end of my rope,” Leonard says. “There are many people in this situation.”