Chronic pain patients urge care on opioid reforms
TAMPA — Will Michele Jacobovitz get out of bed today?
That depends on how many painkillers she has left in her monthly prescription, which she’s sometimes forced to ration. Some mornings are harder than others.
Jacobovitz, 56, has suffered from chronic pain since a 1987 car accident. The Pasco County resident has had 73 surgeries since, from her neck to her ankles, and she has the scars to prove it. In December, she was diagnosed with breast cancer.
She says it’s impossible to function without popping a highly addictive painkiller with acetaminophen and Oxycodone components in the morning. Without it, she says, there are days she can’t get up at all. Or get to the bathroom in time. It can be humiliating.
Jacobovitz says she’s not addicted to painkillers, just absolutely dependent on them.
“It comes down to quality of life,” she said. “I’m not using these drugs to get high. I’m using them so I can have some kind of life. So I can get out of bed. They don’t take my pain away. But they mask it so I can function.”
She is one of many Floridians who suffer from chronic pain and are worried about a government crackdown that would make it even harder to get the prescription drugs they need every day.
Gov. Rick Scott has proposed legislation that aims to put a dent in the opioid epidemic by prohibiting doctors from prescribing more than three days’ worth of opioids — or seven days if doctors can explain why that’s medically necessary.
Under the measure, Florida would share a database of opioid prescriptions with other states and require doctors to check it routinely. Doctors also would be trained on proper prescribing techniques.
“When people think of opioids, they think of addicts and criminals,” Jacobovitz said. “That’s not us.”
She and others fear they’re being lumped into that group unfairly. They’re part of a chronic pain community that also encompasses many of
Florida’s seniors, who rely on pain medication daily.
Scott’s legislation delves into acute, or short-term, pain. But there’s no mention of those who suffer from chronic conditions and rely on daily, long-term use of prescription painkillers.
Bills in the House and Senate are progressing steadily. And despite concern from doctors and chronic pain patients, the three- and seven-day limits on acute pain prescribing are unlikely to change, legislators say.
“I have been set on the three to seven,” said Sen. Lizbeth Benacquisto, R-Fort Myers, the Senate sponsor of the bill. “That was a very strong position on behalf of the governor.”
Federal officials are chiming in, too.
During an appearance in Tampa, U.S. Attorney General Jeff Sessions touted the Trump administration’s efforts to combat the overdose problem, and said doctors prescribe too many opioids. More people should try aspirin, he said.
“What we’re seeing across the country is a reaction to opioid-related deaths, and a myopic focus to decrease access because of those deaths,” said Dr. Sarah Wakeman, a physician at Massachusetts General Hospital in Boston.
She’s the medical director of the substance use disorders initiative at the hospital and was part of a Massachusetts task force to examine the opioid epidemic.
“What we need is a balanced and nuanced approach,” she said. “More people are buying drugs on the illicit market right now because they can’t find the opioids they were used to getting, and there’s no treatment facilities in their communities. This is different than the people who have reasonable diagnoses.”
Policymakers and the public often confuse dependence on a daily medication with addiction, Wakeman said. “We should be ensuring access to the people who are benefiting from opioids because they have a disease that requires treatment.”
Jacobovitz has seen countless doctors over the years to help repair her broken body. She moved to Florida to take care of her aging parents a decade ago at a time when her home state of Kentucky was pushing stricter limits on prescription drugs. Similar to Scott’s proposal, Kentucky has a limit of three days for opioid prescriptions.
“The number of pain management doctors in the entire state dropped to five,” Jacobovitz said. “It was impossible to get help.”
She fears she’ll have to leave Florida if the current legislation passes. “I don’t know what I’ll do,” she said.
What’s clear is that politicians and advocates feel the need to do something about the pain pill addiction that’s sweeping the country. It’s led to spiking use of cocaine, heroin, drugs illegally laced with fentanyl, and ultimately more overdose deaths. The opioid epidemic killed nearly 15 people a day in Florida in 2016 and even more than that in 2017.
Jacobovitz knows this. She's had her own prescriptions stolen and seen family members suffer with addiction.
“There’s no clear answer here how to handle it,” she says. “I know there are addicts out there. I’ve tried to help some of them, like my niece.”