Pain patients, doctors worry about opioid law
Stacie Bashaw doesn’t know how she’ll cope when her pain medications run out in a few weeks.
Bashaw, of Chickasha, uses two types of opioids and an anti-seizure medication called gabapentin to manage pain from degenerative disks in her back, neuropathy, two types of arthritis and “phantom” pain where the lower half of her right leg was amputated. Sometimes, it’s so bad that she wakes up on the floor, feeling like she’s on fire.
“The other night, it felt like somebody electrocuted me,” she said.
Soon, she will lose access to those medications, based on what might be a bad interpretation of a state law coming into effect on Nov. 1.
Senate Bill 1446 requires doctors who treat chronic pain patients to assess them at least every 90 days, according to the Oklahoma Board of Medical Licensure and Supervision. A certain passage in the bill led some doctors to fear that they would have to see patients every 30 days, however.
Dr. Terrell Phillips, who treats Bashaw and other patients at Comprehensive Pain Care and is president of the Oklahoma Pain Society, said he’s none too happy about the situation either. He didn’t discuss specific patients, but said he cut back on the patients he would see so that he could assess them every 30 days.
“I’m having to release between 500 and 700 patients because of (SB) 1446,” he said. “It’s placed a major burden on the patient.”
There’s no good answer about how to decide which patients to taper off, Phillips said, and he would have liked to have started three months ago, when he could have reduced the dosage more gradually.
Confusion over law
The bill doesn’t specifically tell doctors that they must see fewer patients, but some have cut back their caseloads based on a provision that says they must “assess” patients on long-term opioid therapy each time they renew those patients’ prescriptions. For some, that’s every 30 days, and that caused the confusion, said Lyle Kelsey, executive director of the medical board.
The boards overseeing medical and osteopathic doctors recently released a set of best practices to guide physicians, Kelsey said. Some doctors have taken a more conservative approach and are preparing to comply with the strictest possible interpretation of the law, which was written unclearly, he said. At one point, the law states patients must be assessed every 90 days, so it’s possible lawmakers didn’t understand how frequently some insurance companies require doctors to renew prescriptions.
“With any law, there’s 120 questions,” he said.
What is clear is that doctors will only be able to prescribe seven days’ worth of opioids at a time for patients experiencing what should be shortterm pain after an injury or surgery, Kelsey said. The patient can come back for subsequent seven-day prescriptions, but if treatment with opioids goes beyond three months, the doctor and patient have to make an agreement for regular monitoring, he said.
Until he gets more clarity about the rules, Phillips said he plans to keep working with patients to wean them off their medications. He worries some patients could turn to street drugs because of a lack of help managing chronic pain or addiction, but says the Legislature needs to fix SB 1446 so doctors know what they need to do to stay on the right side of the law.
“We’ve been asking patients to contact their representatives,” he said.
Now, Bashaw said she’s afraid not only of the pain that drove her to seek treatment in the first place, but of withdrawal symptoms as she comes off the opioids. People who have gone through withdrawal describe it as something like a bad flu. In rare cases, it can be dangerous, if a person loses too much fluid and develops a blood chemistry imbalance.
Her doctor gave her only about half of a month’s supply, Bashaw said, and she doesn’t that will allow her enough time to reduce her dose.
“I could see weaning myself off it if (my doctor) had given me a whole month’s worth, but he didn’t do that,” she said. “It’s like signing a death sentence.”