Declared Opioid Emergency Does Not Address Compliant Patients

Will President Trump’s declaration of the opioid crisis as a “national public health emergency” make those who take opioids responsibly the unintended victims of this most recent war on drugs?

Donald Trump's War on DrugsPresident Donald Trump declares a national opioid emergency on October 26, 2017 but at what cost will it be to patients who take the medication responsibly for chronic pain? Photo by Michael Vadon // CC BY-SA 2.0: https://flic.kr/p/rWHUgf

President Donald Trump declared the current opioid crisis a “national public health emergency” in an October 26, 2017 press conference. But he stopped short of allocating federal funds to combat the problem. Nonetheless, this development may once again leave patients who take opioids responsibly to manage chronic pain the unintended victims in the nation’s continuing war against opioid analgesics.

Trump’s speech furthered the momentum that began in 2016, when the Centers for Disease Control and Prevention (CDC) passed recommendations to physicians to reduce opioid use.

Combating the Opioid Problem

Both actions are in response to rising rates of opioid addiction and related deaths in the United States. According to the CDC, from 1999 to 2014 in the US, more than 165,000 died from overdoses related to opioid pain medication. In the past decade, while deaths from heart disease and cancer (and other leading causes) have decreased, the death rate associated with opioid pain medication has increased substantially. Meanwhile the sales of opioid pain medication coincide with the increase in opioid-related overdose deaths.

In an apparent effort to stem the problem, President Trump told press conference attendees about actions being planned to combat the problem including requiring training in safe opioid practices for prescribers employed by the federal government, a new effort to develop pain killers without addictive properties, cracking down to prevent shipments of fentanyl (a synthetic opioid made in China), and lifting restrictions on funding for drug treatment programs through Medicare.

Already the CDC guideline and the World Health Organization leaders calls for physicians to treat chronic pain (in patients without cancer) with non-opioid therapy options, or to use the lowest effective dose of opioids possible and carefully evaluate the benefits and harms of continued use with patients every three months. These recommendations have resulted in fewer doctors prescribing opioids; and among those that do, greatly reducing patients’ dosing, leaving many people with chronic pain suffering.

How Will This Impact Responsible Opioid Users?

Now advocates for patients with pain worry that the president’s message will further impact responsible opioid users in a negative way. In fact, Forest Tennant, MD, DrPH, Practical Pain Management Editor in Chief believes that an entire class of patients with chronic diseases are being overlooked in the federal push to reduce opioid abuse.

“This is not the first war on opioids. Presidents from Nixon to Bush have been declaring a war on drugs and yet they have failed to distinguish between drug abusers seeking illicit street drugs and legitimate patients with unyielding pain who need treatment,” Dr. Tennant says. “Let’s not confuse the needs of patients with pain with the challenges of helping addicts. It’s time to focus on drug abusers, but not at the cost of the 80-year-old woman with diabetic neuropathy, or the many patients struggling with cancer pain. Their physicians should not be hindered from delivering proper pain medication. Physicians take the Hippocratic oath and promise to relieve pain and suffering."

Thomas Buchheit, MD, chief of the Pain Medicine Division in the Duke Department of Anesthesiology agrees with Dr. Tennant. “We need to make sure we don’t marginalize pain patients or penalize doctors who try to take care of them in a truly compassionate manner. We’re seeing many primary care physicians who are no longer willing to prescribe opioids, even at low doses for low-risk patients, because of the concern over medical and legal liability.” If we drive these patients outside the medical system, Dr. Buchheit continues, “it will have significant negative consequences, including increased death rates.”

Pain Patients Feel the Brunt of Federal Efforts

One of the numerous patients who has been experiencing pain and suffering as the result of the CDC guideline is Gary Nations, a 54-year-old Mississippi resident and a medically-retired police officer with severe pain caused by a degenerative disk disorder. His opioid doses have been greatly reduced by his pain specialist over the past year, leaving him in pain and angry about the situation.

"I'm very sorry for the loss to the families [affected by opioid abuse],” Nations said in response to Trump’s press conference, which included families who have lost relatives to opioid abuse and overdose. “It’s tragic when a family member abuses opioid medications or street drugs. However, I'm not responsible for what happened to them. I'm still alive and I use my opioid medications as they are intended to be used,” he stresses. “I'm trying to have the best life I can have even though I'm still in some pain every day. I—and others like me—shouldn't be getting punished because others made the decision to abuse a certain class of drugs,” he adds.

The media is full of stories like Nations’—pain patients being forced in desperation to find other ways to manage increasing pain and reduced quality of life. Online message boards have numerous posts of patients in pain turning to black market drugs or considering suicide because their distress is so extreme.

Exploring Other Options

Jordan Tishler MD, president and CMO of inhaleMD, a Massachusetts-based holistic medicine and medical cannabis practice, said that many Americans—both those in the general population and also military veterans—are being left behind in current policies. He pointed out that while the current federal response to opioids has good intentions, it may be leaving people like Nations (who is not Dr. Tishler’s patient) to suffer.

“There is no question that we have become too liberal with opioid medication over the last decade or so. There were several pain control initiatives that helped lead us to this point,” Dr. Tishler admits. “However, the efforts to curb the hazards of opioid use currently are draconian and misunderstand the root causes. Higher scrutiny of clinicians and patients has only led to fear of being punished in both groups, and has resulted in many pain sufferers being ‘cut off’ from their pain medications. This is not the best way to solve this situation.”

He recommends that pain patients consider other treatment options, including medical cannabis, to address pain. While the federal government currently prohibits the use of medical cannabis, many states have already made it legal, opening up new alternatives for people grappling with pain from chronic illness and injuries.

Dr. Tennant recommends pain patients meet with a specialist to be sure they have a proper diagnosis and to explore other appropriate pain management options that could help ease their suffering. For patients who feel they are being overlooked by their physicians, Dr. Tennant urges them to take action by filing a complaint with their state medical board. To access a directory of state medical boards, visit the Federation of State Medical Boards’ website.

 

View Practical Pain Management's Editorial on this subject.

Updated on: 11/09/17
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The Smart Patient's Guide to Chronic Pain Management
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