To curb the ongoing tidal wave of opioid addiction and overdose deaths, state and federal governments have put in place policies that restrict doctors’ ability to prescribe opioids such as OxyContin, Vicodin, and Percocet. Although well-meaning, these policies are unleashing several unintended — yet entirely predictable — consequences.
One is an unprecedented spike in drug overdose deaths, quite rightly described as a nationwide epidemic. When opioid pills become difficult to obtain, some patients who depend on these prescription medications to get through the day relatively pain-free switch to heroin. That’s a dangerous move because heroin, like any street drug, can be mixed with or substituted by fentanyl, and even more dangerous drug. A fatal dose of fentanyl is just three milligrams, roughly the weight of a few grains of salt. Fentanyl is what killed Prince.
Another consequence is the needless stress inflicted upon patients who legitimately and responsibly rely on opioids for various medical conditions but now find it far more difficult to access them. One of us (Alex) suffers from migraines and relies on triptans — drugs designed specifically to prevent or stop migraines — to cope. When they don’t work, Vicodin offers relief. This is a common strategy for migraine sufferers.
Josh has severe asthma and sometimes needs prednisone, a steroid, to keep breathing normally. One of prednisone’s worrisome side effects is a boost in blood pressure high enough to potentially trigger a stroke or heart attack. Coughing further elevates blood pressure, which is difficult to control in the midst of an asthma attack. Codeine and other opioids do an effective job of suppressing coughing.
Both of us have been in the position of needing opioids for our respective conditions when our doctors were not available — and no other doctor or health care provider was willing to prescribe it. That has meant hours of unnecessary migraine pain and potentially dangerous coughing.
To prevent this from happening again, each of us independently squirreled away Vicodin that was prescribed following dental procedures. We know that one day we will need an opioid but have trouble obtaining it.
We’re actually the lucky ones. Our need for opioids is sporadic. Hoarding opioids isn’t possible for people with severe chronic pain who need these drugs to function on a day-to-day basis.
The Seattle Times reported the heart-wrenching story of Denny Peck. He lived with chronic pain for 26 years following a commercial fishing accident that crushed several of his vertebrae. Peck was prescribed opioids and other medications through a Seattle pain clinic. But when the clinic suddenly closed, he could not find a doctor to prescribe the medication he needed to survive. Unable to live with the pain, Peck killed himself. “No doctor would chance losing his license due to new laws, and Denny saw no help from the medical people although he tried and tried,” his family wrote in an obituary.
Peck’s case is an extreme example of what individuals with chronic pain, and those with other conditions eased by opioids, are finding — their physicians, some of whom had been responsibly and carefully providing them with opioids for years for legitimate medical reasons, are now reluctant to do so for fear of losing their licenses. This is another unintended consequence of the latest opioid-prescribing policies.
An untenable, one-size-fits-all mindset to opioid control isn’t working.
We can and must fix this. We recommend at least three changes to existing opioid-prescribing policies.
First, the CDC’s 2016 guideline for prescribing opioids for chronic pain, the culmination of several years’ worth of government meddling in the affairs of pain patients and their doctors, should be scrapped and replaced with rules that do not punish patients with legitimate needs for opioids or the doctors who are trying to help them.
Second, it must be made clear to physicians that their licenses are not in jeopardy for properly doing their jobs. Of course, doctors who have a long history of overprescribing or abusing their privilege should be punished by the Drug Enforcement Agency. But lumping together these two groups is a grievous mistake.
Third, we should create a national health database of opioid use and users that would be made available to health care providers. Though such a system must be designed with privacy at its core, it would prevent people from doctor shopping for opioids while still allowing patients to obtain the medications they need.
To fairly evaluate any policy, the benefits of implementing it must be weighed against the risks of not implementing it. In this case, we believe the harm caused by a Draconian opioid policy is far outweighing the benefits.
Josh Bloom, PhD, is director of chemical and pharmaceutical sciences and Alex Berezow, PhD, is senior fellow of biomedical science at the American Council on Science and Health.
Finally someone in the medical field that gets it. It’s somewhat of a relief to know that the ” educated class” knows how tragically ignorant it is to put the fear of God in the physician’s to prescribe medication to the public because they don’t want to lose their licenses but in doing that people have to turn to the street to prevent going into full blown withdrawal and have never had to do heroin before so they have no idea what is in the dope they are getting which is why the overdose rate went through the roof. So it’s a really big viscous deadly cycle that easily could have been prevented if the arrogant government would let the doctors do their job by regulating the country’s patients who need pain meds to live. While they should be focusing there attention on the cartels and keeping the fucking phentanal off the street so these young punk’s quite cutting the heroin with something they know nothing about. All they know is they can put 20 grams of cut on one gram of phentanal. Meanwhile they are killing young privlaged teens with money and could care less bc they get the shit so cheap. Before that crap hit the street a gram of heroin was 160 bucks. Now you can get a gram of phentanal for 50 dollars. Its absolutely ridiculous. I’m diagnosed bipolar with a anxiety disorder and have to jump through hoops to get the medicane i need to get through the day. Something has to be done. I hope that you are the ones who have enough information to get this disaster rectified. My thoughts and prayers are with you
For the past six or seven years most doctors that I’ve seen or know of are deathly afraid to write any kind of opioid medications especially at any higher dose the opioid problem is missed characterized they have a heroin problem not so much the pills and most of the people that were addicted to the pills If over taken,the doctors didn’t listen to the patient and just cut them off. Common sense Tells you to put them on sub text or whatever you call that stuff to get you off heroin and wean them off that. insurance companies have been covering those meds for years now. Fentanyl laced heroin IS the biggest problem by far
T, too, am in a similar predicament. I’ve been on oxycodone for 6 yrs for Crohns disease, inflammatory polyarthritis, psoriatic arthritis, osteoarthrits, severe DDD of all lumbar vertebrae. I was stable on oxycodone, simponi and imuran for those years. I got cancer from simponi so imuran and simponi were stopped. consequently my pain increased so the dr. increased oxycodone. He was called in twice by arkansas medical association with all the documentation why my pain med increased. He was threatened to lose his license. He quit pain management. New doctor is weaning me off oxyodone due to such risk. The only side effect I had was decreased diarrhea from crohns which was a blessing. I was compliant with my regime. I will be placed on buprenorphine another narcotic which after much research has more potential side effects than oxycodone. I’ve been an RN 38 yrs. and love research. I can see how the CDC guidelines have been misinterpreted to the detriment of those truly needing opiates. I will comply with new regime if it works. If not my rheumatologist has agreed to treat my pain with long-term low dose steroids. They have horrible side effects but i want some quality of life like keep my house clean, grocery shop, go to church and socialize. Now I lie in bed most of the time, depressed and anxious about the future. I’m 70yo and resposible. How can medicine become a cookie cutter procedure. The CDC hasn’t examined me or reviewed my cat scans, mris, labs or done a physical exam. So who is really prescribing? Not the MD which by law is necessary. Wish the best for all pain patients and I won’t kill myself due to religious beliefs but its tempting at times.
In my opinion, the use of street drugs like heroin, street fentanyl, and methamphetamines (opiates), shouldn’t be considered or included with prescribed drugs like hydrocodone, OxyContin, or medically prescribed fentanyl patches (opioids). They are NOT the same thing, and too many people, including doctors, use the terms interchangeably. The deaths from overdoses of street drugs shouldn’t be counted as a prescription overdose unless the person is deliberately misusing the rx.
I believe there are far too many people so do use their medications to get high, however, and those people need to be monitored carefully for suspected abuse if they use more than the usual and customary prescribed amount. I’ve been taking hydrocodone for a long time. My insurer allows 90 pills per month. I rarely take 3 pills per day, so my 30-day amount lasts anywhere from 6 to 8 weeks, depending on my pain level. I have fibromyalgia and RA, with quite a bit of cervical and spinal stenosis, and residual pain from a rollover car accident 20 years ago. I don’t “hoard” my pills, I use them when I need them and don’t use them when I don’t need them. That sounds simple enough.
You are so right. Street drugs contain all sorts of ingredients that can cause deadly reactions. Anaphylaxis, Stevens Johnson syndrome are the most common reactions that can kill someone very quickly after an injection. While we’ve been trained by Hollywood and government messages to believe this is what heroin/opiate overdose looks like, actual opiate OD is a long process (1-12 hrs) in which breathing slows, leading to a feedback loop during which fewer signals from brain to lungs to breathe. This process can be interrupted, with no permanent harm.
Also, of deaths that are attributed to opiates, 80% have 1-4 other drugs on the death certificate. The most common, fully 1/3, are benzodiazepines, which can be fatal by themselves.
The most disturbing thing is that “opiate death” is a bureaucratic category, not the conclusion of a scientific investigation. Only 8.5% of deceased Americans are autopsied. There are 2432 offices in the US with legal authority to declare cause/of-death (most chronically understaffed). Of those offices, 2/3 are run by elected coroners, most with no requirements for scientific or medical credentials, 2/3 of offices have no in-house toxicology lab, 2/3 no in-house tissue lab, 1/3 no x-ray. Sending out samples to drug test one decedent costs $2500, and if the total national yearly spending for death investigations is divided by the number of decedents, it’s less than $3 per individual. One example to consider is Justice Scalia. The county coroner declared his death a heart attack during the phone call when she received news of his death, with no examination of the body or the scene.
Hi, hello my name is Wanda and I have a daughter with MS. She was diagnosed when she was 27 years old.
The started her on pain medicine, she was on 15mg of oxys 3 or 4 times a day when one day it was taken away, nothing to help her ween off . This is what turned my daughter to use street drugs. I need to thank the “The Hospital “ for my daughter being on heroin, for if she was weened off she wouldn’t of used street drugs. All the doctors started taking all their patients off pain medicine. This has hurt a lot of patients and turned them to use street drugs.
The CDC Guidelines were meant to be guidelines for primary care physicians. We have an overdose problem in this country not a prescription overdose problem. The CDC guidelines have been so politicized and hyped due to the self-interest of a few like Andrew Kolodny that the legitimate intractable pain patient in the US has been forgotten. Since when did one-size-fits all work for anyone, most especially in medicine. We have patients in this country with intractable pain disorders – like arachnoiditis, RSD, CRPS and other centralized pain syndromes which are ignored in this current plan. Where do these patients go? They don’t have cancer pain. Do these individuals have a right to live. I’m one of them – I’ve had arachnoiditis since a dural compromise in surgery ten years ago. No one knew how to treat me until I found Forrest Tennant, M.D a specialist in intractable pain disorders who is now working on a protocol to teach other physicians about the disease. He saved my life. And now because a few red flags were raised the DEA raided his clinic in West Covina. He’d just received a life time achievement award at Pain Week….managing intractable pain is not like making coffee in the morning. I imagine patients are hoarding their meds – we’re accused of selling them…a ridiculous statement. Will I be allowed to live – not sure at this point. Nancy Jeanne Marr, M.S.W., M.P.H.
Nancy,
I think you just expressed the thoughts of all of us who are Dr. Tennant’s patients. Great job! Required reading for @DEALosAngeles & DEAHQ.
What mystifies me in the barrage of media output about the “opioid epidemic” is the lose of the chronic pain sufferer’s collective voice. There seems to be no advocacy for people with intractable, chronic pain, no discussion to implement a system to facilitate them. Within the current system the high school lacrosse player with a sprained ankle is in the same category as someone with severe spinal stenosis or even stage four cancer. Addressing this issue by leveling patients would make so much more sense than simply categorizing and limiting the medication they need to function.
That’s because the DEA has been cooking up the “opioid epidemic” since at least 2011:
https://www.deadiversion.usdoj.gov/mtgs/pharm_awareness/
My state of Wisconsin,,,we are literally censorred in EVERY NEWSPAPER IN WISCONSIN,, if we write any comment ,”for” the use of MEDICINE,, for chronic medical painful condition,,,so our voice is willfully being censored,,,maryw
The government, CDC, DEA and doctors are know known murders, What they have done is inhumane , cruel and evil. No wonder America is hated by just bout every country and its own American people. They are MURDERS.
ITS CALLED TORTURE AND GENOCIDE OF THE HUMAN BEINGS WITH CHRONIC MEDICAL CONDITIONS..they purposely made our field of medicine expensive,..I use to go 1nce a year to my pm doc,,250 bucks a year,,Now as we all know..w/our FORCED 90 DAY,,OR 30 DAY visits,,,forced pee test,,etc,,its 2-3 000 x 12 or x3,,,,,either 10,000$$$ or 120,000$$$$,,,,the government purposely made it expensive,,U know why they moved the weakest meds to a class 2,,,to get a better felony charge on our doctors,,thats it,,,,it had NOTHING,NOTHING,,TO DO W.SAFETY.. it called torture and genocide and until they are stopped legally and charged w/torture,which carries a life sentence for any government entity,,,it will just kep happening,,,maryw