BIRMINGHAM, Ala. — About four years ago, Dr. Stefan Kertesz started hearing that patients who had been taking opioid painkillers for years were being taken off their medications. Sometimes it was an aggressive reduction they weren’t on board with, sometimes it was all at once. Clinicians told patients they no longer felt comfortable treating them.
Kertesz, a primary care physician who also specializes in addiction medicine, had not spent his career investigating long-term opioid use or chronic pain. But he grew concerned by the medical community’s efforts to regain control over prescribing patterns after years of lax distribution. Limiting prescriptions for new patients had clear benefits, he thought, but he wondered about the results of reductions among “legacy patients.” Their outcomes weren’t being tracked.
Now, Kertesz is a leading advocate against policies that call for aggressive reductions in long-term opioid prescriptions or have resulted in forced cutbacks. He argues that well-intentioned initiatives to avoid the mistakes of the past have introduced new problems. He’s warned that clinicians’ decisions are destabilizing patients’ lives and leaving them in pain — and in some cases could drive patients to obtain opioids illicitly or even take their lives.
“I think I’m particularly provoked by situations where harm is done in the name of helping,” Kertesz said. “What really gets me is when responsible parties say we will protect you, and then they call upon us to harm people.”
It’s a case that Kertesz, 52, has tried to make with nuance and precision, bounded by an emphasis on the history of overprescribing and the benefits of tapering for patients for whom it works. But against a backdrop of tens of thousands of opioid overdose deaths each year and an ongoing reckoning about the roots of the opioid addiction crisis, it’s the dialectical equivalent of pinning the tail on a bucking bronco. Kertesz’s critics have questioned his motives. He’s heard he’s been called “the candyman.”
“I am really worried that people like Stefan Kertesz, who is trying to champion ‘patient-centered care,’ in some ways are feeding into the same misleading messaging rolled out by Purdue [Pharma] and others that not to prescribe opioids is tantamount to torturing patients,” said Dr. Anna Lembke, the medical director of addiction medicine at Stanford. (Lembke has served as a paid expert witness for plaintiffs suing Purdue and others in the opioid supply chain for their alleged role in the opioid crisis.)
The debate is playing out as doctors try to move beyond their days of overprescribing while responsibly treating chronic pain. It is also playing out in settings like Kertesz’s office here at a Veterans Affairs clinic, where a patient named Jerry Brown, a 63-year-old former boilermaker and carpenter, recently showed up.
Brown had a compressed spinal cord and severe neck pain. For more than a decade, dating back to before he started seeing Kertesz, he had been taking about 300 morphine milligram equivalents (MME) of opioids a day — a dosage equivalent to more than three times the level that clinicians should “avoid or carefully justify,” according to federal officials.
Kertesz and Brown tried a 10% dose reduction a few years ago. But Brown became volatile and less active and complained of revived pain, so Kertesz eased back.
Kertesz, who treats patients who are or have been homeless, told Brown that he had “incurred risk” with his dose. “Do you know that I wish you hadn’t had your doses increased?” he asked.
“Yes,” Brown replied.
They could try again to taper the dose to reduce that risk. But Brown had stable housing and activities to keep him busy — he helped his ex-wife out at her home and cleaned up after her Chihuahuas. He had anxiety and sometimes had trouble getting to the clinic because of transportation problems. But there was no evidence he had misused or sold his drugs, or misused other substances.
In this case, Kertesz’s takeaway was: “Leave well enough alone.”
Opioid prescribing has been declining since 2012, though levels remain higher than they were two decades ago. Today, depending on the estimate, anywhere from 8 million to 18 million Americans take opioids for chronic pain.
The interest in reducing their dosages is predicated in part on efforts to minimize patients’ risk of overdose and addiction. But there are other considerations. Enduring opioid use makes people more sensitive to pain, many experts believe. Opioid use has also been associated with anxiety, depression, and other health issues.
Plus, as people become dependent, the drugs might just be staving off symptoms of withdrawal that would come without another dose, rather than treating the original source of pain.
In short, experts say, long-term opioid use is not good medicine.
Kertesz, who is also a professor at the University of Alabama at Birmingham School of Medicine, agrees with all of that. But he believes that lowering dosages will hurt some patients who are leading functional lives on opioids, and that top-down strategies won’t protect them.
So, in 2015, when the Centers for Disease Control and Prevention proposed prescribing guidelines for primary care clinicians treating chronic pain, Kertesz grew nervous.
The guidelines, a set of measured recommendations finalized in March 2016, suggested clinicians try other therapies for pain before moving to opioids and prescribe only the lowest effective dose and duration of the drugs. (The guidelines do not apply to end-of-life or cancer care.) For patients on high doses, the guidelines said, “If benefits do not outweigh harms of continued opioid therapy, clinicians should optimize other therapies and work with patients to taper opioids to lower dosages or to taper and discontinue opioids.”
“Our day-to-day practice aligns with nearly all principles laid out in the guideline,” Kertesz wrote in a comment he submitted on the draft. But he cautioned the voluntary recommendations could be implemented too stringently by others.
“This is a guideline like no other … its guidance will affect the immediate well-being of millions of Americans with chronic pain,” he wrote.
After the release of the guidelines, Kertesz started seeing ripple effects. In early 2017, federal officials unveiled a Medicare proposal that would have blocked prescriptions higher than 90 MME without a special review. Around the same time, the National Committee for Quality Assurance considered docking clinicians’ scores if they had patients on high doses for long periods.
Kertesz, other experts, and some medical societies protested such proposals, contending they invoked the CDC guidelines while violating them.
“Most of us wish to see an evolution toward fewer opioid starts and fewer patients at high doses,” Kertesz and colleagues wrote in response to the NCQA plan. “The proposed NCQA measure indulges no such subtleties.”
The discussion overall has been hindered by limited research, including evidence for the benefits of forced tapering. But as of October 2018, 33 states had codified some prescription limits into law. Pharmacies and insurers capped prescriptions at 90 MME. Law enforcement agencies warned high prescribers.
Some initiatives have focused on avoiding “new starts,” not on tapering legacy patients. But Kertesz and other advocates argued the pressure of all the policies and warnings inculcated an anxiety around prescribing.
Chronic pain patients were seen as legally risky and medically complicated, so they had trouble finding providers.
Kertesz and his allies raised their concerns in the popular and academic presses and at conferences, building momentum over the years. They collected anecdotes from patients who said they had been harmed in some way by dose reductions or involuntary tapers.
“It is imperative that healthcare professionals and administrators realize that the Guideline does not endorse mandated involuntary dose reduction or discontinuation,” read a March letter co-authored by Kertesz calling on the CDC to reiterate its recommendations were not binding. The letter continued: “Patients have endured not only unnecessary suffering, but some have turned to suicide or illicit substance use.”
More than 300 patient advocates and experts, including three former White House drug czars, signed it.
Kertesz sees his advocacy work as an extension of several throughlines in his career. For one, he has patients who have been on opioids for years, and he knows the stress clinicians face when renewing a high-dose prescription. He also has a history of arguing for causes that stretches back to writing op-eds for his high school newspaper in Silicon Valley.
But his willingness to take on what he sees as injustices does not mean he feels self-assured about doing so.
“Every single bit of it involves ambivalence and driving myself crazy,” he said. “Like, am I making a mistake? Am I going to blow up my career?”
When Kertesz thinks, he leans forward and pulls his hair back. His obsessive streak extends to both his career and his personal life. (He’s become a fencing fanatic, having taken up the sport less than six years ago.) When he talks about medicine, he pauses mid-conversation to point out whether his statements are based on randomized trials or his own inference. He can appear scatterbrained and is working with a coach to become more structured.
“He’s not like a heroic figure on a horse. He’s more like a neurotic figure on a horse,” said Dr. Saul Weiner of the University of Illinois at Chicago, who became friends with Kertesz while working at a hospital in Gabon during medical school.
Having tenure has made Kertesz more comfortable being outspoken. And he feels he may have more credibility than other physicians to make this specific case. He is a primary care physician who cares for people who are homeless and, beyond some former stock ownership, has no ties to drug companies, as opposed to a pain specialist who received research funding from them. (Kertesz noted that he recently packed his own PB&J for a conference, the implication being he’ll avoid even a pharma-funded sandwich spread.)
But other leaders of Health Professionals for Patients in Pain, the group that wrote the March letter calling on the CDC to clarify its guidelines, have projects that are supported by drug companies. They disclose as much on the group’s site, but it’s left the group exposed to the criticism that it’s not wholly removed from the pharmaceutical industry.
Kertesz “certainly is very close to people who are being paid by opioid manufacturers,” said Dr. Adriane Fugh-Berman of Georgetown University, who studies the pharma industry’s influence on medicine. “He’s certainly worked with people who have close ties to opioid manufacturers.”
Kertesz said that because of the industry’s history of opioid promotion, such criticisms need to be part of the discussion.
Fugh-Berman is among the experts who have challenged Kertesz’s most alarming claim: that pain patients are being driven to suicide. They argue advocates are relying on anecdotes more suited to a political candidate’s barnstorming of Iowa than the kind of scientific evidence needed to substantiate claims of a new epidemic. Establishing cause and effect in suicide is complex, and studies have shown an association between opioid use and suicide.
“Where is your evidence of documented suicides from people who are tapered?” Fugh-Berman asked Kertesz following a presentation at a conference last year.
Kertesz replied that he had reviewed medical records from people who had died by suicide after an opioid reduction. He added a caveat: “You have three things that are potentially simultaneously associated with harm: Pain itself. Opioid dependence, the dependence itself. And the event, however we wish to interpret it clinically — as resurgent pain or untreated opioid dependence — in patients who are having opioids taken away.”
Kertesz is now trying to secure funding to study such suicides.
Fugh-Berman and Kertesz are often cast as representatives of two fundamentally opposed camps. (Indeed, Stanford’s Lembke and Kertesz are slated to square off in a “spicy debate” at an upcoming medical conference.)
Such a framing elides what they agree on. Kertesz emphasizes that opioids were massively overprescribed, that the patients he’s worried about should have never been on these doses, and that many patients will be better off after tapering. Lembke stresses that tapers need to go slowly and that patients should be monitored closely during the process — never pushed out of care.
But they disagree on exactly how to go about lowering prescribing and the proportion of patients who can be tapered without compromising quality of life.
Lembke argues that top-down policies are required to counter all the incentives clinicians have to keep patients on opioids. She has called for medical centers to establish teams that can guide patients through the process. She also said that some patients should be switched to buprenorphine — an opioid addiction medication that eases withdrawal symptoms — even if they do not meet the diagnosis of opioid use disorder.
“To leave them at those doses because it’s too hard, that’s not OK,” she said.
Lembke noted that prescription policies typically include exceptions for some patients to remain on high-dose opioids.
“There are rare instances where I would agree that maybe the most judicious path is ‘leave well enough alone,’” she said. “But that would be where the patient has to commute four hours to get to my clinic, they have no social support, they have no family, they have no psychological or emotional resources to help them do this hard thing which really from a medical perspective they need to do.”
Kertesz takes a different view. He supports doctors who encourage tapers, and he has spoken about tapering a patient off her medications against her wishes in one case. But he believes those are choices for clinicians to make, and that overarching policies will lead to mismanaged care.
Backing mandatory limits, he said, “assumes that what’s going to happen at the systems level will reflect the best clinician.”
Last month, the authors of the CDC guidelines published a paper that said “some policies and practices purportedly derived from the guideline have in fact been inconsistent with, and often go beyond, its recommendations.” They called out “hard limits and abrupt tapering of drug dosages” that their guidance did not endorse.
It was what Kertesz and his colleagues had been asking for. But now, they face the more difficult task of ensuring every group that overshot the CDC guidelines corrects course.
The national attention Kertesz has received for his efforts felt far removed from the room where he was seeing his patients earlier this month. One was in the midst of a taper experiment, from 40 MME to 35 MME a day. But there was also talk of blood pressure medications and cancer screenings — primary care basics.
Then there was Byron, 47. He asked that his last name not be used, but Kertesz and the staff at the clinic called him their Jonah. He had been swallowed up by his addiction and maybe should have died, but here he was, like God had some plan for him.
Byron was staying at a recovery home, but he felt listless without the rush of drugs or living on the street, he told Kertesz. Kertesz bumped up his buprenorphine dose, but the existential anguish was a harder problem to address.
“At any given moment, any one of us feels unsure about who to be or what to do or how to do it,” Kertesz told him.
“You have extra burdens, but you’re not alone,” he continued. “Everyone has times when they don’t have clarity.”
This story has been updated with information about Dr. Anna Lembke’s work as a paid expert witness in opioid litigation. This information was disclosed after the story was originally published.
About the Author Reprints
The audacity to think “patient-centered care” v. never allow the patient any potential to harm the practice…
I seem to be an enigma. At age 14, I suffered a catastrophic hip/knee injury while playing high school sports. I was naturally strong, fast and fit and found work arounds, etc to stay competitive at sports and a generally healthy life style. Over the next 28 yrs, I would have ~ 10 bilateral knee surgeries for torn cartilage despite having done nothing to cause such injuries. In late 30s, arguably the most fit period of life, I was preparing to slalom ski competitively. I had already had some back problems but nothing routine chiropractic, massage, PT and yoga couldn’t resolve. One night, performing a groin stretch I felt/heard a popping sensation. All hell broke loose in my body, “It may be a poor analogy, but it what followed upon my person/body was something akin to a car when the timing belt is out of adjustment and the engine just doesn’t run right. I rapidly lost ~30 lbs, bladder was out of control, electric arcs running all over in pelvis, hip and spine. Also, I began to have severe sudden lower extremity weakness. In the intervening 20 yrs. I had three more surgeries, once that benefitted me but never addressed the causal event.
Further, I was stunned at the medical communities reaction to my predicament. Initially, I was well-prepared and assertive in seeking a proper diagnosis through standard medical history review and examination as well as any diagnostic testing. Today, I can tell you I am bedridden with chronic pain due unaddressed now chronic injuries, Further, the initial injuries progressively destroyed spine, hips, etc. I was put on much pain medicine, though I can’t say if my provider grasped that I was worsening all the time due activity, thus masking with more meds. It is akin to a compound fracture in one’s femur and a med. professional attempting to mask pain with morphine while encouraging me to get back out there and be active. Despite, having never failed a screening due misuse, etc of meds (lab erred at one pt, 3 out of 5x. I began insisting on a second means of screening (blood) as I had no faith in the other typical screening technique. Interestingly, roughly 3 yrs later, having titrated off or down in dosages, I was unceremoniously fired from the clinic. I found a new MD, she seemed to agree w/my viewpoint, yet nothing has ever been done to correct injuries causing pain. In my case there are clear cause and effect at work, but time is short, history is never read, my medical records are such that were anyone attempt to read them in hopes of discerning why I have chronic pain it would be/and has proven impossible.
So as of today, bed-ridden, primary and pain providers are aware, and I have not sought any increases in medication, in fact, titrated off two more. It ought to be noted all the reducing number and quantity of dosage was of my own undertaking. Now, in over twenty years, no issues with testing through this remains a cause of tremendous anxiety. I’m told fail once, receive a stern phone call, fail two times and fired. No explanation relative to reviewing test results retesting sample, etc, just fired,
Once when the provider writing my scripts for 3 of the last 10 yrs, felt this dose now to high, commented, “Could you imagine what would happen to the practice if you overdosed. Patient-centered care by b____! Every month there are new, more and more difficult hoops to continue jumping to continue the status quo. I hate the meds, but in lieu of being repaired I cling to them. As far as stats relative to opioid OD this is a well known point as being largely due heroine and black market meds like fentanyl, a good drug if prescribed correctly but I watched a show on TV, where the narrator was discussing the rampant illegal drugs of all sorts is ravaging San Francisco, noting due illegal street drugs. Yet multiple entities still like to imply this is a prescription pain med prescribed to one with years of experience. Lumping pain patients into the war on drugs is an utter Federal evil perpetrated on some of the least politically defensible citizens so it can be claimed some headway is made on the Drug War.
I expected patient-centered care, I received no team of doctors with different expertise, I received no status different from a drug abuser. My intent was meds be a short term holdover until a sure resolution is found. I’ve done everything asked of me, not so much b/c I’m forever signing new patient contracts but b/c I know what is safe and right. This is me, not their dosing guidelines, etc, Yet I’m loathed b/c a script was missed and I kindly reminded. This has turned into a comedy of errors, an echo chamber of group think w/o ideas being challenged. For me, good insurance, etc. it is a ongoing nightmare and for all those whether suffering addiction or just poor care and being added to the list it is a Federal Government, Pharma, AMA, blight.
My heart breaks for those suffering unnecessarily, It’s as though we literally have no value.
I will keep all in my prayers, and hope for a fundamental shift from greed to compassionate. Also, for the individuals in utter agony all the time, regardless of cause.
Please never forget how valuable you/we are. More so than can be imagined,
Best wishes.
I sent you a long comment .I oppressed the envelope by your picture. And composed a letter.I need help to how to start a program to get free or affordable Sebutex they have to cont.theraphy output. Meetings.drug screening etc.I mean starting from scratch
I am a patient with a terminal illness, I am still active but in an incredible amount of pain which I just have to mentally swallow every day. For a time I was prescribed 5mg per day, 5/325 once per day which gave me enough relief to be able to sleep, so during the day its hell, but I could live with it, then this false Opioid crisis was “created” and my doctor said that I needed to go to a methadone clinic, (I am like methadone? I am only taking one 5/325 pill per day are you insane?) This doctor like many is from pakistan, (not questioning his education or his practice at all but I believe that there are many doctors from other nations practicing in this nation that are terrified of the DEA) they do not fully understand this crazy situation where the CDC omitted multiple drug abuse instances along with invalid use of valid prescriptions. Simply stated the CDC lied about prescription pain medications and they did it in such a way that it appeared to be a big deal but in fact it was not at all what they made it look like. I could go on but when you look at the statistics from 2017 and 2018 it looks very different than if you go all the way back to 1970 and then tabulate up all the deaths since 1970 and then fail to separate out illegal drug use that ended in death from invalid prescriptions alone… Do you know how many patients have died from taking prescription pain medications as directed by the doctor? None, Zero, NADA, Nothing No one single patient has died from taking the prescription as the doctor directed. . . In Every single case where death occured there were multiple medications present, Heroin, Cocaine, Meth, LSD, Designer drugs, (all of these are illegal) but the CDC did not bother to separate out those deaths from deaths where only pain medications were involved? Why is that? Answer that question and you will have the answer to why large manufacturers of pain medications have paid out millions and millions to state governments. The real problem at this point is what about responsible patients? What about patients that are not addicted? What about patients that benefit from long term use of low dose pain medications? Where does that leave us? I could tell you but you already know the answer. . . When you lump everything together into one pile and then scream Wolf… Danger… That is not science, That is not helping preserve life… That is just stupid…. But here we are in a position where pain medication has been criminalized by the government just like they used to do in the former Soviet Union… don’t believe it google it and you will see plenty of evidence of how bad it was when the government attempted to put hard rules in place that did not take into account the illness of the patient or the efficacy of the medications prescribed. So I suffer on day after day thinking that someday I might find a little relief, but not really holding my breath at this point…
You have latched onto something I’d long suspected, I also find it ironic how wildly and quickly literally every entity within healthcare obliged the original CDC guidelines… guideline, a recommendation, not a law. Yet the whole stinking industry has clamored to fall in line, when CDC said they never meant for their guideline to be taken as such, nobody in industry budged. They’ve all got themselves safely insulated and the compliant patient lives in terror of a bad drug screen. The doctor’s seem quite incapable of unique, patient specific think but rather just want to be told what to do. One reason, most haven’t a clue relative to history/exam rather relying on diagnostic tests and cookbook diagnosing/treatment. Further, pharma made a concerted effort a couple decades ago. Focus on designing symptom relief such that in lieu of repairing/curing cause of pain, hbp, etc, just take this script for the rest of your live.
I have very specific injuries that left unattended have caused compensating injuries to a point of appearing very complicated. I’m 17 yrs into pain management, getting older, losing hope but have not yet had a thorough history taken by somebody at all or attached to my care, same goes w/exam. Lots of diagnostics, imaging, etc. that overwhelmingly confirm my complaints but are nevertheless ignored. What is happening can only be described as cruel and sadistic.
Most “raw” data relative to opioid nothing seems to be relative to a period ’99-’12. Most entities then analyze data and present in the most alarming terms possible when stats overwhelmingly aren’t performed correctly.
Specifically, to your point, I watch a few local news stations that are all about the opioid ____. Some months ago, they reported “another opioid overdose death”. I read the article, the individual drank a case of booze, then some quantity of cocaine and finished off with some illegal fentanyl. That one died, all other substances appear to be ignored except illegal fentanyl which I believe is typically injected or smoked, tons of black market pill presses make it too, so don’t know about straight up oral pill form, That OD death was stacked up undistinguishable from all those who’ve never misused, abused script medicine like me, But the Regulatory agencies and thus industry never cease putting new and smaller hoops for me to jump through.
When these guidelines were about to be introduced, my provider was pissed, noting, insulin and bp meds as potentially lethal. When the CDC guidelines came out, they’d all already been brought into line. No questions asked, Why is the CDC espousing dosing guidelines for any medication anyway, At least, in ’16 it was not at all a part of their mission. They were allowing possible Ebola carriers to fly and wander all over the US. This is a sad commentary on greed in healthcare and the regulatory entities of government that interact.
There tends to still be ongoing debates re: long term opioid therapy; however as in Dr.-Patient relationships before the Guidelines were introduced, the decision was in the hands of the trained physicians! That’s all but disappeared, leaving the many legacy pain patients suffering. In my opinion, doctors are Not able to treat patients properly anymore which goes completely against their oath of ,” Do No Harm”. Why is our government demanding to be a part of this crisis now of under treatment for chronic pain patients? Isn’t it supposed to be left with those doctors who’ve been specifically extensively trained, with experience in having these relationships with the legacy patients? I also believe that because the DEA has Never had a real handle on original,” War On Drugs “ they’re now taking hold of Any/All available tactics,( within their given powers now from the DOJ primarily over reaching as bullying really in directing them to attack everyone prescribing pain medications as a whole, w/o any basis or scientific evidence of wrongdoing! One Size does NOT fit all!) that dramatically encroaches on Pain Management Dr.’s and now even Palliative Care. When will they come to terms with the fact that we should be treated respectfully and not categorized or labeled as addicts or given diagnosis of Drug Seeking Behavior w/o just cause!?! It’s just plain unethical how they proclaim and pressure doctors trying their best at reducing pain levels for more manageable lives, which had been done before they stepped in. I myself have become a victim of the other side of this opioid crisis as mentioned above. I also have the additional health risks associated with being rapidly and forcefully tapered unwillingly. There’s tachycardia now, high blood pressure plus increased anxiety with depression happening since those so called recommendations turned into regulations throughout many states. I now understand how many are considering suicide over living life in excruciating pain.
In ~ 2016, about 15 very powerful senators visited DEA director about the presumed opioid crisis. They demanded assurance that legit, pharmaceutical sources would cut manufacturing while the DEA was well aware of black market pill presses, ingredients by way of China->Mexico->US black market. The director complied. Relative to chronic pain patients receiving a script from their doctor, the O.D., misuse is horribly, horribly overstated then and now. Practice and cash always lead before patient, it’s possible even legacy pain patients who’ve seen the same doctor for yrs, don’t have any providers truly or fully aware of their condition.
Best wishes,
Post frequently here re: safety and efficacy of buprenorphine. Recently received feed back that patients (as well as physicians who do not wish to use buprenorphine-perceived as being only for OUD patients) also see this med as not for pain, only addiction–definitely untrue. Patients also very fearful of experiencing withdrawal symptoms if transferred to bup. Should not happen with knowledgeable doc. Is that the case out there with patients? It shouldn’t be. Call me at 208-290-3567 with questions.
I was cut down to only ten pills a month earlier this year, after being on three pills a day for 8 years. So I dealt with it, saved them for the worst days, and tried not to dwell on thoughts of suicide. Then they sent me to the cardiologist to see why my blood pressure was so high and why my heart rate was so fast. Diagnosis: untreated pain makes my blood pressure and heart rate go up. God bless that cardiologist. Too soon to say if this will help me make my case to my primary care doctor–hoping for the best, but steeling myself for disappointment again. Meanwhile, I’ve turned into a cranky old grouch, to put it mildly. I’ve fallen out of touch with friends and family, I’ve given up old hobbies that I once loved.
My diagnosis for high bp about 20 yrs ago, now that I’ve had meds reduced bp is through the roof, seemingly uncontrolled. I need to get exercise, be active. Were any of these cranks to read a proper health history, they’d realize that won’t help as my pain is directly symptomatic of a few really bad injuries that over time created additional compensating injuries. I hope the best for you, can appreciate the crankiness, unable to do things I loved or stay in touch w/loved ones. Please don’t ever forget how valuable you are, for real.
I am a 64 yr old with lupus, chronic headaches/migraines/pain and was on a low dose of hydrocodone for approx. 15 yrs when just recently my PCP cut off my meds for no good reason. I have never abused them but take as prescribed and they’ve kept me from at least doing daily activities to the best of my limited ability. He didn’t even taper me but cut me off cold turkey, by his staff saying he will no longer give me refills. Now I’m constantly in more pain than I can bear, have gotten more depressed and hopeless, thinking this is how I have to live the rest of my life. Dr. Kertesz is right: Without relief from pain, we may seek illegal drugs and I’m willing to try medical marijuana now, despite never wanting to ever in my life. I’ve even had suicidal ideation because of this. Who wants to live the rest of their life in such pain? At least a low dose helped take the edge off and made my life tolerable. Now there will be none of that. I am very angry and will be looking for a new doctor but who’s to say they’ll be any different??
I totally understand what you are going through. It’s daunting to think the pain will never be relieved. I try to get through one day at a time and not think about being in pain forever. I pray you find a more sensible and empathetic dr. My dr has tapered my meds down a ton, and they put me through drug testing and all sorts of indignities to get the medication thry do still provide. My dr apologized for the reduction, but he said he couldn’t risk prison time for prescribing higher doses. I have literally tried everything they recommended, and nothing helped much. I did get a pain pump, which does help somewhat. I don’t know if that’s an option for you. Every time I hear politicians talk about the opioid crisis, I figure more of my meds will be taken away. I’ve been in pain over 20 years, and I have taken meds the whole time. I find if I focus on other things that I enjoy that I can handle the pain a little better. I’m grateful for a husband who understands and has been with me through most of it. I pray things get better for you!!