Wednesday, February 7, 2018

Collateral Damage from the War on Opiate Abuse

Collateral Damage from the War on Opiate Abuse

Chronic pain patients are not drug addicts!

Imagine that you are taking opiates for chronic pain. After a relatively short period of time you will develop a dependency. And if your supply of pills is interrupted for any reason, you will suffer withdrawals, the same as if you were an addict who has been taking opiates for fun. The withdrawals will certainly increase the extreme pain you'll be experiencing because you don't have opiates to keep your chronic pain in check.

This scenario is experienced every day in America by thousands of people who suffer from chronic pain and who are dependent on opiates to lead a normal life. I'm not talking about acute pain, which is short-term. This is about chronic pain. And I'm not talking about opiate abuse or addiction.  

People often confuse opiate dependence with addiction. It happens so often with medical professionals these days that it seems intentional. Taking opiates for chronic pain will result in dependence and increased tolerance. These things can be managed and are not signs of addiction. It is the responsibility of the doctor and the patient together to manage the dosage so that it's only enough for adequate pain relief.

Addiction happens when people begin taking opiates for mood enhancement. Once you cross that "Red" line, addiction will follow. Signs of addiction include taking increasing dosages for recreation without giving a thought to the negative consequences that will result.  

So let's not treat people who are dependent on opiates as if they are addicted. The fact that someone is dependent on opiates to lead a normal life is not a problem that has to be solved. Opiate dependence is no different than a diabetic's dependence on insulin, until/unless someone makes the choice to abuse it.  

One thing Americans seem to be very proficient at is overcompensating. 

The opiate crisis was caused by too many prescriptions for people who didn't need them and irresponsible behavior by patients. The solution now includes preventing people who suffer from chronic pain from getting the opiates they need at all, or subjecting them to systemic delays and third-party reviews put in place to slow the prescribing process. 

New rules for pharmacies mean that pharmacists can decide on their own not to fill your prescription, to reduce the quantity, or they can delay processing it for several days while they "check the drug abuse database." 

Pharmacy Benefit Management Companies like Express Scripts (now there's a misnomer) give themselves 7-14 days to fill a prescription and the average is 3-5 days. Then the transit time through the US mail can take another 3-4 days. If your doctor won't let you request a refill early (and most won't, because...Opiates!) then you will have to make your 30-day supply last for 37-38 days or more every month, and if you run out...well, that's just too bad. Our systems and processes were put in place to reduce opiate abuse, and you'll just have to live with it.

Your doctor, who wishes they didn't have to write any opiate prescriptions, because they don't want the hassle and the attention of the DEA, begin to think they're doing you a big favor. So you shouldn't complain about delays or ask them to make any accommodation like ordering refills in advance or increasing the number of pills, so that they last 38 days instead of only 30. They are usually sympathetic, but they are not going to put themselves at increased risk by adjusting any policy they think protects them. And if you complain, you run the risk of having that interpreted as "addictive behavior."

So where does this leave people who suffer from chronic pain? They are paying the price for the bad decisions and drug abuse of others. If opiate addicts don't get their pills, they at least have alternatives -- there's always heroin, Methadone, etc. If chronic pain patients don't get their pills, they go through withdrawals and many will die either from the withdrawals, the inevitable depression that comes from being in that predicament, or from the damage to their health from severe untreated pain. 

Opiate Withdrawal

In 1996, the American Pain Society introduced the notion that pain should be regarded as the “fifth vital sign.” Standardized guidelines for assessing patients’ perceived pain levels (self-reported on a scale of zero-to-ten) were adopted in 1998, and updated by the Federation of State Medical Boards in 2004. As a result, many doctors began to aggressively treat pain with opiates; some were too careless, and others weren't paying attention to the warning signs of addiction in their patients. 

So who is responsible for the opiate epidemic? 

The media, law enforcement and some politicians want to blame the drug companies and doctors, but they don't seem to want to assign the blame where it most properly belongs; on the people who made the decision to abuse opiates. 

Addiction doesn't happen by accident or because your doctor gave out "too many" pills. People who become addicted did so because they made the decision to use opiates for mood enhancement instead of pain relief. They deserve our compassion, understanding, and help. But they are not being helped by us ignoring the behavior that got them in trouble, just because some lawyers want to sue the drug companies for negligence. After all, it's the opiate addicts who were the MOST negligent.

Many millions of people are in extreme pain every single day and all too often they are not able to get the medication they need. Many more people die from not having the prescription pain medications they need, than die from the drug abuse the government is trying to prevent. One of the major causes of those deaths is the overuse and abuse of OTC NSAIDS like acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) by people who are desperate for pain relief.

Untreated severe chronic pain can happen to you, or someone you know, especially if you live in a rural area. Freedom from chronic pain should be a fundamental human right. Don't accept lame excuses from your doctor or your pharmacist. Don't let anyone equate dependence on opiates for a legitimate medical reason with opiate addiction. 

You can make a difference, and you should try, because you and everyone you care about is at risk for having their life destroyed by chronic untreated pain.

You're in chronic Debilitating Pain and would like some painkillers to make life tolerable? Sorry, those are addictive, Try some Advil!


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