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WaPo: Patients can't access pain treatment...

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"Are you fed up with the stress and paperwork of being a pain specialist?"

  • YES, totally fed-up

    Votes: 7 53.8%
  • NO, I'll keep at it until they bury me.

    Votes: 6 46.2%

  • Total voters
    13

drusso

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https://www.washingtonpost.com/outl...c9f29a55815_story.html?utm_term=.40a2715da577

"My doctor chose to leave pain management. He told me he could no longer stand the paperwork and stress involved with being a pain specialist and trying to decide between protecting his ability to provide for his family and protecting his patients."

The other opioid crisis: pain patients who can’t access the medicine we need
Changing guidelines for prescriptions have left people like me without care.


By Anne Fuqua
Anne Fuqua is a former nurse living in Birmingham, Ala.
March 9

When you hear the words “opioid crisis,” you probably think about tragic deaths from addiction. But there is another opioid crisis, one I know well: the inability of pain patients to access the medication they need to function.

I was diagnosed with primary generalized dystonia in my late teens. It’s a neurological disorder that causes involuntary movements and painful muscle spasms. I was unable to tolerate most of the medications used to treat Parkinson’s disease, which are commonly used against dystonia. The ones I could tolerate didn’t help. But for reasons doctors don’t fully understand, opioids have a dramatic effect on my symptoms. My body is not nearly as rigid and jerky. The spasms that pulled my body to the side, making it difficult to sit up straight, are gone. My fingers are no longer clenched.

But my situation has gotten more complicated. At first it was small things. In 2014, my doctor started requiring more frequent appointments to keep writing my prescriptions. I didn’t mind. Next, my doctor decided to no longer participate in my insurance. It cost me $150 out of pocket for each visit, but it was worth it to be able to continue the life I had worked so hard to build.


In 2015, the state of Alabama began sending mandatory prescription monitoring reports to physicians who prescribed patients high doses of opioids, along with a form letter encouraging doctors to carefully consider whether their patients should be receiving this dose. My doctor, who had treated me for nine years, was apologetic. I could see the sadness in his expression as he explained that he would need to reduce my dose. That first reduction was small, and I tolerated it easily. The second reduction, however, brought the return of pain and several of my dystonia symptoms, problems I had not dealt with in years. My doctor was distressed, and he decided to put me back on my original dosage.

My relief was short-lived. A few months later, my doctor chose to leave pain management. He told me he could no longer stand the paperwork and stress involved with being a pain specialist and trying to decide between protecting his ability to provide for his family and protecting his patients.

What followed was the hardest time of my entire life. I had to taper my medication while searching for a new doctor. I became completely debilitated and could barely manage on my own. Pain and spasms feed on each other, creating a vicious cycle. Moving from one chair to another was once again a very difficult task. I could no longer drive the van I had worked to purchase.


I had my records sent to many doctors across Alabama. Some of my contacts in the medical community reached out to doctors on my behalf. No one was even willing to evaluate me. When the Centers for Disease Control and Prevention introduced guidelines for opioid prescribing in 2016, doctors began treating pain patients differently. It didn’t matter if a patient had been stable and benefitting from medication for many years. Doctors pulled back.

I was able to find a doctor out of state who was willing to treat me, but many patients have not been so lucky. In 2014, I started keeping a list of pain patients who had committed suicide, unable to cope with the pain. Sometimes the list grows weekly, sometimes daily. I knew some of these people personally; some names were submitted to me by their loved ones. Others were mentioned in the comment sections of articles or posted on Facebook. Sometimes it’s not even a full name. My list has more than 100 entries. Children have lost mothers, fathers and grandparents. I have lost friends. Just a few years ago, discussion of suicide was rare in the community of pain patients. Now I see it on online bulletin boards, in article comments and in online groups dedicated to the subject. That’s my opioid crisis.

As a former nurse, I never dreamed that our government would encroach to this degree on the relationship patients have with their medical providers. Twenty years ago, when I was attending nursing school, the Joint Commission, a healthcare accreditation board, introduced the “fifth vital sign,” which required health-care providers to ask patients whether they had pain and how severe it was as part of the routine assessment of vital signs. Now we’ve done an about-face because of opioid abuse to implement policies that will cause physicians to abandon patients or taper medications regardless of whether this will harm their quality of life.

I would love to return to working as a nurse, though I can’t imagine doing it now. I used to work for a hospice service. I don’t want to tell a patient writhing in pain at 4 a.m. that he will have to find a way to cope because prescribing policy changes now affect patients with cancer and those who’ve just had surgery.

My opioid crisis is wondering whether each time I fill my medications will be the last time. I wonder how much longer I’ll be able to do the things I enjoy. I’m 38 years old. There’s so much that I want to do with my life. I want to go back to work part time, but I’m afraid to, because my future is so uncertain. I feel like I’m on death row.

There are multiple opioid crises in America. The crisis of people in the throes of addiction deserves the time, attention and talents of health-care providers and legislators. But the crisis of people in pain deserves the same.

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Aether2000

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The pendulum swung very fast due to piling on of state attorney generals, families of deceased patients (who could care less about their death but very much cared about suing for $$$), State and US Supreme Court and other court rulings, the FDA, DEA, county prosecutors, the US House and Senate, county and city governments, and several other groups. It was an avalanche that provoked many physicians to curtail prescribing of opioids, eradicate opioids from their practices, or quit pain medicine altogether. There will not be any safe harbors for at least a decade. The lack of studies showing these potent drugs were doing anything other than causing addiction and death was the nail in the coffin of opioid prescribing. Some of the patients did indeed committed suicide due to overly rapid withdrawal, or the thought of exiting the life of a continuously drug-induced intoxicated state they had for the past decade.

The pendulum swinging this rapidly could have been avoided a decade ago by physicians conducting studies proving they were actually doing some good instead of being drug dealers. We failed to conduct such studies and then had no basis to prescribe once the body count began to mount. So it is too bad for patients. But physicians had no choice with the governments guns pointed at their heads.

Ultimately it was all about self preservation.....and physicians should never have been placed in the position of having to choose between a potential prison sentence for themselves or the suicide of their patients.
 
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NJPAIN

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If a physician died saving lives during the “Spanish flu” pandemic of 1918 they were extremely dedicated individuals who sacrificed themselves for a noble cause. If you loose your license or end up in jail prescribing opioids for chronic non- malignant pain sufferers you are a fool that now can’t provide for your family. Patients think both situations warrant the same level of “ dedication”.


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Ducttape

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should physicians shoulder the blame for any complications?

I agree with algo. also, I must still add that the wholesale change in physician attitude towards opioids was through Big Pharma and their greed. in no small part, they were also a contributing factor towards why studies were not done - many of the initial articles touting opioids were confabulated to appear as if they were scientifically based.
 

Ducttape

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FWIW, this is one of 101N's working aged disabled patients. why would someone start a patient with this diagnosis on narcotics in the first place is beyond me. now, she has dystonia and opioid dependence.



a list of 100 entries over the past few years is a lot.

it is just over 90..



as in there are 90 deaths every 2 days from prescription opioid overdose...
 
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