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Opioid Crackdown Has Patients Struggling to Get Their Meds
Opioid Crackdown Has Patients Struggling to Get Their Meds
Patient groups and health providers are challenging limits placed on prescription opioids
Evelyn Lopez, a cancer survivor, says doctors are stopping to write opioid prescriptions out of fear that they may lose their practicing authority for opioid-related violations.
Evelyn Lopez, a cancer survivor, says doctors are stopping to write opioid prescriptions out of fear that they may lose their practicing authority for opioid-related violations. PHOTO: EVELYN LOPEZ
By Stephanie Armour
April 26, 2018 8:00 a.m. ET
13 COMMENTS
The war on opioids is making it tough for Evelyn Lopez to get narcotic pain medication.
A doctor recently stopped prescribing an opioid she had taken for years, saying it wasn’t worth possible federal scrutiny. Ms. Lopez, a 53-year-old cancer survivor, also must travel 45 minutes to pick up another opioid prescription because her doctor isn’t allowed to call a pharmacy for a refill.
“I have to jump through more and more hurdles,” said Ms. Lopez, of Hazlet, N.J., who has chronic pain from treatment for her non-Hodgkin lymphoma, which is in remission. “For people like me who depend on this medication, what they’re doing is a huge injustice.”
America is battling an opioid crisis, and the Trump administration has joined Congress and state capitals in the fight. But Ms. Lopez’s frustrations illustrate the growing number of obstacles now facing patients with legitimate needs for opioids. Patient groups and health providers are increasingly challenging the limits placed on prescription opioids in the name of combating the epidemic.
About 115 Americans die each day from opioid overdose, according to the Centers for Disease Control and Prevention, prompting almost 30 states to pass laws governing how long patients can get opioids or how strong a daily dose can be. Some require long-term users to submit to pill counts or urine tests that often aren’t covered by insurance. In the private sector, liability worries have some pharmacies refusing to stock opioids altogether, while some insurers and drug-benefit managers have said they would limit the doses.
There could be more limits to come. President Donald Trump in March pledged to reduce opioid prescriptions by a third over the next three years. Congress is weighing legislation that would limit first-time opioid prescriptions to three days.
More advocacy and doctors’ groups say the measures, while often harming legitimate patients, do little to curtail an epidemic increasingly fueled by illicit rather than prescribed opioids. For example, some evidence suggests constraints on prescriptions are driving opioid misusers to illegal fentanyl, a drug whose use is more likely to result in death, according to a review of government data published in the Journal of American Physicians and Surgeons.
Tapering
Number of prescriptions written per 100 people, annually
“The decision should be between the doctor and the patient,” said Dr. Patrice Harris, past chair of the American Medical Association. “What the AMA and physicians are seeing is that the policies on restricting opioids are having a negative effect.”
Lawmakers and addiction specialists, however, say that the limits are needed because opioids are extremely addictive, and that overprescribing helped fuel the current crisis. Studies have shown there are often more effective opioid alternatives to manage chronic pain, they say.
The rise in opioid use can be traced in part to a concern in the late 1980s that pain was being undertreated, resulting in an accompanying push for more treatment. Pharmaceutical companies began heavily marketing opioids to physicians, especially with the release of OxyContin in 1996.
Millions of patients today are addicted, even though research shows the opioids don’t work for such conditions as fibromyalgia, back pain and headache, said Andrew Kolodny, co-director of Opioid Policy Research at Brandeis University. These patients can be challenging because they don’t want to transition off opioids, doctors say. “Many of them may truly believe the opioids are helping them,” Dr. Kolodny said.
Patient advocacy groups—some of which get funding from drugmakers—say the focus on prescriptions is misplaced. “It’s political. President Trump made this mandate and doesn’t care if he knocks down people with chronic pain in the process,” said Jana Shatzer, 55, of Cedar Rapids, Iowa, who takes prescription opioids.
The American Hospital Association sent a letter to lawmakers warning against the proposed three-day limit on first-time opioid prescriptions. In April, patients held rallies in several states. In Corvallis, Ore., a group stood in a drizzle with umbrellas and placards that read “Patients, Not Addicts.” In Boise, Idaho, they displayed shoes representing patients who commit suicide because of barriers to prescription opioids.
Doctors, academics and patients denounced a proposal that would have essentially set a strict limit on opioid pain medication for Medicare beneficiaries unless authorized by a doctor, and the proposal was dropped last month.
In New Jersey, Ms. Lopez said she used to wake up every morning with extreme pain. She endured eight months of chemotherapy after her lymphoma, diagnosed in 2010, spread to her jawline, chest, back, hips and liver. She underwent a second round of treatment that included a steroid she said damaged her bones and joints.
The cancer went into remission, but she was in such pain she couldn’t sleep. She tried acupuncture, massage and other options before taking opioids. “It was at that moment I realized my life would change,” she said. “I was able to fix myself meals, wash my clothes, and better yet, take showers.”
Then-New Jersey Gov. Chris Christie signed legislation in 2017 limiting initial opioid prescriptions for acute pain to five days, among other restrictions. And in 2016, more than 30 New Jersey doctors and prescribers had their practicing authority revoked, suspended or restricted for opioid-related violations.
After a hernia surgery, Ms. Lopez said, a hospital in 2017 prescribed a liquid opioid that her husband filled. Her regular doctor flagged her for “doctor shopping,” meaning she had ostensibly sought out a physician who would write her an opioid prescription.
“He was worried he could lose his license,” she said. “I felt so violated, like I had to prove myself.”
Ms. Lopez understands the concerns about opioid addiction. “My father was a heroin addict, so I get it,” she said. “But when a pain-management doctor is too afraid to write a script, it’s crazy to me.”
Write to Stephanie Armour at [email protected]
Opioid Crackdown Has Patients Struggling to Get Their Meds
Patient groups and health providers are challenging limits placed on prescription opioids
Evelyn Lopez, a cancer survivor, says doctors are stopping to write opioid prescriptions out of fear that they may lose their practicing authority for opioid-related violations.
Evelyn Lopez, a cancer survivor, says doctors are stopping to write opioid prescriptions out of fear that they may lose their practicing authority for opioid-related violations. PHOTO: EVELYN LOPEZ
By Stephanie Armour
April 26, 2018 8:00 a.m. ET
13 COMMENTS
The war on opioids is making it tough for Evelyn Lopez to get narcotic pain medication.
A doctor recently stopped prescribing an opioid she had taken for years, saying it wasn’t worth possible federal scrutiny. Ms. Lopez, a 53-year-old cancer survivor, also must travel 45 minutes to pick up another opioid prescription because her doctor isn’t allowed to call a pharmacy for a refill.
“I have to jump through more and more hurdles,” said Ms. Lopez, of Hazlet, N.J., who has chronic pain from treatment for her non-Hodgkin lymphoma, which is in remission. “For people like me who depend on this medication, what they’re doing is a huge injustice.”
America is battling an opioid crisis, and the Trump administration has joined Congress and state capitals in the fight. But Ms. Lopez’s frustrations illustrate the growing number of obstacles now facing patients with legitimate needs for opioids. Patient groups and health providers are increasingly challenging the limits placed on prescription opioids in the name of combating the epidemic.
About 115 Americans die each day from opioid overdose, according to the Centers for Disease Control and Prevention, prompting almost 30 states to pass laws governing how long patients can get opioids or how strong a daily dose can be. Some require long-term users to submit to pill counts or urine tests that often aren’t covered by insurance. In the private sector, liability worries have some pharmacies refusing to stock opioids altogether, while some insurers and drug-benefit managers have said they would limit the doses.
There could be more limits to come. President Donald Trump in March pledged to reduce opioid prescriptions by a third over the next three years. Congress is weighing legislation that would limit first-time opioid prescriptions to three days.
More advocacy and doctors’ groups say the measures, while often harming legitimate patients, do little to curtail an epidemic increasingly fueled by illicit rather than prescribed opioids. For example, some evidence suggests constraints on prescriptions are driving opioid misusers to illegal fentanyl, a drug whose use is more likely to result in death, according to a review of government data published in the Journal of American Physicians and Surgeons.
Tapering
Number of prescriptions written per 100 people, annually
“The decision should be between the doctor and the patient,” said Dr. Patrice Harris, past chair of the American Medical Association. “What the AMA and physicians are seeing is that the policies on restricting opioids are having a negative effect.”
Lawmakers and addiction specialists, however, say that the limits are needed because opioids are extremely addictive, and that overprescribing helped fuel the current crisis. Studies have shown there are often more effective opioid alternatives to manage chronic pain, they say.
The rise in opioid use can be traced in part to a concern in the late 1980s that pain was being undertreated, resulting in an accompanying push for more treatment. Pharmaceutical companies began heavily marketing opioids to physicians, especially with the release of OxyContin in 1996.
Millions of patients today are addicted, even though research shows the opioids don’t work for such conditions as fibromyalgia, back pain and headache, said Andrew Kolodny, co-director of Opioid Policy Research at Brandeis University. These patients can be challenging because they don’t want to transition off opioids, doctors say. “Many of them may truly believe the opioids are helping them,” Dr. Kolodny said.
Patient advocacy groups—some of which get funding from drugmakers—say the focus on prescriptions is misplaced. “It’s political. President Trump made this mandate and doesn’t care if he knocks down people with chronic pain in the process,” said Jana Shatzer, 55, of Cedar Rapids, Iowa, who takes prescription opioids.
The American Hospital Association sent a letter to lawmakers warning against the proposed three-day limit on first-time opioid prescriptions. In April, patients held rallies in several states. In Corvallis, Ore., a group stood in a drizzle with umbrellas and placards that read “Patients, Not Addicts.” In Boise, Idaho, they displayed shoes representing patients who commit suicide because of barriers to prescription opioids.
Doctors, academics and patients denounced a proposal that would have essentially set a strict limit on opioid pain medication for Medicare beneficiaries unless authorized by a doctor, and the proposal was dropped last month.
In New Jersey, Ms. Lopez said she used to wake up every morning with extreme pain. She endured eight months of chemotherapy after her lymphoma, diagnosed in 2010, spread to her jawline, chest, back, hips and liver. She underwent a second round of treatment that included a steroid she said damaged her bones and joints.
The cancer went into remission, but she was in such pain she couldn’t sleep. She tried acupuncture, massage and other options before taking opioids. “It was at that moment I realized my life would change,” she said. “I was able to fix myself meals, wash my clothes, and better yet, take showers.”
Then-New Jersey Gov. Chris Christie signed legislation in 2017 limiting initial opioid prescriptions for acute pain to five days, among other restrictions. And in 2016, more than 30 New Jersey doctors and prescribers had their practicing authority revoked, suspended or restricted for opioid-related violations.
After a hernia surgery, Ms. Lopez said, a hospital in 2017 prescribed a liquid opioid that her husband filled. Her regular doctor flagged her for “doctor shopping,” meaning she had ostensibly sought out a physician who would write her an opioid prescription.
“He was worried he could lose his license,” she said. “I felt so violated, like I had to prove myself.”
Ms. Lopez understands the concerns about opioid addiction. “My father was a heroin addict, so I get it,” she said. “But when a pain-management doctor is too afraid to write a script, it’s crazy to me.”
Write to Stephanie Armour at [email protected]
