The extent of the opioid crisis is stunning, both in its breadth and its severity. Sadly, despite controversial legislative efforts to stem the tide, death rates continue to rise. Media is saturated with tragic stories of youngsters developing a deadly addiction after taking pain medication intended for someone else (e.g., a parent who recently had surgery).
Deaths from heroin overdoses, for example, are soaring. The problem is so pronounced, that many states have made the go-to antidote, Narcan (Naloxone HCI), over-the-counter. Its nasal spray form is the first in a series of new delivery mechanisms pending FDA approval. Previously, the medication was only available in injectable form.
The intention is to make the safe antidote easy-to-administer, as well as simple, cheap, and legal to acquire. The hope, of course, is that the victim him or herself, or a loved one, will have life-saving Narcan on hand, should the worst occur.
Unintended Victims in Response to Opioid Crisis
Unfortunately, in legislators’ furor to limit accessibility of opioids to vulnerable populations whose addictions cause them to abuse the drugs, they have also limited accessibility to those who legitimately need prescriptions to combat severe, debilitating, chronic pain.
This approach is comparable to requiring a by-the-week prescription for no more than 1 safety razor per week, from a psychiatrist specializing in treating self-injury patients, in an effort to reduce the growing trend for troubled adolescents to use the razor blades to cut themselves.
The reality is that lawmakers have inserted themselves square in the center of the doctor-patient relationship. Instead of allowing physicians to do their jobs, legislators in many states are tying their hands. Maine, a state with one of the most restrictive opioid crisis-related laws in the country, has gone so far as to prohibit physicians from prescribing more than a given dose of a given medication.
Patients Suffering in Pain, Feel Forgotten
The objective is noble: put a cap on the availability of prescription drugs to abusers. However, hasting to combat the growing problem of opioid abuse, many states and the feds are enacting pain medication prescription laws with a sword, rather than a scalpel. And unfortunately, patients in pain have become unwitting victims.
Jermaine Ortiz, a 41-year old stay-at-home dad with two young daughters, was involved in a four-car pileup in 2003. His right knee was nearly shattered when his legs became pinned under the dash. He also experienced severe bruising of his right hip. After completing three surgeries and procedures, Ortiz found relief through the narcotic Hydrocodone (Vicodin) and NSAID Meloxicam. He says the pain control regimen allows him to care for his daughters while his wife works.
“I tried different anti-inflammatories like Naproxen and Ibuprofen, then Codeine (a weaker opioid) first,” Ortiz says. Doctors performed a nerve block, which only made it worse. “The drug combo I have now finally allowed me to function.” He admits over the last 14 years, his dosage of Vicodin has increased some every few years.
Many patients in chronic pain are finding it increasingly difficult to get the medications they need. In some cases, they are required to jump through a dizzying array of bureaucratic-powered hoops.
In January, Ortiz’s orthopedist required that he begin submitting to random drug tests to prove he was not selling pills. He was also made to consult with a pain management specialist to reduce his need for the opioid. Ortiz asked why he could not continue the established, effective medication regimen they have used for years. His doctor was empathetic, but cited new requirements to lessen the number of patients being prescribed opioids.
Some patients in need are inappropriately labeled “medication seekers,” a term used to identify abusers who see doctors only to get a prescription. When, in reality, they are chronic pain sufferers. Others cannot afford unnecessary co-pays when opioid crisis laws require multiple office visits to acquire refills on medication they will likely be on for the rest of their lives.
But the problem is not limited to chronic pain patients. Doctors, both in private practice and in ERs, are increasingly reluctant to prescribe appropriate narcotic analgesics. They fear that they will be flagged in a state or federal monitoring system. In one hospital in New Jersey, for example, they have entirely discontinued prescribing opioids in their emergency department.
Ortiz hopes lawmakers and the public will understand there is another side to limiting availability of opioids. “I hurt, and the worst part is my doctor, my family, and I all know I don’t have to be hurting.”