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Jay Lawrence, a former truck driver, is a case in point. When his doctor refused to continue his medication in early 2017 — even though he had severe pain from spinal cord injuries and was not addicted — he told his wife that he’d had enough. In a park where they’d recently renewed their wedding vows, he fatally shot himself in the chest while she held his hand.
Thousands of pain medication recipients have had their doses reduced or eliminated. But this attempt to save people from addiction is leaving many patients in perpetual pain — and thus inadvertently ruining, or even ending, lives.
A Veterans Health Administration study found alarming rates of suicidal acts “following discontinuation of opioid therapy.” Human Rights Watch recently released a report detailing the struggles of chronic pain patients in the United States to find relief and care as a result of government efforts to reduce prescriptions.
Prescribing outside the C.D.C. guidelines can lead to scrutiny by medical boards and even the Drug Enforcement Administration — and the result has been that many doctors have either quit prescribing entirely or tapered patients’ doses to fit the guidelines.
According to a 2017 Boston Globe survey, nearly 70 percent of family and internal medicine doctors nationwide reported having reduced their prescribing in the previous two years — and nearly 10 percent reported stopping prescribing pain medication entirely.
The State of Oregon is considering a proposal that would require that all Medicaid patients with certain forms of chronic pain be forced off opioids. But not all patients can manage without opioids and some — whether because of metabolic or genetic differences, or tolerance from long-term use — will always need higher doses than the C.D.C. recommends.
By working to reduce prescribing, government regulators, insurers, law enforcement officials, legislators and other policymakers have ignored the genuine dangers of leaving people in agony, including suicide and increased risk for heart attacks and strokes.
And with the Trump administration having pledged to cut the manufacturing of opioids by pharmaceutical companies by an additional 10 percent, even more patients are at risk.
But while medical opioid use has fallen by nearly one-third since peaking around 2011 — and deaths associated with prescription opioids have stabilized — overall opioid overdose fatalities have recently hit a high as more potent, illegally manufactured opioids hit the streets.
Indeed, as prescribing fell, deaths connected to illicit opioids skyrocketed. From 2010 to 2016, heroin overdose mortality rose by nearly 500 percent — and mortality associated with illegally manufactured fentanyl jumped 600 percent from 2013 to 2016 alone.
Officials with the Centers for Disease Control admit that they do not specifically track suicides by patients who have lost medical access to pain relievers, so we don’t really know how many people are killing themselves because they can’t live with their pain.
In the rush to reduce opioid misuse, it is easy to forget that millions of people have safely taken these drugs for years. Data show that less than 8 percent of chronic pain patients become addicted, according to a study that has the director of the National Institute on Drug Abuse as a co-writer. And overwhelmingly, prescription opioid addiction doesn’t begin with a doctor’s prescription: About 80 percent of people who start misusing these drugs are getting them from family, friends and other people’s medicine cabinets — not from legitimate pain treatment.
It is true that long-term, high-dose opioid use is associated with increased overdose risk. But proponents for cutting pain medication use often fail to recognize that simply reducing or ending pain pill prescriptions can be risky, too.
A 2017 study of about 500 veterans who were forced to taper found that 9 percent became suicidal and 2 percent actually acted on those thoughts. Other research recently presented at a major health services conference showed that 30 percent of those who were made to taper completely were dead within six months, though the data didn’t show the cause of death.
After years of complacency, doctors are finally starting to fight back. Dr. McAneny cited her experience to support a resolution, subsequently passed by the medical association, that warns against “misapplication” of the guidelines. The group stresses that dose alone is not a reason for insurers or pharmacists to block access — and that doctors with good clinical reasons for variance should not be investigated or prosecuted.
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https://www.nytimes.com/2019/02/09/opinion/sunday/pain-opioids.html