I’d like to tell you my entire story, but I don’t have time. Though I’ve been sitting here at my desk for just a few minutes, a hard knot has already formed in my upper right thigh and my lower back muscles have begun to spasm. I feel like I’ve run a half-marathon and I’ve barely gotten out of bed today.
But I’m not going to give up yet. It’s important to me to let you know what’s going on in the world of daily pain and how the rising wave of anti-opiate sentiment is affecting people like me.
Just as importantly, I’d ask you to consider whether any pro-choice legislator has the right to come between myself and my doctor on how we make medication decisions. (By the way, in case it matters, I’m a middle-aged female who has always been grateful for the reproductive choices I’ve had.)
Some facts on chronic pain in the US
Before I go any further, I’d like to share some facts on chronic pain in this country. According to recent research from the Centers for Disease Control, 19.6 million Americans experience chronic pain which limits their ability to work, socialize, have fun and take care of themselves. The researcher notes that chronic pain contributes to an estimated $560 billion each year in direct medical costs, lost productivity and disability programs.
As chronic pain goes, mine is far from exotic. My condition is very common and can often be managed with physical therapy and medication, which can include but doesn’t necessarily call for treatment with narcotics.
However, my primary care doctor and I agree that the narcotics treatment might be appropriate for me at this point. I have been tried on virtually every non-narcotic medication available to address my symptoms, but none has proven as effective as the opioids. And while I’m not in agony 24/7 (thank God!) the condition hurts enough to sideline me fairly often.
In the past, getting treated with a modest, carefully-managed daily dose of narcotics wouldn’t have been a big deal under these circumstances.
After all, while they can be dangerous in the wrong hands, there are reasons opiates aren’t illegal, and according to can be prescribed with relative safety if the patient follows the rules of the pain management program. According to research published in the New England Journal of Medicine, less than 8% of chronic pain patients become addicted, and while this should be taken into consideration, other research suggests that this figure is even lower if those with a handful of known risk factors are taken into consideration.
Usually, pain management patients face regular urine testing to ensure that patients aren’t using the narcotics in combination with other dangerous drugs, tightly controlled prescriptions and other restrictions intended to keep the patient on the straight and narrow. Until relatively recently they seemed to be sufficient.
But then came the opiate crisis, and the world changed for people like me. No matter how carefully we follow the rules, what our track record has been the past or how well-documented our condition may be, pain management patients are having their doses cut arbitrarily or being refused medication treatment which could allow them to continue or resume normal lives.
A surge of new opioid restrictions hit the states
In recent years, in response to reports of rising opioid-related death rates, states have begun to enact rules restricting the dosage, timing, and availability of narcotic prescriptions. For example, Nevada and Arizona have limited scribing doses of opioids to 90 daily morphine milligram equivalents (MMEs) per day, and Massachusetts passed a law limiting first-time opioid prescription to seven days. Most of these laws have been pushed by legislators with no medical training or experience with chronic pain.
All told, at least 33 states have adopted guidelines, limits or other requirements for prescribing opioids, most of which were passed in 2017 — and experts expect to see more emerge These rules generally apply to first-time narcotics users, not chronic pain patients, but as I can tell you firsthand, it created a chilling effect which extends well beyond those taking Percocet or two after one-time events like breaking a bone or having dental surgery.
In my particular case, my health insurer has gotten so gun-shy about narcotics prescribing that it’s taken me almost a year to even get an appointment with the doctor in the network who does, in fact, consider cases like mine. Bear in mind that by no means has the FDA changed how it regulates these drugs; this is just a business seeing what’s in the air and complying in advance.
Okay, at this point I imagine you’re thinking, “Gee, I’m sorry people are hurting but aren’t these measures necessary to protect those who are overdosing on narcotics and dying in the street?” Sadly, there’s considerable evidence to the contrary. I’d actually feel a lot better about my own pain, which is intrusive and difficult but somewhat tolerable if the hurdles legislatures have erected actually saved the lives of addicts.
I’m not going through a ton of statistics at you to prove this point, as I need to put my feet back up soon, but here’s a couple of arguments to mull over:
- According to a new study from Harvard Medical School, there’s been a drop of more than 50% in monthly opioid prescribing by physicians for new patients. If such prescriptions are a major cause of opioid-related injury and death, why haven’t the rates of such injuries and deaths fallen as prescription rates fall?
- According to the CDC, synthetic opioids are currently the main driver of drug overdose deaths, notably fentanyl, which is 80 to 100 times stronger than morphine. Apparently, the use of designer analogs for fentanyl is a major contributor to deaths from street/illegal opiate use. If so, how does slapping sitting ducks like me with restrictions help?
What happened to letting me and my doctor decide?
Now, I’m finally where I wanted to be at the beginning of this essay. Here’s the point I want to make.
With two-thirds of states having already imposed new restrictions on narcotics prescribing, I have to believe that some pro-choice legislators have signed off on such measures.
I imagine many of those pro-choice legislators have told constituents or members of the press that the decision whether or not to terminate a pregnancy should be between a woman and her doctor. If so, how are decisions about which legal-to-prescribe medication to take any less mine and my doctors’ to make? Where are your arguments for bodily autonomy where my aging body is concerned?
I understand that some of you may have had good intentions when taking action on the narcotics abuse issue. And I’m not even suggesting that the state doesn’t have some legitimate interest in addressing public welfare and safety, which maybe be how some of you see this matter.
However, I do think that the way in which states hope to control what I ingest is uncomfortably familiar, and given that such controls don’t even seem likely to save the addicted and dying, create useless suffering to boot.
And now, I AM going back to bed in the hopes of a healthier (and less painful) day tomorrow.