Sunday , June 20 2021

As physicians decrease or end opioid prescriptions, many patients are driven to despair, suicide



This is the first in a three-part series on the country's struggle to cope with a paralyzing crisis of opiates, and unintended casualties have left in its wake.

It happened slowly. The pain caused by a 1980 back fracture, the result of an accident with a tractor trailer, further weakened Jay Lawrence's body and spirit.

In 2006, the arms and legs of the veteran native Tennessee and Navy were asleep. The excruciating pain reduced him to tears. Several surgeries, chiropractic adjustments, and physical therapy did not work.

He finally found solace in painkillers – 120 milligrams per day of morphine. A high dose, but he reduced the pain enough for him to take walks with his wife, buy groceries and even make some movies.

But last February the doctor at the pain clinic made shocking news: he was cutting Lawrence's daily dose, first to 90 milligrams, then in short steps, up to 30 milligrams. The doctor said the reduced dose was in response to the Centers for Disease Control and Prevention's (CDC) prescription guidelines, released in 2016 as part of a nationwide effort against the opioid, according to Lawrence's wife Meredith.

"The doctor said:" You know these guidelines will eventually become a law. So we decided as a group that we're going to take all our patients, "she told Fox News in an interview.

Lawrence's pain returned with vengeance. He could barely move or sleep. He messed up his pants, unable to make the bathroom in time, Meredith said.

"It seems like all the nerves in my body are on fire," he told his wife.

Meredith said she and her husband went to their primary care physician and asked for a referral to another pain clinic. They were told it would take at least six weeks.

That was too much for Lawrence. In March, the day of his next medical appointment, when his dose of analgesic would be reduced again, he went to a nearby park with his wife. And in the same place where they renewed their wedding vows just two years earlier, they shook hands.

He raised a gun to his chest and killed himself.

Jay and Meredith Lawrence

Jay and Meredith Lawrence
(Photo by Savannah DeAnn)

Lawrence, who was 58, became one of an undetermined number among the 20 million people who suffer from chronic pain who chose suicide after they were cut off or opiate recipes were denied. Suicides have motivated many of those who continue to suffer from pain – and family members and advocates of those who have taken their lives – to call for a reassessment of the rush of reducing opioid dosages to those who need them the most.

"We have a terrible problem. We have people committing suicide just by being forced to stop with opioids, painkillers, and chronic pain, "said Thomas Kline, a North Carolina family physician and former program administrator at Harvard Medical School.

"It's mass hysteria, a witch hunt. It's one of the worst health crises in our history, "said Kline, who has 26,000 followers on Twitter, and a Web site where he publishes the names of those he said committed suicide after his opioids had been cut or removed. "There are five to seven million people being tortured on purpose."

The CDC does not have suicide numbers after its painkillers have been cut. But most physicians who spoke to Fox News said they knew of one to six patients who lost their lives after losing access to opiate treatment and being turned away from other doctors who now see prescription painkillers as a hassle.

Several prominent doctors and advocacy organizations for pain patients have said they have heard hundreds of people who say they have been left in debilitating pain and are considering suicide. The issue earlier this year drew the attention of Human Rights Watch, which launched an investigation.

"Clearly, there are patients now who feel that life is not worth living if they come back to life with pain," said Diederik Lohman, director of Human Rights Watch's Human Rights Watch. "Many of the patients we talk to are very respectful of the law and would turn to suicide before going out to get illicit drugs. Government has a duty to respond to the overdose crisis, but in a way detrimental to people who have a problem legitimate doctor are a matter of human rights. "

We have a terrible problem, we have people committing suicide just by being forced to stop with opioids, painkillers and chronic pain. It's a mass hysteria, a witch hunt. It is one of the worst medical care crises in our history. There are 5 to 7 million people being tortured on purpose.

– Dr. Thomas Kline, former administrator of the Harvard Medical School program, and editor of the list of pain patients who died of suicide.

Many patients with pain say they understand the urgent need for political leaders and government agencies to fight the drug overdose epidemic. But targeting the millions who legitimately suffer from chronic pain is seeking a solution that does not address the preponderance of illegal drugs, they argue – or the rate of overdoses caused by them.

The CDC released a report on Nov. 30 showing that despite a drop in analgesic revenues over the years, the drug overdose rate continues to rise with the growth driven by the illicit opioid fentanyl and its cousins. It is a trend that has been going on for several years.

"People with pain should not suffer because people without pain are abusing opioids," said Cynthia Touissant, a former California ballet dancer with Complex Regional Pain Syndrome (CRPS) who has left her in bed for 10 years and is unable to speak for five. "Patients with pain do not want to take opiates anymore than cancer patients want to use chemotherapy. However, many people in pain need opioids to function physically and pursue the joyful aspects of life. "

At a recent meeting of the American Medical Association (AMA), the group's president, Dr. Barbara McAneny, spoke about how an advanced prostate cancer patient attempted to commit suicide after he denied opiates to an insurer. "The pendulum shook very far when the pain was designated as a vital sign, and we now run the risk of retreating so much that patients are being harmed," she said, according to published reports.

PROBLEMS WITH CDC GUIDELINES

Federal officials said the CDC guidelines were not intended to stop the proper prescription and use of opioids. "We're not telling any doctor that they can not make a legitimate prescription," according to the US. Attorney General Jeff Sessions told Fox News in an interview before leaving office. "Maybe some doctors are getting very cautious. We do not know.

The sessions recognized that "prescription opiates may be essential for people" and said: "It is very clear that people with serious pain problems need real meaningful pain relief and sometimes [opioids] are the only thing that will provide relief, and it is absolutely legitimate to prescribe it. "

We hear about suicides … It is tragic for someone to take their lives for whatever reason, including that they have had their opioids unilaterally stopped.

– Dr. Debbie Dowell, lead author of the "CDC Guideline for Opioid Prescription for Chronic Pain" of 2016

CDC officials added that they are also aware that those suffering from chronic pain have committed suicide in their struggle to survive with less or no opioids.

"We heard about suicides," said Dr. Debbie Dowell, senior medical adviser to the CDC, and lead author of the opioid prescription guidelines. "We've heard the reports. It is tragic for someone to take their lives for whatever reason, including having their opioids stopped unilaterally. "

Dowell said the scope of suicides caused by insufficient treatment of chronic pain "is not easy to measure. We look at how we can measure this. Sometimes patients or their families do not report it. "

The CDC guidelines focused on primary care physicians and recommended extreme caution in opioid prescribing. He also suggested a maximum daily dose of 90 milligrams equivalent of morphine for analgesic patients for the first time.

But the guidelines also warned against forcibly or abruptly reducing those suffering from severe pain who have taken opioids responsibly, noting that a drastic change could lead to withdrawal and serious illness.

Untreated pain, say many health experts, can also lead to hypertension, more severe pain conditions and other problems. Health professionals say this is a situation that can affect anyone – just a slip, a fall or a poorly done surgery that can cause intense and maybe prolonged pain.

Dowell said that patients should be prescribed case by case.

"We believe everyone deserves effective pain control," she said. "The CDC guidelines are not a regulation or a law – it's a provider orientation."

"He never made a recommendation to take people off the medication unintentionally, or reduce involuntary levels," she said. "The goal was to provide updated guidelines on the benefits and risks of opioids for chronic pain so that the provider and the patient – could make decisions.

GUIDELINES BECOME APPLICATION TOOLS

The CDC statement was apparently lost among the headlines on the impressive number of deaths caused by opiates. Political leaders and government officials have often not noticed the volume – at least 60 percent, according to the US Department of Health and Human Services – of the overdose epidemic caused by illicit drugs, not prescription painkillers.

And when authorities dealt with the share of deaths due to prescriptions, advocates of safe use of opiates argue, they generally grouped patients with pain and dependents who were given illegally prescribed opioids from another person. This contributed to a perfect storm, which formed the basis for a series of rigid federal and state policies, including a Trump administration promising to cut revenues by 30% over the next three years.

Whether in response to CDC guidelines or as a proactive measure to address the opiate crisis on its own, at least 33 states have enacted some sort of legislation related to prescription limits, according to the National Conference of State Legislators. Health professionals and pain patients who have Medicare prescription plans are ready by January when the federal insurance program will give insurers and pharmacists the authority to reject prescriptions that deviate from the dosage recommended by the CDC.

"The CDC guidelines were directed toward primary care physicians, but they were kidnapped and armed as an excuse for draconian legislation," said Michael Schatman, clinical psychologist and director of research and development at Boston Pain Care, a multidisciplinary pain clinic . and editor-in-chief of the Journal of Pain Research. "Illicit opioids, not prescribed opioids, are causing overdose deaths."

The CDC guidelines … were kidnapped and armed as an excuse for draconian legislation.

– Michael Schatman, editor-in-chief of the Journal of Pain

The disproportionate focus on painkillers prescribed by officers responding to the epidemic of overdose, pain experts and public health researchers largely tells why the drug-related death rate continues to increase while legal opioids become less available for patients with pain.

"We are targeting the most vulnerable and sickest people who have been on opiates for a long time," said Dr. Stefan Kertesz, a dependency specialist and professor at the University of Alabama at the Birmingham School of Medicine. "Insurers are issuing rules that say we will not cover long-term opioids for people over 90 milligrams. Well, five percent of people who get opiates respond for 60% of the prescribed milligrams. With so many milligrams going to a tiny group of very sick people, if you can knock some people off these opioids, you could show a large numeric reduction. "

"What we are really doing is reducing the dose in the most disabled people," said Kertesz, who is on several state opioid safety committees. "Prescription control seems like an easy answer to the epidemic, but that's not stopping the addiction."

Cries for help and gives

In social media, comments sections on news sites, and in emails for Fox News, numerous painkillers claim to have made suicidal plans because their health care provider forcibly reduced their dose to a poor level or stopped them altogether. They talk about being treated as drug addicts by undergoing frequent urine tests and pill counts.

Jay and Meredith Lawrence

Jay and Meredith Lawrence
(Courtesy of Meredith Lawrence)

"I've been in pain management since 2006," a Tampa man said in a Facebook post. "Having an incapacitating disease for which there is no cure and no longer getting the medicines I need. A few months ago, I was researching death with dignity and other assisted suicide if I could not get the help I needed on the road. "

Some have posted comments about a loved one who died of suicide after losing access to a long-term pain treatment and finding it unbearable to continue suffering. Others said that his wife's suffering, along with the frustration and anguish of being rejected or subtracted by doctors, was the reason why they accepted their loved one's suicide plan.

In her new home in Georgia, with her walls covered in photos of her late husband, Meredith Lawrence recalled the helplessness she felt as she suffered, as pain worsened and drugs were reduced.

"He said," I have three choices, "Meredith recalled. "He said I could use illegal drugs, I could suffer the rest of my life with pain, or I could end my life. I'm not going to do the first two. & # 39; "

Lawrence's doctor did not respond to e-mail and telephone requests to comment on that story.

Meanwhile, Twitter hashtags like # SuicideDue2Pain, #DontPunishPain, #PatientsNotAddicts have become commonplace.

People with pain should not suffer because people without pain are abusing opioids.

– Cynthia Touissant, pain patient

"I think of suicide every day," said Dawn Anderson, a former Indiana trauma nurse whose doctor cut her dose of opiates after her office was invaded by the DEA.

"I recently wrote a suicide note to my family," said Anderson, a diabetic whose legs were amputated below the knee. "They've seen everything I've been through. I want to live. But not so.

Anderson, 53, now finds it very painful to stay in prosthetics because of what she says is an under-treated pain and is confined to a wheelchair.

"The pain looks like an electric shock that happens every 30 seconds on some parts of my body," she said, "and on the back is a nagging pain, like a hot poker that is stuck and never goes out. The pain I suffer daily is to take away my will to live.

Anderson's doctor did not respond to requests for comment.

Anne Fuqua, a former Alabama nurse suffering from chronic pain, has recorded 167 suicides since 2014 that she claimed were the direct result of patients who had their opioids cut or cut and suffered uncontrolled pain.

Fuqua said she is in the midst of checking for more suicides that have been reported to her.

Caylee Cresta, a 26-year-old Massachusetts woman, has a rare disease, Stiff Person syndrome, which causes muscle spasms and rapid seizures that fracture her bones and often leave her trapped in an unnatural position for days. She has the condition since she was 19 years old.

"You're afraid your doctor will say your next prescription is the last," said Cresta, adding that when she has a "bad day" it means "I'm no longer a mother, a wife, a daughter."

Ending the pain ending everything seems, at times, like the exit.

Dr. Stefan Kertesz

CALLING FOR ANTI-OPIOID POLICIES

Not everyone agrees that the problem is cutting the legal prescriptions of opiates.

Dr. Andrew Kolodny, who directs opiate research at the Heller School for Social Policy and Management at Brandeis University, believes that government policies on opiates need to be even tougher.

Kolodny, who is also the chief executive officer of prescription opioid physicians and one of the country's most vociferous opioid critics, is reluctant to sound the alarm about the shortage of prescription painkillers.

"The effects of hydrocodone and oxycodone produced in the brain are indistinguishable from the effects produced by heroin," Kolodny said. "So, my point is that when we talk about pain medication with opioids, we're essentially talking about heroin pills."

Kolodny said that opiates play an important role – in limited circumstances – such as ending "end-of-life suffering for some patients" and "for a few days after major surgery."

When we talk about pain medication with opioids, we are essentially talking about heroin pills.

– Dr. Andrew Kolodny, director of opioid research at the Heller School for Social Policy and Management at Brandeis University

Many pain experts and patients blame Kolodny for pressing federal agencies, particularly the CDC, treating opioids as heroin, and patients with pain as people who are an opioid far from being dependent.

Kolodny said that this is not true.

"No role – no – zilch," he said. "PROP was one of many organizations requested by CDC to provide feedback on the guideline. Our letter is publicly available. The CDC did not make the changes we requested. "

For Kolodny, "It's a manufactured controversy … They say with my opioid, I can at least get out of bed." To a heroin user, it's the same thing to them. They say they feel horrible, can not do anything or function until they take their first dose of heroin in the morning. "

Former US Attorney Jeff Sessions

Former US Attorney Jeff Sessions
(Reuters)

FEDS SAY THAT THEY ARE IN WAR

The sessions seemed to see the issue as a war that needs to be fought at full throttle.

"This is the biggest health hazard we've had," he said of fatal overdoses. "Let me say this to the problem of suicide and other problems: they are emerging from the addiction of these drugs," he said. "People do not know how powerful these addictions are. So people get into a situation where they can not continue taking the drugs, and some of them may conclude that they can not live without them. "

"We need to break this cycle," Sessions said. "We are making progress, but we still prescribe a lot more painkillers than in any other country in the world … we as a nation need to face that fact."

Federal and state officials at leading anti-opiate agencies – including the Drug Enforcement Agency (DEA) – found it difficult to provide details to Fox News about how many overdose deaths involved the legitimately prescribed opioids. A Massachusetts Department of Public Health report, widely quoted by many pain experts, said that among 477 people whose opiate deaths were in 2018, 90 percent, or 423 of them, tested positive for fentanyl – a telltale sign of opioid illegal to use.

Pain management experts said they shared the concern and alarm about the terribly high percentage of drug overdoses.

"I share the concern of the nation that more than 100 people a day die of overdose. But my patient almost died of a sub-dose, "said McAneny, the AMA president.

"My patient suffered in part because of the repression of opiates … When I visited my patient in the hospital while he was recovering from his suicide attempt, I apologized for not knowing that his medication was denied," McAneny said. had failed him.

If you are thinking about suicide, are concerned about a friend or loved one, or would like emotional support, the National Lifeguard Prevention Lifeline network is available 24 hours a day, 7 days a week, in the United States. Lifeline is available to everyone, it's free and confidential – 1-800-273-TALK (8255)

The deaf and hearing impaired can contact the Lifeline via TTY at 1-800-799-4889. National Prevention of Suicide – 1-888-628-9454


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