By R Carter
This article includes preliminary results from a survey on chronic pain patients treated by primary care providers.
Since the beginning, when public health officials began noticing an increase in opioid related overdose deaths and a rise in the number prescriptions written for opioids, the default assumption has been that the two were inextricably related. After eleven years of effort to improve our ability to connect the dots between these two data points the probability of it being just that simple has evaded us. No one doubts that a criminal element has operated in the ranks of our healthcare system, and there’s good reason for that. Up until 2003 the healthcare system, ie prescribers for the most part, operated on an honor system, the guiding rule being the medical judgement of the prescriber for what was best for the patient. Clearly, there needs to be some oversight to ensure that this is what happens. But until lawyers, law enforcement schools and political science majors are required to have a medical degree as well, we are better off leaving prescribing in the hands of those who have the knowledge on how to do it safely and responsibly.
Despite the fact that prescribing is not directly related to opioid overdose deaths, unless you use CDC death certificate data for making such a claim, state attorney general’s continue to pursue legal action against manufacturers and distributors in an effort to offset the costs states have endured at coping with the overdose problem. We’ve seen the state of Oklahoma reduce its actions against J&J from trying to fix direct blame, to suing as a public nuisance. Not a very strong argument and one that sends a clear message that the continued rhetoric of opioid overdose deaths caused by a prescribing problem, as one that is only one of many probable causes.
The CDC’s own data is showing a reduction in the number of opioids prescribed, but not nearly enough to account for the continued rise in opioid related deaths. Since late 2018 the DOJ in it’s press releases has changed it’s language from that of being a prescription opioid crisis to that of being a Synthetic Opioid crisis of illegal Fentanyl to account for the huge number of analogs infiltrating our borders. Fewer doctors are coming under investigation and those which are, more often than not, are clearly involved some illegal activity.
A survey currently underway on this site, shows that 81% of chronic pain patients have been taking opioids more than ten years and use the medication daily. 31% are prescribed by primary care providers, 65% by pain specialist. 24% prescribe less than 90 MME per day, 20% prescribing less than 50 MME per day, with 14% prescribing above the 90 MME recommended by the CDC. 50% no longer prescribe sedatives with opioids while 31% will when medically indicated.
The damage by our current efforts to thwart drug addiction by going after prescribers and chronic pain patients has also produced significant damage, with 60% of patients believing that their prescribers are dishonest with them, either for why they recommend non-opioid treatments or press patients into reducing the amount of opioids taken. 93% report they are undermedicated to the extent that it is destroying their lives or preventing them from finding gainful employment.
67% report being force tapered or terminated from opioids without medical assistance, simply cut off cold turkey and turned away. 43% report permanent complications which have made them worse off, 25% considered suicide seriously enough to write a letter or leave a message to their family members and 3% suffered an adverse event which involved a hospital stay. 74% report now being unemployable because of being under treated, with 11% forced to take lower paying jobs because of forced reductions in pain medication. Of those unemployed or forced to take lower paying jobs 18% reported a $5K to $10K a year reduction in income, 27% a $10K to $30K reduction, 26% a $30K to $50K reduction, 13% a $50K to $70K reduction and 18% report a reduction in excess of $90K per year.
40% report having Medicare, 34% Employer provided insurance coverage, 12% Medicaid, 9% self pay, 3% private insurance through self-employment and 2% through the VA system. The age groups for respondents were 18-30 5%, 31-40 13%, 41-50 23%, 51-65 50% and greater 65 9%.
These stats are based on 535 respondents from all 50 states, the survey will continue as long as individuals continue to provide responses.
With 50 million chronic pain patients in the US, 20 million taking opioids daily as reported by the Pain Management Best Practices Inter-Agency Task Force and 48 million Americans undergoing surgery each year, 2 million of those being added to the ranks of the chronic pain community, our political leaders should pause for a moment and consider the ramifications of targeting this group with further reductions or eliminating pain medications completely. Such actions are not only inhumane but fail to address the real cause for opioid overdose deaths, that criminal element which imports them across our borders and sells them on our streets.