When Denying Opioids for Pain can Hurt, Rather than Help

We are all aware of the opioid epidemic that is plaguing our county, and I am personally aware of the terrible toll it’s had on the United States and other countries, but I have some thoughts.

 

According to the CDC.gov website, “In 2018, 67,367 drug overdose deaths occurred in the United States. The age-adjusted rate of overdose deaths decreased by 4.6% from 2017 (21.7 per 100,000) to 2018 (20.7 per 100,000). Opioids—mainly synthetic opioids (other than methadone)—are currently the main driver of drug overdose deaths. Opioids were involved in 46,802 overdose deaths in 2018 (69.5% of all drug overdose deaths).1 Two out of three (67.0%) opioid-involved overdose deaths involve synthetic opioids.” Synthetic or not, the number of deaths at the hands of these drugs is frightening and sobering. Tens of thousands of families have been destroyed. The public, as well as the government, are clamoring for stricter guidelines for prescribing strong opioids, with some even advocating a complete end to their use. Toward this end, hospitals and doctors responded to the bad press by dramatically reducing prescriptions for opioids for any reason.

 

This is a personal topic for me. My wife has chronic pain from a condition that does not show up on any tests or images. She’s been poked, prodded, scanned, examined, etc. As they test, her pain takes over, with no respite.  The kind of chronic issue is not important for purposes of this article, because there are dozens of these kinds of conditions that are characterized by severe, chronic pain.

 

My wife has had dozens of horrific experiences at local ERs.  Every 2-3 months her pain flares up and she starts a cycle of 2-3 weeks of almost daily ER visits.  Let’s just say for argument’s sake, she does everything that on a normal day works and keeps her out of the hospital. So, her pain is at a 10, but she still refuses to go to the hospital.  After about 3-4 hours of pain and trying to stay out of the hospital at all costs, I convince her to go.  Most people would ask, “Why would you want to stay out of the hospital at all costs? Isn’t that where she can get some relief?” The answer is because they will treat her like a drug addict and cause more stress that in turn exacerbates the pain. Due to the intense pain, she also vomits uncontrollably, dozens of times an hour for several hours. For this reason, she cannot take oral prescription pain killers because she will just throw them up before they have a chance to do their job. And of course, there’s always the possibility of dehydration due to the uncontrolled vomiting.

 

In chronic pain situations, the patient, close caregivers and family members typically know what has been effective at handling the patient’s pain in the past. Requesting a specific drug from the doctors and nurses in the ER automatically makes them assume you are drug seeking. From that moment, ER personnel will not treat you fairly. Imagine that! You have paid attention every other time you have been in the ER for your condition, and for that you are a drug seeker and addict. I have the distinction of being thrown out of every single hospital ER pithing a 20 mile radius for daring to ask why my wife has to wait hours to get pain relief and an IV for hydration. I ask this question when everyone is standing around talking and laughing, and again it is because they think she caused this herself and all she wants is drugs. The ER doctors HAVE ABSOLUTELY NO IDEA how to treat her condition, but act like God while she suffers. They have no problem giving her anti-psychotic drugs that make her groggy for the next two days, but will not give her the small dose of the medications that have been proven to work for her – an opioid and Zofran for the nausea. Proven effective medications! When she is given the proper medications, she sleeps for about an hour then, miraculously, is feeling good and ready to go to work.

 

That is just day one of the 2-3-week cycle of hell.  Fast forward to day six of her cycle.  She would have been in the ER 4 or 5 times at this point, and the ER staff is getting more and more belligerent with her.  They look at her as a drug addict, only there for her “fix.” But only a complete mental lightweight who has no capacity to think critically would think that.  If she has not been here since her last cycle months ago, she must be going to other sources to get these drugs and comes here only when she can’t get her fix there, right?  WRONG!  They do not bother to educate themselves on her history that is documented in their own files. Addicts need ever-increasing doses to get the same “high”. Logically, if they bothered to look at my wife’s history, they would see the low doses in the past that gave her relief. If she was using this whole time, she’d need ever-increasing doses. For pointing that out, I was asked to leave the ER. Again.

 

I have called the Patient Advocate at almost every visit. I always get the same story. They are nice but no one seems to want to help because they are afraid of getting in trouble for giving a patient opioids.  Forget that they medically need it.  Forget that they can’t take it at home.  My wife was given a 30-day prescription for a very strong oral opioid, because the doctor is again not listening. In the almost three years she has had this condition, she has used 2 or 3 of the pills, total. She had hoped she could keep it down long enough to combat the searing pain, but she could not. Just in case you can’t count, that is 27 or 28 still sitting in her bottle.  We have even brought the bottle in to show the ER staff how few had been taken, but they can’t even be bothered to listen to us, to learn something. Instead, we get lectured on her “addiction.” It’s insulting and disturbing, and possibly criminal, or at least cruel. The crazy part is for the last twenty years; my wife has owned a successful law practice and regularly appears in front of judges without any problems. I don’t think she could do that strung out on opioids.

 

At a small local ER in Smithtown, New York, I was so upset by all of this that I reached out to the chief Medical Officer of the Hospital.  I was yessed to death so the situation and gather the team to see what could be done. Of course, he did nothing. Three months later my wife needed to go back to the ER with pain that was off the charts. She ran into the same nonsense, as usual.  So, I reached out to the same Chief Medical Officer and was told, with zero room for interpretation, “If you don’t like the way we run the ER, go find another.”  This hospital is five minutes from my house.  We now have to go to a hospital about 25 minutes from my house.  That 25 minutes is the longest ride ever.  I even tried to reach out to the hospital system and got nowhere. I find this situation to be completely unacceptable and it seems to go against the Hippocratic Oath of “first do no harm”.  They are so arrogant it gets in the way of doing their job properly.

 

We were told that, given the severity of my wife’s pain, we should consider seeing a pain management specialist. We finally get in to see one, but he doesn’t take our insurance. We are paying out of pocket for the privilege of seeing this guy, who is supposedly an expert with her condition. We asked about protocol in the case of a flare-up in her condition. With a straight face, he responds, “Oh, just go to the hospital. They will take care of the pain with IV drugs.”  I imagine my hands tightening around his neck. “The hospital?” I think to myself.  This is maddeningly frustrating.  At this point, my wife is in between cycles, so every morning is still a struggle for her, but she is tough as nails and puts on a brave face and attacks it head on. The pain is about a 6 or 7 out of ten most mornings, but when she has to go to the hospital is it a 10 out of 10 and won’t go away.

 

Anyone that has had these similar stories, please share this and comment about your experience. I am working on something that might help, but it is a ways off.  I will share more when I can.

 

The Libertarian Gangsta

 

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