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Dear CVS: A Message About Your New Opioid Policy From a Chronic Pain Patient

Dear CVS,

Can we talk? Have you ever had one of those friends who was about to make a career-ending decision and you just felt you had to say something? I’m that friend. No, not the one in trouble. The other one. Sit down, because I’m about to do you a favor.

I awoke this morning to read what I can only assume you believe to be the “positive” headline that CVS stores will limit access to opioids. What have you done?

I get it. Someone sat in one of your risk management meetings discussing your potential liability in a lawsuit from an overdose and suggested this step as a way to:

1. Fix a social epidemic

2. Reduce liability

3. “Help” consumers

The problem is, what you are doing is just the opposite. If anything, you may now find desperate patients resorting to illegal means to manage their pain, or worse yet, suicide – a possible outcome for some who cannot get the proper help to deal with physical pain.

While this is a free market economy, and you are well within your right to manage your business as you see fit, you are hurting patients who have trusted you to be an ally in their health management.

I suspect that you, like many, do not truly understand the world of chronic pain. Let me take you on a journey. And please keep in mind that I am one of 100 million Americans with this problem.

I was born with Ehlers-Danlos syndrome, a genetic defect that means the glue that holds my body together is defective. The disease replicates itself in many ways, from organ ruptures to the hallmark dislocated joints, but almost all patients share chronic, intractable pain. In 2011, I developed issues with my spinal cord related to the disease. I have been treated with opioids since the age of 15 because my condition does not improve. As a matter of fact, for some individuals with EDS, the condition can be terminal.

In addition to being treated for my pain, I’m also a productive member of society. I have a master’s degree, a CEO level job and I’m a college professor at two universities. I pay my taxes, have no criminal record and I am a health nut. I also have days I cannot function due to pain. Days where I have to use my wheelchair to have an outing with my friends. Days where I lay in my car and cry on my lunch break so I can get through the work day. And this is with a pain management protocol. Imagine my world post-CVS – where I cannot get my prescription filled.

As an average patient on a pain management protocol, I am subjected to plenty of scrutiny and checks – and frankly I don’t need it coming from you too. I, like most patients, sign a contract with my physician that I will do many things, including: not getting pain medication from another physician, even in an emergency, coming to the office within 24 hours if requested to drug test, proving to the office I was out of town if I cannot get there in 24 hours and randomly drug testing on a regular basis to show the only substances in my system are those prescribed to me – and that those substances are indeed there (proving I’m not selling my medication).

On top of that, I see the look on your pharmacists’ faces when I pick up my prescription – I know what you’re thinking. I battle my insurance company constantly to cover the high costs of my medication – including providing charts and graphs from a pain tracking system I use. In short – I’m vetted. My physician has confirmed my diagnosis with a geneticist, tried other methods, monitors me closely and has determined that the slip of paper he gave me is the best treatment for my needs. So why do you now want to get a say in this too?

The actual word used in the first sentence of the most recent Forbes article on this policy change is scrutiny. “Pharmacy giant CVS Health will ratchet up scrutiny of opioid prescriptions in an effort to reduce misuse and abuse of the overprescribed painkillers.” Do you not think from the above that we as patients do not receive enough scrutiny? Do you not think we have jumped through enough hoops and been looked down upon prior to visiting your establishment?

“CVS said its program will include ‘limiting to seven days the supply of opioids dispensed for certain acute prescriptions for patients who are new to therapy; limiting the daily dosage of opioids dispensed based on the strength of the opioid; and requiring the use of immediate-release formulations of opioids before extended-release opioids are dispensed.’”

If you’d like my chart from my physician’s office you’ll find 20 years of trails of “immediate-release formulations” that did not work. I’m sure your pharmacy staff can also tell you that immediate-release formulations are great for breakthrough pain but do not manage long-term pain. You’ll also find about 30 pages of data I take the initiative to collect, just to get my prior authorization from my insurance. As a customer, it’s appalling to me that you now want in on the bullying of chronic pain patients.

Your Chief Medical Officer, Dr. Troyen Brennan, wrote that “in many ways, the abuse of opiates can be seen as the leading public health emergency the United States faces today.” That is not true. I believe the leading health problem we face today is the ineffective care and treatment of those with chronic pain conditions. Until we solve the mystery of pain, or treat patients appropriately, we will always have those individuals who are so desperate they will find illegal means to help themselves.

I am not for a second discrediting that there are individuals who are trying to obtain prescriptions for recreational use under false pretenses. However, I think that determination lies with the doctor, most of whom utilize the above referenced pain management protocol. It also should not impact my treatment because some individuals are abusing the system.

What you are doing is effectively finding people illegally parking in the disability spaces and saying, “We’re limiting the number of disability spaces so people don’t abuse them.”  You can quickly see where this is illogical. You would never do that. People need those spaces. So why then are you doing this with legally prescribed medications?

As you think about the dozens of statistics you’ve seen on the opioid crisis in America, let me leave you with these statistics:

100 million Americans experience chronic pain.

Chronic pain is the number one cause of long-term disability in the United States.

And most sobering of all:

Psychology Today estimates that as many as 20,000 or more Americans with chronic pain die by suicide each year – well more than the government’s tally of 16,235 deaths from prescription opioids each year.

“The dismal situation with chronic pain — and the potential link with suicide — is unlikely to improve until the federal government takes the pain epidemic seriously. While the government spends $2,562 on research for every person with HIV/AIDS, it spends only $4 for every person with pain.” (Psychology Today)

You are in a unique position CVS. You can be part of the problem or part of the solution. But you can’t be in the business of part-time helper and part-time vigilante. Fulfill your company’s mission: “to improve the lives of those we serve by making innovative and high-quality health and pharmacy services safe, affordable and easy to access.” Access. You wrote it. It is in your mission statement. Fulfill you mission. Primum non nocere.   

I await your response,

Amanda Wroten
Patient. Wife. Human.

Editor’s note: This story reflects an individual’s experience and is not an endorsement from The Mighty. We believe in sharing a variety of perspectives from our community.

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Photo courtesy of CVS Pharmacy Facebook page