The Other Side of the Opioid Epidemic: Denying Treatment to People With Chronic Pain

When I went into the office one Saturday afternoon in August 1994, I planned to spend a few hours finishing a brief that was due in federal court Monday morning. At the time, I was a civil rights attorney for the justice department. After 30 minutes of working at my desk, my back started to burn; it felt as if acid were eating my spine. In rapid succession, my muscles seized and threw me from my chair. I landed on the floor, stunned, as my body filled with searing pain.

What I didn’t know then was that the pain would persist, and that I would unable to sit, stand or walk unassisted for almost 20 years. Nor could I have imagined that I would one day take opioids for pain.

We hear a lot today about opioids. Newspapers run a steady stream of stories of lives lost from overdose and abuse. What we rarely hear is the other side. Opioids are the most powerful medication we have for treating severe pain. For me, opioids were life-restoring.

Proper pain management that included treatment with opioids lifted me from the desperate circumstances of being bedridden and unable to sleep for months at a time to someone who negotiated major settlement agreements, argued important cases in federal court and supervised thousands of matters in U.S. attorneys’ offices across the country. I still could not sit or stand – I negotiated via video-teleconference, argued from a reclining lawn chair and managed cases from a jerry-rigged, platform bed – but I could and did work and function.

Pain patients today are not so fortunate. In our effort to thwart the genuine problem of drug overdoses, we are taking life-sustaining pain medicine away from people who are struggling.

Long-term legitimate pain patients who have relied on opioid analgesics can no longer fill their prescriptions in the many states that set dosage and supply limits, often of three to seven days. Even in states that contain
exceptions for long-term pain care, insurance companies and pharmacy policies use such laws as a reason to deny coverage or fills. Pain patients are denied treatment and involuntarily tapered off of opioid medication, even if they’ve never shown any risks of abuse. The results may include increased suffering, loss of function or suicide.

Recently, Attorney General Jeff Sessions responded to the concerns of pain patients by telling them, “Sometimes you just need two Bufferin or something and go to bed.” His comment shows an astonishing misunderstanding of a condition whose quality of life index (QLI) is akin to that of late-stage cancer. Nearly 50 million Americans have severe or persistent pain, which 25 times more than those who misuse opioids. Chronic pain is the number one cause of disability in America, and it costs the US economy half a trillion dollars every year.

There is an important but often glossed over distinction between using medication for a health condition in a way that restores function, enabling work and participation in family life, and misusing a substance in a manner that destroys function.

Most people who take opioids for pain do not abuse them: studies show risk for addiction in such patients varying between .07 and 8 percent. And, when opioids are prescribed properly with screening and follow through care, the risk of addiction goes down significantly.

The substantial majority of people who have misused prescription opioids never received them in a healthcare setting; they obtained them from medicine cabinets, family and friends or bought on the street.

Like many pain patients, I initially resisted taking opioids. I exhausted every other possible treatment first.

Because my condition resulted from a surgery when a doctor severed nerve plexuses in my spine, I tried infusions, nerve blocks and even a repeat surgery. I did physical therapy, acupuncture and biofeedback. But nothing abated the pain.

Treatment with opioids and integrative care allowed me to maintain a job, a sense of purpose and community until I found my way to healing. Mine is a story rarely told of someone who took opioid analgesics for years and went off them without incident when the pain remitted. Given the environment today, such stories may well become extinct.

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Getty Image by Stuart Ritchie

This story originally appeared on The Hill.

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