I'm a Chronic Pain Patient. Here's Why Walmart's New Opioid Policy Misses the Mark.

Editor's Note

Please see a doctor before starting or stopping a medication.

Walmart recently announced that they are going to limit some prescriptions of opioid medications to seven-day supplies, and are also going to institute dosage limits. As usual, people are applauding yet another “brave” step to curb opioid addiction.

As usual, I, like many other chronic pain patients, responded to the news with fear and fatigue. I don’t patronize Walmart, and the med I take is not one of the ones that is demonized. All the same, those emotions seem to be background noise for me these days.

There’s so much fear for chronic pain patients right now. Everyone’s walking the high wire, wondering if this is the day they will lose their access to treatment.

There’s fear that their doctors will be too intimidated to keep prescribing the medications they take.

Fear that new government regulations will make said medications unavailable altogether.

Fear that in order to receive the meds that work, they’ll be forced to spend a lot out of pocket for repeat visits to a pain clinic, undergo other treatments that cause harm and be subjected to random pill counts and urine tests. It’s guilty until proven innocent in many corners of the pain management world, and one has to keep proving it over and over again.

Fear that next week there will be yet another pharmacy that proudly tells the world they’ll restrict access to these meds.

And I’m tired of the fact that if you express your concerns about any of this, people tut and tsk and accuse you of being addicted. Really? It couldn’t possibly be that people are worried about losing access to medication that helps preserve their quality of life, could it? I’d feel the same way if the Powers That Be were putting up unreasonable barriers to obtaining medicine for my asthma, PCOS or immune deficiency (and those meds have serious side effects, too. One of my asthma meds is black boxed, in fact).

Because that’s what’s happening here. My medical care is being compromised by the actions of others. I don’t abuse my medication, and I shouldn’t be punished because others do. I’m tired of the government and companies like Walmart deciding that the way to stop misuse of certain medications is to withhold them from the people who use them properly.

I’m tired of the Powers That Be deciding that pain is somehow a lesser medical issue that does not impact quality of life if it is not treated effectively. Every time there’s an article about opiates, there invariably will be comments from the peanut gallery on how everything would be fine if we’d all just meditate or use CBD oil or destroy our livers and kidneys by taking over-the-counter pain meds every day. There will be other comments about how nobody needs to take opiates long-term, as though those physicians (armchair or not) are familiar with every single patient and circumstance.

I’m tired of people vilifying opioids while blithely ignoring the risks of the medications that are touted as their replacements. Many other drugs beside opioids are cited in poison control calls. As the National Kidney Foundation notes, many over-the-counter pain relievers are not necessarily intended to be taken on a long-term basis. Acetaminophen (if you’re not in North America, that’s paracetamol) is the leading cause of acute liver failure in the USA. NSAIDs – non-steroidal anti-inflammatories – can cause severe kidney damage, especially when they are taken with other nephrotoxic drugs. The NSAID Vioxx was pulled from the market after causing an estimated 88,000 heart attacks and being shown to increase risks of cardiac events and strokes. Other common drugs prescribed for pain management have been linked to suicidal ideation in some patients. I personally took a low dose of one of these Replacement Wonder Drugs for five months. By the end of that time frame, I’d gained weight, my retinas had been damaged, I was seeing double and my personality was different. But nobody seems to care about that, because some drugs are now “good,” and others are “bad,” and can’t possibly be the safest and least disruptive option for some patients.

I’m tired of people confusing dependence with addiction. The FDA Commissioner Scott Gottlieb himself debunked this, stating, “Someone who is physically dependent on opioids as a result of the treatment of pain but who is not craving more or harming themselves or others is not addicted.” Guess what? One can’t stop asthma meds, mito meds or PCOS meds cold turkey either, because it could cause some serious disruption and harm. One can’t abruptly stop the “replacement” meds they tout for pain, like pregabalin and gabapentin, for the same reason. But that’s OK; physical dependence is only an issue with opioids, apparently.

I’m tired of the Powers That Be overlooking the fact that chronic pain and illness patients are often capable of handling many other dangerous drugs responsibly. Chronic illness patients often give themselves multiple injections, monitor their own vitals, flush their own lines, do their own infusions at home and are given freedom to toggle doses up and down as necessary. In my medicine cabinet right now, there are five different standby meds, some of which have very serious potential side effects. My doctors fully trust me to know when and how to take them. There are a few other meds where my dosage is at my discretion. Some of those meds could deal real damage, or even death, if they were misused. Nobody blinks at that. But when it comes to opioids, the goalposts move and apparently none of us are responsible at all.

Walmart seems to think that if they restrict prescriptions, it will stop addiction. There isn’t a single person in power who seems to consider, even for a moment, that it will also add to the misery of countless pain patients, many of whom already have to jump through hoops to get their meds. Even the simple act of going to the store can be an ordeal for someone with chronic illness. Maybe they don’t have a vehicle, so they have to arrange or pay for transportation. Maybe the cost of gas or bus fare or a ride-share every single week will be a financial hardship, especially if they’re on a fixed income. Maybe their insurance will not pay for repeated prescriptions every month, so they’ll be fronting the cost for three of those four monthly fills. Maybe the act of going to the store so often will deplete energy and steal spoons they need for more important matters. But that’s now what they’ll have to do – and likely go through the third degree with the pharmacists every single time – to get the meds that help them reduce their pain.

I’m not going to dismiss the damage that addiction causes to those who live with it. But I’m going to express my fatigue – and anger – at the fact that the damage being inflicted on chronic pain patients is being soundly and completely ignored. Don’t our lives count, too? Is it truly better to have people rendered unable to function due to pain, or to experience worse side effects from the replacement treatments, or to die by suicide because it’s simply unbearable, than to allow them to access meds that help them? Is it better to force legitimate pain patients to run expensive and stressful gauntlets because other people abuse their meds?

Right now, the Powers That Be seem to be answering those questions with a resounding “yes.” It’s apparently fine to sacrifice chronic illness and pain patients in this battle. And it’s tiresome and infuriating to be treated as collateral damage.

Getty Image by Darwin Brandis

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