By DEBBIE BURKE and ANN BUKACEK, MD
(Names have been changed to protect identities)
Ned R., 74, is an Army veteran who was wounded in the Vietnam conflict and exposed to Agent Orange. Now he’s the casualty of another war—the war on drugs targeting the opioid crisis.
His voice chokes when he talks about fellow Montana veterans: “We served our country, were wounded for our country, and now we cannot get pain relief for those same wounds.”
Seniors and veterans are suffering the unintended consequences of laws meant to combat abuse of prescription narcotics. People suffering from chronic pain are often denied needed drugs or must deal with burdensome regulations.
“No one can really quantify pain,” Ned says. He believes VA restrictions send a chilling message: “We’re going to see your pain follows an administrative path,” rather than take care of veterans’ medical needs.
If responsible physicians who are properly treating their patients run afoul of bureaucratic regulations, they risk losing their medical licenses.
Out of fear, many doctors no longer prescribe Schedule II narcotics (hydromorphone, morphine, codeine, oxycodone, etc.), even when those medications potentially can be the safest, most effective way to treat chronic pain.
Other regulations “blacklist” legitimate patients from pharmacies and medical providers, or put up roadblocks that make it difficult, if not impossible, for seniors with limited transportation to obtain medicine on schedule, when they need it.
Because of the media blitz about the opioid crisis, many seniors fear becoming addicts. They stop taking prescribed pain medicine. Instead, they self-medicate with over-the-counter (OTC) remedies that can cause kidney, stomach, and liver damage.
This is Part 1 of a 3-part series that examines how political good intentions to reduce drug abuse paved the road to hell for suffering seniors in Montana, Idaho, and throughout the U.S.
Dr. Ann Bukacek, recipient of the 2019 American College of Physicians Laureate Award for Montana, and coauthor Debbie Burke will examine how recent regulations make innocent seniors and veterans pay the price in pain.
Written and Unwritten Rules
In 2016, the Centers for Disease Control (CDC) issued new guidelines for prescribing opiates that caused many doctors to radically change how they treated patients in pain.
Even the physicians who wrote the guidelines admitted they were based on low quality or no research, stating, “The recommendations in the guidelines are voluntary, rather than prescriptive, standards. They are based on emerging evidence, including observational studies or randomized clinical trials with notable limitations. Clinicians should consider the circumstances and unique needs of each patient when providing care.”
Nevertheless, legislators and government bureaucrats forced these admittedly flawed guidelines into regulations and laws in a number of states, including Montana. Seniors and veterans are asking why.
Dr. Bukacek says, “Many physicians have abandoned their pain patients since the 2016 CDC guidelines were released. Some incorrectly believed the guidelines were based on hard science.
“Others were guilt-ridden by media sensationalism that physicians are at the root of the crisis. Some worried they couldn’t keep up with frequently changing requirements that are sometimes contradictory. Furthermore, physicians are not notified of changes by licensing boards or law enforcement. Hospital corporations are severely restricting narcotic prescriptions, tying the hands of the doctors who are their employees. The bottom line: physicians fear losing their medical licenses.”
For these reasons, in numerous cases, doctors cut off patients from pain medicine even when those drugs were thoughtfully prescribed, relieved suffering, and allowed significantly improved functioning. The results have been grave for seniors and veterans.
As of June, 2019, the CDC is finally reviewing and “evaluating the consequences” of the guidelines, but, for some, it’s too late. An estimated 20 to 40 percent of drug overdose deaths may be suicides, including suicide driven by unbearable pain after being deprived of opioids.
Dr. Thomas Kline, former Harvard Medical School program advisor, says, “We have people committing suicide for no other reason than being forced to stop opioids, pain medication, for chronic pain…There are five to seven million people being tortured on purpose.”
His website publishes some names of people who committed suicide after having their pain control drugs forcibly reduced or eliminated.
Diederik Lohman, director of Health and Human Rights for Human Rights Watch, says, “Many of the patients we spoke to are very law-abiding and would turn to suicide before going to the street to get illicit drugs. The government has a duty to respond to the overdose crisis, but to do so in a way that is harming people who have a legitimate medical issue is a human rights issue.”
Additionally, some insurance companies wrongly use CDC guidelines to justify excluding narcotics or reducing doses, even though those drugs were previously covered. This increases company’s profits at the expense of suffering patients. Without insurance coverage, many seniors cannot afford their pain pills.
What Are Drug Registries and How Do They Work?
Most states have prescription drug monitoring programs that have been in effect for years. Montana Prescription Drug Registry (MPDR) started in 2012; Idaho’s AWARxE dates from 1997.
Registries were created to prevent “doctor-shopping,” where people visit a number of different medical providers to illegally obtain multiple prescriptions for controlled substances.
Seniors with varied health problems are often treated by more than one physician. For instance, a senior may see an orthopedic surgeon for arthritis and a cardiologist for high blood pressure. That is not the same as “doctor shopping.”
If one specialist is not aware of drugs prescribed by another specialist, problems can arise. In those situations, registries help catch and prevent potentially harmful drug interactions. But that does not justify leaving seniors and veterans in pain.
Under Montana law HB 86, physicians must check MPDR every three months before re-prescribing Schedule II drugs.
The Idaho State Board of Medicine’s policy recognizes opioid analgesics have a legitimate medical purpose when prescribed properly, while acknowledging the potential for abuse. Their policy states: “The Board expects that physicians incorporate safeguards into their practices, to minimize the potential for the abuse and diversion of controlled substances.”
They further say physicians should not fear disciplinary action for prescribing narcotics for legitimate medical purposes as long as the doctor uses sound clinical judgment.
Idaho’s registry requires medical providers to enter patient information on the state database by the end of the next business day, so it’s current and up to date.
Doctor Shortages Squeeze Seniors
There is already a shortage of medical providers, particularly in rural states like Montana and Idaho. The CDC recommendations caused many physicians to give up their narcotic licenses. Two major surveys showed 70 percent of doctors polled had drastically reduced narcotic prescriptions, or stopped prescribing them altogether.
That means seniors face long waits to see the dwindling number of physicians who can or will prescribe pain pills. If you can’t see a doctor, you can’t get your pain medicine.
In Part 2 of this series, seniors share personal experiences of how they pay the price in pain for the crackdown on prescription narcotics. ISI
Ann Bukacek, MD, practices internal medicine in Kalispell and was awarded the 2019 American College of Physicians Laureate for Montana. She serves on the Flathead City-County Board of Health. Debbie Burke lives in Kalispell and writes mystery/suspense novels as well as articles. Her recent thriller, Stalking Midas, addresses elder fraud. debbieburkewriter.com