Are doctors cutting back on opioids too much and too quickly?


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18 comments

  1. Paul

    This has happened to me in the past, where I was taking hydrocodone for many years without a problem, then was cutoff do to them following the CDC guidelines. I know this is a world wide problem, and I do not know how I could handle this if it happens again to me, most probably I will either seek out drug dealers or end my life without seeking help. I say this because this issue is not about my well being far as I can see it, but about control and causing me and my family suffering. I do not prefer death unless that is my best option. The same can be said for the 4000 deaths that you state in your article. One thing I did not see is any statistics on how many of the 4000 can be attributed to getting uncontrolled medications to relieve their severe pain as they were not able to get the proper medication and level from their doctor. I personally would not ever sell my medications as all little that I have is used by me so that I do not suffer from debilitating pain to the point that death is a better choice than life. I have since a small child used (some unfortunately say abused as they think that any use of medication is abuse) so that I am able to breath properly, function normally and much much later not be in severe pain due to back injuries, where doctors say that surgery probably will not help me. I have multiple compressed disks pushing on my spinal cord throughout by back a few in the middle, but mostly lower back. I do not always take medication on a schedule, but when I feel pain and also keep track of how much I have taken. I know if lower parts of my body are hurting where I know there are no injuries that it is time for medication. To me this is not really living but existing by the use of medication. The same can be said for those with diabetes, my asthma, and other chronic conditions. It comes down to existing with the medication or death. When people say that people that do not have cancer should not be using such medications, they are basically saying to me that they prefer that I am dead. However they are unwilling to admit that. I know life on drugs is not a perfect life, but it is life none the less as without them the only choice for me is to die. The pain not accounting for withdrawals is so much that I am unable to breath properly or even walk properly. Then on top of it I am unable to get proper treatment for ADHD that has been with me since my childhood. That again adds more to my inability to function properly. All I can say is that my government is basically saying to me that I am better off dead at this point, as they do not want to let doctors prescribe for me the medications that help me to live a good and enjoyable productive life. All I can really say to this is I am glad to not have children, so I can put an end to asthma in my family tree. Also they will not have to live with student loans they will never be able to afford to pay off as well. Millions upon millions of children born to a father on disability is probably the best thing that could happen to this country, as it is the only way to really slay the dragon.

    • Adele Hedley

      I have been taking opiates for 6 years. I have chronic pain with 6 spinal operations, ileostomy, Crohn’s disease and two small bowel resection.
      I have kept my pain away for 6 years but now that the uk government has realised that almost every doctor has over prescribed to the wrong patients and through this I am suffering. I do not want to be taken of a pain killer that works for me.
      I was written a plan to drop 10% every 6 weeks. But now I’ve moved and joined a new practice I’ve just been told I’m dropping 10% every two weeks
      I will lose my job at this rate as I cannot function. I shake, sweat and can’t concentrate.
      I had an appointment today only to be told I was to join a drugs and alcohol clinic. So now I m being labelled a druggy!!! Apparently it’s for people who misuse drug!! But I don’t misuse them!
      I’ve been told that drug pushers wait in the car park so they can sell to someone who is desperate like me. My doctor has told me that I have to stick to the plan! I asked what would happen if I was suffering badly with pain and withdrawal? He said that they will stick to the plan regardless
      I just don’t know what to do! My partner wants me to join another surgery but will it be like this where ever I go
      I’ve been in tears today! I have been spoken too at work, I can’t cope and I’m in pain. Basically the doctors have washed there hands of people who need strong pain killers.
      Please if there is anyone out there who can advise me I would be so grateful.

      I don’t want to take my own life nor do I want to start of hard street drugs but I’m being pushed in that direction

  2. Vivian

    Addiction patients are very different from chronic pain patients. Just because someone has chronic pain and is on opioid pain medication, does not mean that they have addiction problems. We should not lump addiction and chronic pain patients together.

    • Sharon

      Yes! I so agree. I was put on oxycodone by my family doctor for combination of Lupus fibro and spinal surgery issues. He kept up in the Dells for his own personal agenda and eventually I left him because he was abusing me. A very long story but imagine being stuck with no doctor I found a rheumatologist who was prescribing tonight but would not prescribe those high amounts. But I thank God that he’s so prescribing me and I wish I was off of them. At 62 years old it’s so much harder after being on opiates for over 10 years the pain and withdrawals very rude

  3. Margaret deMello MSW

    I think doctors are overreacting to the problem of opioid addiction. It is simply unethical to withdraw or withhold necessary pain medication for legitimate illness or injury. Also there is no research on specific medication addiction rates among specific populations, ie osteoarthritis and other chronic care patients, on long acting morphine sulfate for instance.

    Concerning the bio-feedback theory of pain reduction, exercise, cognitive and relaxation exercises only goes so far. In this regard, health care providers and pain specialists may be over emphasizing psychogenic contributing factors. I recently had a ‘tori’ , overgrown bone in my palate, removed. The dental surgeon 4 or 5 prescription Tylenol which wear off in two hours, whereas the pain lasted two weeks. This is really unfair, especially on older patients.

    I have not noticed any addiction risk evaluation from any of my doctors over the years. Perhaps they should get better training in how to assess and treat patients with co-occurring diagnoses. Also, if opioids are not prescribed, then alternative pain medication is needed. There are horrendous side effects to many, many prescription drugs and these continue to be used, particularly psychiatric medications. So, I just think the various medical associations need to re consider their knee jerk reaction to what is predominantly a street drug crises ie fentanyl. About 1400 drug overdoses in Vancouver were illegal drug overdoes.

  4. Richard A Lawhern, Ph.D.

    It is now established beyond any reasonable contradiction that medically managed opioid prescriptions are not a significant sustaining element in the so-called “opioid crisis” in the US or Canada. US CDC data on opioid prescription rates and rates of opioid overdose related deaths in the 50 US States and District of Columbia for 2016 show no cause and effect relationship whatever. Absolute risk of overdose death or drug toxicity among medically managed pain patients is on the order of 0.02% (20 deaths per hundred thousand), comparable to the mortality of blood thinners widely used to prevent stroke and atrial fibrillation. Contributions of medically managed prescriptions are lost in the noise of huge volumes of street drugs, notably illegally manufactured fentanyl.

    Incidence of diagnosis for opioid abuse or extended prescription of opioid pain relievers among post-surgical patients prescribed opioids for pain control is significantly less than 0.6% during follow-up periods averaging 2.5 years. Many of these diagnoses are incorrectly made by doctors who lack training in both addiction and the emergence of chronic pain conditions caused by surgery itself. Fewer than 1% of post surgical patients continue a prescription longer than 13 weeks, and incidence of abuse is only weakly sensitive to doses between 20 and over 120 morphine milligram equivalents per day. Many physicians in pain management also acknowledge that optimal dose rates vary widely between individuals, in a general range of 50 to 1000 MME (yes, ONE THOUSAND). Over 1.6 million older patients in the US are maintained on opioid pain relief, many of them for decades. The US National Institutes on Drug Abuse confirms that opioid abuse or addiction among these patients is vanishingly rare, despite effects of drug tolerance.

    The only ways in which prescription opioids play a part in our public health issue on addiction is in initial exposures of people who never saw a doctor, by diversion: theft from home medicine closets or being passed along by a relative. Even in this role, addiction is not sustained by prescription drugs diverted at home. Addiction is created and sustained by purchases of less regulated drugs in street markets, not by doctor prescriptions. And the driving factors in addiction are almost entirely socio-economic, not medical exposure.

    Physicians wishing to explore truth rather than hype and nonsense may begin with several white papers mounted by the
    Alliance for the Treatment of Intractable Pain. We’re easily found in a google search.

    Restrictions on prescribed opioids and coerced tapering of existing therapies to below therapeutic levels are literally disabling and killing patients. Hospitals are experiencing shortages of opioids vitally needed in surgery. And all the while, overdose deaths from illegal fentanyl, heroin, diverted methadone and morphine continue to skyrocket.

    • Tim Mason

      I find the cutbacks to be true when patients have been with a certain provider (Pain Specialist) for an extended period of time. Also, when the patient fails to try physical therapy and massage as complementary treatments. A patient should also submit MR, CT images to verify a cause of the pain.
      A person that advocates for himself or herself should shop for alternative physicians before the doctor relationship sours. This type of doctor shopping is not to be confused with the DEA definition of “doctor shopping”. In some states the pain physician turns the patient over to a what is called “physician extenders” which can vary from a PA, NP, NP-C etc. These individuals are usually 30 years old or younger and have only weekend courses to instruct them in pain management.
      I recently had a relationship go sour because I had not seen the MD in 8 months and infact found it difficult to see him. Even upon submission of new imaging that indicated a worsening condition the NP weighed in and continued to try and sell me on a spinal cord stimulator, 5 different models in all.
      I advocated for myself and made an appointment with a physician associated with a major university with a medical school.
      I was then referred to their pain management department which included a well educated staff in spinal conditions and pain. We discussed the “Guidelines” which they knew were not based on scientific data. Furthermore, some doctors do what is best for themselves and their practice and not in the best interest of the patient.
      Document everything and keep files. If you can get to a university setting with a neurosurgeon and be referred to a good pain management practice.
      Where I am now-All visits are provided by a doctor-no physician extenders.
      It is a journey but keep looking.

    • stephanie

      I enjoyed reading your input on the article about the “opioid crisis”. I myself am a chronic pain patient and have been on opioids for 20+ years with good results. As like everyone, I also suffer from medication cut backs. My question to you is, is it only a recommendation of the CDC to pain doctors that they follow the 90 mg morphine protocol? Is it fair that the CDC put us in a one-size fits all profile?? What if any avenues do we chronic pain patients have now?? Hasn’t the “opioid crisis” been going on since President Nixon was in office?

  5. Jeff

    I was just assessed as having zero risk of opiate abuse and was taking twice my current dose back in 2001 by the same doctor who is now wanting to cut my prescription to force me to comply to these idiotic CDC guidelines what are based on false premises as expounded most diligently by this author. Thank you for helping us in this fight, but please get this article to the mainstream media. All we get is bad press from the overdose of drug addicts trying to get stoned and since the government is impotent at solving the actual problem, to score points with voters in a tight election everyone screams “do something” and so this is the knee jerk reaction to cut those with chronic pain, the most helpless members of society who are like me with multiple end stage diseases that are incurable, untreatable, degenerative, and only going to get worse with time as we continue to age. Yes we’d all love an equal or better non-opiate pain reliever but until such medication is through clinical trials, FDA approved, and made available on a comparable cost so our insurance will pay for said medicine, leave us alone! Haven’t we already suffered enough thanks to inherited diseases and auto accidents that were NOT OUR FAULTs! For heavens sake, I can go buy cigarettes at the convenience store that kill a hundred times more people every year, with no known health benefits, and without a prescription, a monthly visit to the pain doctor, a drug screen, and a psych evaluation to confirm I am 100% complaint with my prescriptions. I have permanent spinal cord damage, all my joints in my lower body are worn out from generalized (systemic) osteoarthritis, I have had a dozen major surgeries including joint replacement, spine surgery, ankle surgery, knee surgery, and I can’t even count steroid injections, blocks, and 200 physical therapy appointments, yet there is no cure, no treatment, no solution to end my pain and I’m OK with that as long as I am given the life, liberty, and pursuit of happiness guaranteed to me as US Constitutional rights to medical treatment as determined by my physician without government interference based on some biased, poorly researched, and illogical CDC study that even the authors admitted should not have been used for the purposes that our political system and now medical system have adopted as gospel even though over 150 years of experiences with opiates and every major medical textbook scream otherwise. Someone help us before the suicide rates from tortured pain patients makes the death rates from legit pain patient overdoses seem insignificant!

    • Alisa

      Very well said! We are compliant to three point of rediculousness, yet made to suffer thanks to fake numbers and addicts putting us in a bad light. I’m a 25 yr chronic pain patient, with 23 surgeries under my belt. My doctor referred me to pain management 18 months ago, yet no practice would touch me. They said, “We can’t help you.” I figured out that the main cause was that I’m over 90 MME. In addition, the PM docs in my area only want procedure patients, as they make them a quick buck and have fast turn around times (90 days or less from 1st to last appt.) I feel like a prisoner to the system, as I can’t leave the area for long thanks to pill counts and monthly Dr visits. Something needs to change.

      • David Cole

        That’s exactly what I’ve experienced, they don’t want opioid maintained people, they want you to get spinal stimulators, spinal blocks, or some other stupid crap that don’t work and leads to more pain, disability, stress, anxiety depression, etc. Then we have the CDC coming out and admitting they over counted RX opioid prescription desk by 50%, their researchers think it’s much higher because they didn’t count all the other drugs people were taking. Considering less than 1% of people who take opioid pain medication have any problem with addiction, and when it comes to intractable/chronic pain patients it’s virtually non-existent. This whole fake RX opiate crisis is a pathetic display of ignorance.

    • Jane Bond

      Well said. I wanted to tell U about fat cells being altered naturally & turned into netural stem cells which can be used to repain any part of the body. It is new. Started in Wales I think. Of course right now it is new,expensive & of course not FDA approved. I am also waiting for a TB vaccine to become FDA approved to help fix,cure or remove FM disorders. I am hoping it will work. I did the nre FMtest.com for blood to confirm I have FM. Hope this information is helpful. Do hang in. I am cut off all pain meds now even though I have FM,OA & a broken back + other disorders causing pain.. I am hanging in no matter what. Thanks for sharing.

  6. Tess

    This article has some points agree with like the decision to taper or cut should be up to patient and not forced. But there is some info that is not correct.Like that long term pain meds can built a tolerance.Everyone can build a tolerance to any med even insulin. And people with intractable pain may need more due to pain or they could be fast metabolisors.All of us have different shapes and sizes and metabolize meds differently. Most people with intractable pain have tried nonopitiate treatments first and many times those treatments have made us worst.Prescribing of opiate meds has been going down for the last 10yrs in America. So when policy makers ,doctors say people are overdosing from prescribed meds is wrong.The numbers or data was wrong and the people that overdosed had multiple drugs in their system and some illegal mix in too.

  7. John G Nee

    My own doctor retired at the end of March 2018. This is a very large practice that has offices and diagnostic offices all over Massachusetts USA. I was in between doctors and had finished the last prescription from the doctor who retired 6 days before I was seen by the new doctor. They took a urine test and I got a telephone call from some militant nurse telling me that my levels of opioids in my system will well below what they should be if I was taking my pain medication as I should have been taking it. My response to that was there was a 6-day period where I had no medication. Their response was well there still should have been some in your system. My response was no there shouldn’t it goes out of your system in 2 or 3 days. And then they’re telling me I came up with Vicodin in my system and Vicodin had been prescribed to me because all of my teeth have been pulled in August of 2017 in that 6 day. When I had no pain medication and I had three quarters of a bottle of Vicodin left I took some of the Vicodin. I then went in for the appointment with the new doctor taking over for my old doctor and signed a pain contract now as far as my lawyer is concerned a contract is not officially viable until it has been signed by both parties so I could have done anything I wanted to during that 60. And they had nothing to say about it meaning the doctor’s office. Although I did not take anything that was not prescribed to me I was kicked out of the practice without any pain medication and I was on 10 10 mg oxycodone per day and 330 mg morphine’s per day because there was something wrong with every level of my spine I have 30% of a stomach left and they’re my old doctor described me as a person who has the injuries and illnesses of 11 men. And my new daughter just cut me off. No weaning nothing and I have to try and find another primary care physician when this particular group of Physicians owns about 3/4 of the state of Massachusetts and in all the areas that I live in it’s all his practice and his people I don’t know what I’m supposed to do I’m in so much pain and withdrawal but it’s driving me crazy. My wife is going to complain to the board of registration in medicine and anybody else that we can complain to. As my husband says walk a mile in my shoes for one day and you will feel the constant pain that I am in every single day because every bit of my back is broken I have arachnoiditis down the bottom from a failed back surgery. I have fractures in the middle of my back the T8 and another two fractures that they can do nothing about I also have two discs in my neck that are pressing in words towards my spine that could paralyze me if I move the wrong way and this was just diagnosed by this quack of a doctor and he still threw me out of his practice knowing that I could get paralyzed if I turn the wrong way. I also only have 30% of my stomach left because in 2014 I had a 10-hour surgery where they remove 70% of my stomach due to ulceration they removed about 4 feet of my intestines do to ulcerative colitis and then it took them another 6 hours to repair the intestines as they were and it took to surgeon sewing them up I have all of these records. I also have a tarsal Coalition in my left ankle and my left ankle doesn’t move at all it does is swell I’ve also lost two fingers on my left hand due to sore injuries that I have to I have to have surgery for every couple of years so that we can keep the fingers intact and keep the scar tissue around them down. After a wonderful 10-year relationship with my old primary care physician who was wonderful and diagnosing all of these issues and problems I get sent to this Quack and it’s in his former practice and he throws me out the door because he doesn’t want to give me pain medication after 1 meeting. He didn’t even look at my records I had to have my wife come with me to explain everything that was wrong with me and you know he’s questioning me about things that from 2011 the arachnoiditis that came up in the pictures I sent and my wife said yeah that’s been coming up in the MRI since 1999. And I also told him that I was aware of all of the problems out there that doctors were facing in order to prescribe narcotic medications and I voluntarily said you can start weaning me back so that we can get myself down to just a few medications a day but I don’t know when when my urine didn’t show with all of the pain medications I was supposed to be on even though there was a 6-day gap between doctors and prescriptions and I came up with a Vicodin that was prescribed to me by another doctor they did not even want to hear the explanation they just threw me out the door he didn’t even want to see me. So now what am I supposed to do kill myself because of the chronic pain like that other guy 53 years old put a gun to his head and shot himself cuz he couldn’t stand it anymore cuz he took his opioids away from him that’s what this is coming to is awful and it’s horrible and you doctors and and whoever is overseeing the doctors on this need to come to some kind of a consensus or the needs to be a law passed that you can’t just throw somebody out the door they have to be weaned off of these medications before they can be thrown out the door I am very very angry at this and yes I’m going to be running a lot of letters but what good is that going to do for me when the when the doctors can do whatever the hell they want. Thank you for listening. John G. Nee, Brockton, ma USA

    • Mary Meaden

      I hear you John and I think that’s some lawyers should start a class action lawsuit against these doctors who I just throwing people out the door without any kind of weaning I think of that poor man 53 years old killed himself and his widow should be the first one to go to a lawyer about this. We need class action lawsuit started in every single state in the USA and in Canada if we have to we all need to come together to get this thing done this is absolutely ridiculous what they’re doing to people in pain.

  8. Jackie

    I have been taking oxygen since I’m 18. I’m now 45 and have never abused my meds. I think what Trump is doing to us poor low quality of life disabled patients is dead wrong. I have never once took a double dose, . I have spinal Stenosis, fibromyalgia, brain tumor, titanium plates screws and rods making my foot up as a result of falling off a roof, I have herniated, bulging and siac compression as well Wich with all these ailments gives me not one bit of any kind of a quality life. I’m still in pain even when I take my medicine. My Dr just advised me that he’s cutting Everyones prescription down 12% a month. Wvwn my father who was a Vietnam War Verteran who is 100 % disabled is being cut too. What about the people who have cancer? This is an absolutely shame and I would like to know who to get in touch with regarding this matter. If I’m cut off my pain pills,I’d rather be dead too so take that into consideration because many people will be committing suicide because they just can’t bare the pain their in. Trump changed as soon as he took Presidency. I wish I didn’t vote for him. If he had any pain he would understand what us people are saying but being that he doesn’t experience pain at all he’s thoughtless about the people who need it to have a somewhat kind of life. Wvwn with pain pills they don’t take all pain away. My life is useless without them. What about thoae of us that need them to function daily? Nobody cares. The Drs are too afraid they’re gonna lose their license so they treat us like rats in a cage. We’ve gotten sick from the cut down,and fully back in just as much pain as we were before taking them. If you abuse them yes by all means cut the patients off. But if the patient never had a problem, leave well enough alone! Why? What kind of life am I going to have aoon? Nothing but pain and suicidal from the pain so it’s a no win situation and watch Patient should be treated as an individual and only the Dr knows who’s abusing the pills. That’s all. My rant is over. If I get dropped another 12% I fear the pain I’ll be in will be enough for me to commit suicide. I don’t want to live with absolutely no quality of life and I will not live in this pain I experience on a daily basis.

    • Jackie

      Jackie June 17th, 2018 at 8:29 am
      I DID NOT MEAN OXYGEN! SPELL check IS BAd! I meant OXYCODONE 30mgs 4X daily.

    • Dennis

      With this new law in effect I’m scared that the pain that I am going through they’re going to cut my medication off I do not know what to do

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