Medical and legal experts say government scrutiny of prescriptions is causing more doctors to stop prescribing opioids, and patients taking opioid drugs for pain are being “abandoned” by doctors. ”.
Doctors and lawyers say they fear they will be warned by the Drug Enforcement Administration that it could revoke approvals to prescribe controlled substances or prosecute cases of suspected illegal prescribing. Fear is said to be the main reason.
Patients taken in by doctors, physician assistants and nurses say they are a fallout from a crackdown aimed at reducing opioid overdoses and addiction, and are enduring severe pain while they look for other health care providers. do.
“The crisis has left us alone,” said Calverton resident Steve Drag, 62. He suffers from severe back pain and has spent most of his time unable to move since being abandoned in 2020. “We are considered drug seekers”, pill seekers…we have a proven track record. In my case, I’ve been using opioids for over 20 years without any problems, instead of losing my life and being bedridden. ”
Estimated 2.3 million people Had prescription opioid use disorder, or addiction, in 2020, according to federal data.Opioid prescription 46% decrease According to the American Medical Association, between 2012 and 2021, tens of thousands of Americans continues to die every year However, most deaths are not caused by prescription drugs, but by illegally manufactured synthetic opioids, including fentanyl.
What you need to know
- Increased number of healthcare In an effort to reduce opioid overdose and abuse, health care providers are “abandoning” patients who use opioids for pain relief for fear of government oversight, medical and legal experts say. points out.
- The patient says he is enduring severe pain. And their quality of life plummets after they are “dropped” by their doctor or their opioid dosage is drastically reduced.
- Federal guidelines prohibit abandoning patients. Stopping opioids suddenly or reducing dosage rapidly. But patient advocates said the practice is common.
Experts agree that neglecting opioid patients can cause serious harm, but differ on whether opioids are appropriate for people newly diagnosed with chronic pain.
Centers for Disease Control and Prevention 2022 Opioid prescribing guidelines Warn patients against abandoning them, abruptly discontinuing opioids, or rapidly reducing dosage.
But Claudia Merandi, executive director of the Doctor Patient Forum, which advocates for pain patients who use opioids, said the problem is widespread.
“We receive about 600 messages a month from abandoned patients,” said Merandi, of East Providence, Rhode Island.
“I spend half my day lying down,” says the Hicksville patient.
Don Peterson, 66, of Hicksville, suffers from degenerative discs, severe spinal stenosis, severe arthritis and diabetic neuropathy, and has been taking opioids for more than 20 years.
He said that starting in 2020, his oxycodone dose was repeatedly reduced at the medical institutions he visited. In 2021, after his doctor left the practice, his physician assistant was “told to find another doctor” even though the practice had other doctors.
“He said, ‘We don’t prescribe opioids here anymore,'” Peterson recalls.
After multiple surgeries, Don Peterson of Hicksville needed a prescription for opioids for pain, but had trouble finding a doctor to prescribe them. Credit: Newsday/Thomas A. Ferrara
Peterson said he found another doctor who tried various injections and other non-opioid treatments, but nothing worked after several hours. The doctor refused to increase the oxycodone dose to the previous level.
After taking the full dose, she said, “I was able to move around, do things around the house, cook, take out the trash, do some yard work, and be sociable.” That’s fine,” Peterson said. “Right now, I can’t do anything because of the pain, and I spend at least half the day lying down.”
The sharp decline in opioid prescriptions comes amid disagreements among medical professionals over the role of opioids in relieving chronic pain.
The CDC’s 2022 Non-binding Opioid Guidelines were a revision of the 2016 guidelines. criticized by many medical experts “It’s overly restrictive, which causes some clinicians to avoid problems with state and federal authorities,” said Dr. Kevin Zacharoff, pain and addiction course director and clinical assistant professor at Stony Brook University Renaissance School of Medicine. “I stopped prescribing opioids because of this.”
Although the 2022 document “relaxed” the guidelines, Zacharoff said it was “very difficult to go back” and many medical professionals were still affected by the old recommendations.
The 2022 CDC guidelines state that while “opioids can be an essential drug for pain management,” a review of studies found that there is “insufficient evidence to demonstrate the long-term benefits of prescription opioid treatment for chronic pain.” It has been found that long-term use is difficult. There is a risk of misuse or overdose.
The CDC states that clinicians should continue opioid treatment if the benefits outweigh the risks, but also try non-nopioid treatments.
Dr. Charles Algoff, president-elect of the American Academy of Pain Medicine and professor of neurology at Albany Medical College, said that if opioids are helping people, they should continue, and that some new chronic pain patients are He said that it should also be prescribed.
“If people are benefiting from opioid therapy and we can show them it’s done safely, why would we take someone off opioid therapy?” he asked. Ta.
Argov, co-author of a study published last year In the journal “Pain” Researchers who found that opioids are a “viable option” for some chronic pain patients said, “Clearly some, but not the majority, of chronic pain patients do not use chronic opioids for non-cancer pain.” “While they are benefiting from therapy, the data also confirm that many patients suffer from chronic pain.” People aren’t like that. The challenge is finding what is best for the patient. ”
Cases that require a cautious approach
Dr. Andrew Kolodny, president of the Association of Health Professionals for Responsible Opioid Prescribing, which supports more “prudent” prescribing of opioids, and medical director of the Opioid Policy Research Collaborative at Brandeis University in Massachusetts, said the new stated that opioids should not be prescribed to chronic pain patients. .
“We’re still prescribing a lot of opioids,” he says.
Despite the decline in prescribing, the U.S. still has highest rate of opioid prescriptions In the world.
But Dr. Kolodny said that “abandonment is a very serious issue,” and that some doctors may not understand how difficult it is to taper off opioids.
“No one wants these patients,” he said. “They’ve become like hot potatoes. They’re put on drugs that are very difficult to get off. Many of these people may never come off opioids.”
He sees them as “victims of a very aggressive overprescription” that began in the 1990s, when opioid manufacturers exaggerated the benefits of opioids and misled doctors about their risks.
Kolodny argued that patient abandonment was not due to concerns about the DEA, but rather fear of legal liability for harm caused by opioids.
Argoff said people who are taken off opioids can become desperate to regain the pain relief they got from drug therapy.
“People are turning to street drugs or committing suicide,” he says.
multiple the study Patients who discontinue opioid treatment have been shown to have an increased risk of suicide, suicidal ideation, and overdose.
Zacharoff said street drugs are especially dangerous today and can contain fentanyl, which can be deadly even in small amounts.
“Drugs obtained through illicit channels in 2023 may be contaminated with fentanyl and must be considered to pose a significant risk of unintentional overdose,” he said. .
‘Abandoned’ by pain management doctor
Kristin Kirel, 43, of Commack, who has suffered from severe spine-related pain for nearly 20 years, said she was “thrown aside” by her pain management doctor last year.
Kirell hasn’t found a new provider.
One reason, she said, is that she was also prescribed benzodiazepines, another controlled substance, by two separate doctors. One was to treat epileptic seizures and the other was to treat anxiety and depression. That’s why some doctors are wary, she says.
Kirel said he has tried many alternatives to opioids, including other drugs and multiple types of injections. But nothing provides as much pain relief as opioids, she says.
“There are so many people suffering and no one seems to care,” she said.
Long Island pain doctor was ‘horrified’
Dr. Edward Rubin, a pain management specialist with offices in Garden City and Lake Success, said he was contacted by the Drug Enforcement Administration several years ago when he was flagged as a high-level prescriber of opioids. After investigating, “they were like, ‘Look, we don’t think you’re doing anything wrong here,'” but they told him about the amount of opioid prescriptions he was writing. He said he had warned them.
“Obviously, I was pretty scared,” he said.
Rubin now scrutinizes patients more closely and typically only accepts opioid patients from doctors he knows and can see the patient’s records.
“We can’t accommodate everyone who needs drugs, in part because of the logistics of availability at my clinic, and in part because of the drugs we can take without worrying about the Drug Enforcement Administration. “Because there is a limited amount of it,” he said.
How does the DEA decide when to alert health care providers about potential excessive or illegal prescribing, and how many providers have been alerted or had their controlled substance registrations revoked for suspected opioids? The agency did not respond to questions about whether it maintains statistics on the number of health care providers who have access to medical care. related crimes.
Drag said his doctor stopped giving him hydrocodone in 2020 without explanation.
“Without the medicine, I would be in excruciating pain, suicidal and unable to do anything,” he said.
Drag said he finally found another doctor last year. The doctor first tried other options that didn’t work, but then had him prescribe half the previous dose of hydrocodone, which worked, but said, “I don’t know what pain relief I know is possible.” I couldn’t get it,” he said.
Mr. Drug spends most of the day sitting in a chair or bed, but is worried about demanding higher doses.
“I don’t want to make him sad because he tells me he won’t treat me anymore,” he said.
