This is an article by Judy Haluka. It was first printed  on ACLS Online  November 14, 2019. 

I offer it with the author’s permission for informational purposes. The author and I have no financial involvement.

THE VIEWS EXPRESSED BY THE AUTHOR ARE HIS OWN AND DO NOT REPRESENT MY VIEW OR MEDICAL ADVICE.

She became what the medical world refers to as a “person in pain.” This is a patient who has significant pain on a daily basis but has no real options from the medical or surgical world to correct it. The thought at the time by pain specialists was that chronic pain would probably be on some type of narcotic for the rest of their lives. This was not thought to be negative as “physically dependent” does not hold the same risks as the addiction that kills so many these days. If the patient has the genes and/or lifestyle conducive to addiction, that is where you get into trouble with abusing medications, increasing doses quickly, drug-seeking behavior, overdose, etc. But in Diane’s case, she was monitored closely by the pain clinic who would ensure that she was taking her medication only as directed and had no increases in dosage beyond what would be expected with normal tolerance issues. Things were going well. Enter the opioid crisis. It is now 12 years later. She remains in follow up with the same pain clinic, although the original physician is long gone. She faithfully submits to drug tests, medication reconciliation, and she has never missed a pain clinic appointment. Although in some pain, each day is manageable while taking medication. There is no doubt she is physically addicted to opioids evidenced by the fact that she gets signs of withdrawal (stomach pain, diarrhea, irritability) if she misses a dose by as much as a couple of hours. But until now, no one has been concerned because the belief is that she will continue to take the medication forever. Until now. She showed up for her pain clinic appointment and was informed that she is going to be weaned off narcotics over the next month because of the new restrictions on prescribing narcotics. She has suddenly plummeted into a world of withdrawal symptoms, and even after the symptoms are gone she will be back to where she started. Debilitating pain that makes it impossible to go to work, or even to enjoy a walk with no answer from the medical community. Remember the beginning of this mess? The accident was through no fault of her own. The surgical infection that resulted in chronic pain was of no fault of her own. She has done everything she was asked to do and played by all of the rules, yet here she is without an answer. She is a true victim of the opioid crisis.

Medicine is supposed to be an intelligent profession. But sometimes I wonder. We tend to do things in extreme ways. We have gone from prescribing opioids to anyone who wants them to send people home after major surgery with a bare minimum of medication and then telling them to take Tylenol® and suck it up. Those who have ended up addicted, whether through their own fault, the fault of the medical profession, or the fault of their genes, have stolen the attention of medicine. The available resources including funding, time, energy, and training are being utilized to solve this issue. The people paying the price are sadly those patients who would benefit from the judicial use of opioids for relief of their pain. We have implemented so many rules and regulations governing the prescription of opioids of any type or dose that many providers would rather just skip it than to navigate the system in order to provide the correct care. The system has made it difficult to prescribe narcotics in a way that encourages abuse, but it has also made it so cumbersome to prescribe narcotics to those who really need them and now many providers simply no longer do it.

If history repeats itself, it will take several years before the pendulum swings back to the center and we can predictably prescribe where needed and with hold where appropriate. The problem is that many patients will suffer, in pain, while taking Tylenol® in the meantime.