The Malevolent Attack on Women
This article, in a slightly edited form, first appeared on Pain News Network on June 26, 2022.
I’m a proud grandfather to two young granddaughters. They are my world. Watching the Supreme Court rescind women’s right to decide what to do with their own bodies made me feel angry that my granddaughters will be subjected to dehumanizing discrimination.
This tyranny against women extends beyond the Supreme Court’s decision over Roe vs. Wade.
I have read multiple accounts of women who are being denied access to opioids because they acknowledge a history of toxic adverse experiences as children or adolescents. Many such instances have occurred after women completed the Opioid Risk Tool (ORT) which asks if the person has a history of preadolescent sexual abuse.
The refusal to prescribe opioids to women with a history of preadolescent sexual abuse is a defensive measure by providers to avoid being accused of causing an Opioid Use Disorder (OUD).
Why I Developed the Opioid Risk Tool (ORT)
The Opioid Risk Tool (ORT) that I developed more than 20 years ago was designed to assess the risk of someone who was prescribed opioids for chronic pain treatment for showing aberrant drug-related behavior.
The ORT was a simple questionnaire that could be administered and scored in less than a minute. It was developed at a time when we had no way to assess the risk of developing opioid abuse in patients who were prescribed an opioid for non-cancer pain. We needed a tool to help evaluate whether the risk of potential harm from opioids outweighed the potential good for each individual.
I never intended for doctors to use the ORT to determine who should or shouldn’t be prescribed an opioid. My goal was to help doctors identify patients who might require more careful observation during treatment, not to deny the person access to opioids.
Since abuse and addiction are diagnosed by observing atypical behaviors, knowing which patients are at greatest risk for displaying those behaviors is useful in establishing appropriate levels of monitoring for abuse. This was intended to protect the patient from potential harm. It was never supposed to be used as an excuse to mistreat patients.
The original version of the ORT contained 10 questions, including whether a patient had a history of preadolescent sexual abuse. Women who answered “yes” scored 3 points; men who responded affirmatively scored 0 points. However, many people have mistakenly thought that 0 points attributed to males meant that a history of sexual abuse would not increase their risk of opioid use disorder. I could have attributed 3 points to males who answered affirmatively, but then I would have had to increase the weighting for females to 9, because the literature supported a much greater (about 3 times greater) risk for females vs. males with a history of sexual abuse. All of the other scores would have had to be adjusted as well. The higher you scored, the more closely your doctor would need to monitor your opioid use during your treatment.
The questionnaire was based on the best evidence at the time. Multiple studies have since confirmed the validity of the questions used in the questionnaire. However, many people have criticized the question on the ORT that asked about a history of preadolescent sexual abuse because of a perceived gender inequity. In addition, some doctors have generalized the ORT’s question about preadolescent trauma so that it applies to a history of female sexual abuse at all ages.
I have written that the ORT has been weaponized by doctors who are looking for a reason to deny patients — particularly, women — adequate pain medication.
There are doctors who use their power to determine whether to treat a woman’s chronic pain with an opioid or allow her to suffer needlessly based on the ORT’s answers. This is no less malevolent than a forced taper resulting in suicides or the use of the CDC opioid prescribing guideline to criminally charge providers for not following the CDC’s recommendation. In all of these situations, an injustice is being committed against innocent people.
It is also not much different from the Supreme Court’s decision to ignore a woman’s right to access full reproductive rights. Both are attacks on women.
Fortunately, Martin D. Cheatle, Ph.D. and his team published Development of the Revised Opioid Risk Tool to Predict Opioid Use Disorder in Patients with Chronic Non-Malignant Pain in the July 2019 edition of Journal of Pain. In his research, Dr. Cheatle found that a revised version of the ORT (ORT-OUD) using 9 questions instead of 10 questions was as accurate as, if not better than, the original ORT in weighing the risk of patients for OUD. The revised ORT eliminates the use of a woman’s sexual abuse history as a factor.
At a time when females have had their human rights taken away by a Supreme Court vote, it is especially appropriate to reconsider how we assess risks for potential opioid abuse for women.
It distresses me to know that, while the original ORT served to help assess the risk opioids posed for individuals, it has also caused harm. Since the question about a woman’s sexual abuse history does not provide any additional benefit, there is no reason to retain it. The ORT-OUD should be used instead of the original ORT.
Lynn R. Webster, MD, is a Senior Fellow, Center for U.S. Policy (CUSP) and Chief Medical Officer of PainScript. He consults with the pharmaceutical industry. He is the author of “The Painful Truth” and co-producer of the documentary “The Painful Truth” which aired nationally on public broadcasting stations.
You can find him on Twitter: @LynnRWebsterMD.
Dr. Webster worded it very succinctly by stating; “the ORT has been weaponized by doctors who are looking for a reason to deny patients — particularly, women — adequate pain medication.”
It seems these days that any and everything imaginable is being used by doctors (because it is) as a reason to deny patients (of every gender, ethnicity, social standing, etc) adequate pain relief.
We are treated as if we are in some way deserving of such a tortured existence. Regardless of whoever we happen to be. and/or whatever we may have otherwise accomplished in our previous lives.
As we collectively (chronic/intractable pain patients) are forced to merely lay around while being physically unable to perform even the least-taxing of day-to-day life functions (as our lives pathetically pass us by), we can all be collectively looking forward to the day our self-absorbed, satanic torturers finally get a taste of the relentless, uncontrollable agony they’ve knowingly bestowed upon each and every one of us.
If the thought of that glorious day doesn’t provide you with sufficient motivation to keep fighting the good fight, I can’t imagine what will. Because I’m certain that day can’t come soon enough for the vast majority of us.
Keep up the good fight! We will eventually overcome.
I think some doctors have also used it against domestic violence survivors. Years ago, I remember a few doctors being VERY interested when I said my back pain began after my abusive first husband threw me backward over a low TV stand. Even though I had horrible black and blue marks on my back, and although they were not psychologists or psychiatrists, they repeatedly wanted to discuss the domestic violence. I caught on pretty quickly that they thought my pain was “all in my head.” Eventually, they found a ruptured L5/S1 disc along with a narrowed nerve root. But I suffered for almost a year before I finally found a doctor who sent me for an MRI and discogram that easily discovered the problems.
Gina I too have had spinal injuries and have had to try and control my pain. I truly feel for you because I know what that is like. I have nerve impingement along with spinal stenosis from cervical to lumbar also with severe degenerative osteoarthritis since my forties. I couldn’t get help till 2012 and it was a battle against health providers and pain management so call experts. I am currently still in the fight but growing weaker and I know what you’re going through. I read Dr. Lynn Webster’s views on opiate use for chronic pain and feel like we still have a chance to find help and stop demonizing these pain relievers. I don’t misuse medication and or agree what’s going on in the streets but yet we have to all be put in the same box and pay heavily. It’s got to stop constant pain tears us apart. I pray always and it helps. Where there is relief for people there should be no blockades. But sadly, there is.
Malevolent attacks on reason and logic are nothing new. In 1974 the US Supreme Court faced a Texas statute invading the doctor-patient relationship to an extreme degree. Under that law, a county sheriff with no medical training could decide that a mass in someone’s uterus was a “potential child” instead of a potential tumor. Life-saving cancer surgery could be obstructed under the Texas statute, to give the tumor time to grow and prove whether it was a tumor or an infant.
Back in 1974 radiology was primitive. We lacked the precise imaging possible by CT and MRI. We lacked multiple immunoassays that could identify uterine cancer. Giving a state official the power to interfere with medical practice was going to kill patients, said Justice Harry Blackmun to his brethren, and the Supreme Court granted certiorari, opening Roe v Wade for hearing. Justice Blackmun’s previous experience in medicine was a summer job during college, as clerk in a physician’s practice. The extreme care he was required to take with patient confidentiality, as a clerk, gave him part of an answer to the Texas question: In any other circumstance, what must a State prove, to get a judicial search warrant and forcibly open a medical practice’s private records? That standard had always been proof beyond a reasonable doubt. Some witness must swear, under penalty of perjury, that a crime had taken place and that the forcible search would solve the crime. Introducing a “potential person” to the mix put a dangerous new power in the hands of the Sheriff, because one did not, under that Texas statute, risk a perjury conviction by falsely testifying about a “potential child” when blocking cancer surgery on a woman. “Potentially pregnant” implies potentially not pregnant. And a cancer case could be made much worse by the delays, with no one held answerable in court, for the harm.
In a blistering dissent from the 7-2 majority in Roe v Wade, Justice Byron White took issue with the solution Blackmun proposed: At 3 months post-conception, the baby was to be considered only one-third human! Because this provision existed nowhere in any of the words of the US Constitition, Justice White saw it as seven judges writing new legislation, contrary to their Constitutional prohibition on writing laws. Justice White would have preferred that the court say what was unconstitutional about a Texas law that protected cancer as equally as it protected children by circumventing the reasonable doubt standard set forth in the Fourth Amendment, then stop there. The Texas Legislature would have been free to write a new law that did not include the error in the 1974 law, caused by their word “potential”. If they could prove they were protecting a real human life they were within their powers. If they could not, they were not.
The Court’s failure to learn from Justice White helped to create the clear and present danger of weaponizing medical tools and guidelines into reasons why “potential addicts” must be protected from themselves by forcing all patients to suffer uncontrolled pain. This has happened in 35 states so far, (Arizona being first to roll it back), with the “CDC Opioid Prescribing Guidelines”. Because the Roe v Wade ruling ignored the fundamental problem of granting powers with no responsibility for how those powers are used and abused, and instead took powers the Court did not have, to make an historic gaffe about some humans not being fully human, the door remained open for opiophobic zealots to attack the rights of all patients to pain care, and to ignore any science inconvenient to them while distorting and weaponizing any science they found convenient.
The real danger posed by that 1974 Texas law got thrown under the Nixon Population Policy bus, and patients keep getting dragged in behind it. Potential addiction, like potential pregnancy, is not a sound reason under the Fourth Amendment, to invade anyone’s Second Amendment right to self defense against disease, which of course is the purpose that humans study and practice medicine.
Sadly, it took Texas 45 years to see part of their egregious error. The new Heartbeat Abortion Law protects proven real babies who display a heartbeat, but allows cancer surgery to proceed immediately on any potential tumors that turn up in a woman’s uterus and display no evidence of a heartbeat. Nobody in Texas has the power to delay cancer surgery to give the tumor a chance to grow a heart.
Texas continues to do bizarre things to pain patients, in the name of “potential addiction”. This includes a recent Austin mayor’s campaign to ban mitragynine and the Kratom plant because she says it “might have something to do with opioid overdoses”. But she credits herself as one of the Enlightened People because she favors all abortions done at any age for any reason. And misses the point of the 1974 case completely.
Very few women whom I meet, are psychopathic enough to want to carry a baby for 8 months and then kill the child for thrills. In fact, I never met such an individual in person.
I do know a great many women who have a personal or family experience with medical malpractice. None of those women views an abortion as desirable. All of them express great concern that a doctor might push them into keeping a dangerous pregnancy and losing their lives because of it. Women with a well-founded fear of medical malpractice want more than lip service paid to the necessity of abortions that preserve the life and health of the mother. Now that state legislators are playing catch-up on these vital issues after a 46-year snooze, it’s a set of subjects that must be addressed.