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Wednesday, August 27, 2014
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Published: Sunday, 4/13/2014

GUEST COLUMN

Regulations replacing clinical judgment in treating pain

The witch-hunt is on, making it hard for patients like me to be treated as an individual, not a risk

BY ELIZABETH BOWMAN

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Thanks to Gov. John Kasich, state and local task forces, and news media, Ohioans are now aware of the state’s opioid and heroin epidemic. Sadly, however, patients with chronic pain have had no voice in this debate.

They are your neighbors, your children, your parents. They are me.

And like me, 97 out of 100 pain patients who use opioids for chronic pain never become addicted.

I have had chronic pain since 1978. My surgeries were successful until degenerative changes forced further intervention. Between surgeries, my family physician managed my pain with Tylenol 3 or Percocet.

I was taught to use the lowest effective dosage of medication for the shortest time. The dosage was never raised. A 30-day supply of medication frequently lasted three months.

This advice served me well. I was able to raise my son, care for my parents and father-in-law, and care for my mother-in-law for 10 years until her death at age 94. My husband and I served as chairmen of the Xavier University Parents’ Council. I have volunteered for local charities.

That was then. This is now.

The family practice group that treated me for more than 15 years no longer prescribes opioids for chronic pain. Nor does my physical medicine specialist.

My spinal surgeon, like most other surgeons, does not prescribe narcotics after three months of post-operative care. He refers patients to their family doctors, many of whom no longer prescribe opioids.

I have three physicians. None now uses opioid medications in treatment plans. When I ask why, the answers astound me:

“The Medical Board and Pharmacy Board are counting the number of pills I prescribe each month, and I won’t risk it.”

“You may be an undercover DEA agent.”

“Just because you look like a nice lady, that doesn’t mean you’re not a user.”

The choice not to prescribe was based on new regulations on opioid prescribing, not on my condition or medication history. Across Ohio, prescribing guidelines are replacing clinical judgment. How can a patient have confidence in medical recommendations, when the government is actively and menacingly entwined in the doctor/​patient relationship?

In a column last February in The Blade, Deputy Editorial Page Editor Jeff Gerritt emphasized the need to avoid a “witch hunt” of doctors who treat pain patients. The witch-hunt is on, making it hard for patients like me to be treated as an individual instead of a risk.

Chronic pain is real. It is relentless. It steals sleep and can make daily tasks impossible. Untreated pain can take you to very dark places.

Once, facing new and painful spinal degeneration, I was treated with water therapy. I was in a therapy pool, weights on my ankles and a device to keep my head above water. All I knew was warmth and an easing of pain.

For the smallest sliver of time, I had the impulse to let go and end the pain. Frightened, I called my family doctor, who adjusted my medication to relieve my increased pain.

Addiction can kill. So can untreated chronic pain.

The regulation of pain management specialists has become Draconian. During my last visit to a pain clinic, I was told that I may need monthly urine drug screens to prove I am not diverting medications. In my years as a patient with pain, I have never given any sign that I may be doing that.

A lab test I had to take cost $380. In a year, my insurance company would have been billed more than $4,500 to prove something that was, based on my history, never an issue. How many nights of inpatient drug rehabilitation could $4,500 provide?

Heroin abuse and its roots in opioid medication demand open-minded and thoughtful attention. The acknowledgement that careful use of opioids can improve lives is a fact that all deliberative bodies should respect.

Prosecutors, addiction specialists, pharmacists, medical boards, addicts, and the loved ones of victims have helped develop new policies, practices, and legislation. But all stakeholders must have a voice in solving this problem, especially pain patients who use these medications to live full and useful lives.

Elizabeth Bowman, of Maumee, is a former medical librarian.



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