National Pain Strategy: The Opioid Crisis Truth

Page through a magazine, and you see the ads: gaunt, defeated faces of those destroyed by addiction. Rheumatology patients look much the same when pain is poorly controlled.

Given our family history in the trenches of autoimmune arthritis, I was asked to support, and blog about the National Pain Strategy (NPS) petition.  Well, I never take things at face value, so I decided a little investigative journalism was warranted.  I am in no way affiliated with the NPS, and opinions contained within are my own.

There are brilliant tools for pain management in the National Pain Strategy, and it is a thing of beauty to see acknowledgement of attitudes, biases, and patient stereotypes as barriers to treatment. On the surface, this seems a reasonable and broad-based approach to caring for patients in chronic pain.  In reality and practice, rheumatology patients are now bearing the undue burden of cautionary care.

Everywhere I turn, there is another news story hammering the Opioid Crisis.  At what point did chronic pain become criminal?  The NPS data focuses on drug abuse, yet most articles about the Opioid Crisis imply negative stereotypes for patients managing chronic pain. So often there is an assumption that patients with chronic pain do not pursue a holistic approach.  If I relied solely on my opioid for pain management, I would be miserable, depressed, and would suffer significant loss of motion. My use of meditation, yoga, walking, clean eating, and creativity is self-prescribed — with unlimited refills.
We’ve been lead to believe we have a champion in our fight for functionality. Instead, implementation of the National Pain Strategy is a bit of a sales job.  I recall Marge Simpson’s lesson in the fine art of sales:

 

“There’s the truth (shaking head), and THE TRUTH (big grin).”

Autoimmune arthritis patients are being lumped into this crisis purely by association with necessary treatment.  It feels as though we are under assault by legislation, medical personnel, the media, and society.  Truth is, we must hedge against ourselves in treating our unceasing chronic pain.  Each prescription bottle of opioids is a Hedge Fund:  balancing each day’s productivity against future physical activity vs current dosage and disease progression.

Despite the NPS acknowledgement that “74-96% of chronic pain patients use their prescriptions without suffering from opioid addiction,” rheumatology patients are suddenly hitting roadblocks in acquiring opioids to facilitate life.  Not existence, but life.
Earlier this year, my rheumatologist moved across the country.  I wrongly assumed his diagnosis and plan of management would carry over.  After reviewing my lab results, and a brief, clothed exam, my new rheumatologist declares my disease is under control.  Ah, thank the heavens!  I responded that my labs looked the same the day I was diagnosed with Seronegative Rheumatoid Arthritis.

She responded by reducing my opioid dosage by 60%.   And just for glee, my body decided to view all NSAIDs as allergens nine years ago.  The body was done with these, finis.  Try selling an NSAID allergy to a new physician.  I am most fortunate that my previous rheumatologist documented my reaction as a severe allergy.

The mission of the National Pain Strategy (full draft here) is a brilliant and reasonable collusion of physicians, researchers, and patient input. Yet somewhere between brilliance and reality, autoimmune arthritis patients are suffering.  We are forced to ration our pain relief.  In real terms, this means rationing our functionality as productive humans — both physical and mental activity is hampered.   People who have never experienced the pain of autoimmune arthritis cannot grasp the distraction of unrelenting systemic pain.

I’ve been puzzled at the sudden focus on this Opioid Crisis, and mused at all of the other public crises we could declare.  I looked into the sudden escalation of opioid prescription abuse, and it seems my hunch is shared:

Bob Twillman, executive director of the American Academy of Pain Management said the “new initiative is a fine idea,” but he’s more concerned with how the National Center for Health Statistics (NCHS) reported its data this year.
“It appears to me that illegally-manufactured fentanyl is being lumped in with legal prescription opioids, accounting for the apparently huge one-year increase in prescription opioid-related overdose deaths.”  He added: “I’m very concerned that this inappropriate lumping (assuming that is what is happening) could result in even greater pressure on opioid prescribing, further increasing the access problems we’ve been hearing so much about.” – Arlotta, CJ. White House: Opioid And Heroin Overdoses Are On The Rise (Contributor) Forbes.

I have to ask, what is the motive of declaring a crisis?  The bipartisan Comprehensive Addiction and Recovery Act (CARA) was signed into law 22 July 2016.  The act authorizes $181 million in new funding each year, which must be funded annually through appropriation.

In general, the mission of the National Pain Strategy is a brilliant and reasonable collusion of physicians, policy makers, researchers, and patient input.  Still, I have to ask:  who profits in the Opioid Crisis?  Clearly not the autoimmune arthritis patient.

We are on the front lines of a war in which our immune systems fired the first shot.

 

 

 

5 Comments

  1. Rick

    Jody, to me this is the issue of the decade for people with chronic pain conditions. We will be better if science can get this issue fixed, and until they do, let's decide to stop the patient blame game.

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  2. Jody

    Thank you, Rick. You are spot on with that. Productivity and contribution are so hampered by chronic pain. There has to be a reasonable solution to adequately treating pain – and validating what we live with.

    (and apologies, I was having problems with Blogger platform and my replies would not appear – thus the move to WordPress)

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  3. Quickbeam

    I have JRA, OA and a profound vitamin D deficit arthralgia. I am 62. I’ve been managing my symptoms on Tramadol and prescription Vitamin D for almost 20 years. I work full time.

    Now I am being treated like a criminal, they are trying to wean me off the only regime that has normalized my life. My joints are toast but at least I am productive on Tramadol. It sickens me that those with arthritis are being treated this way.

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  4. Groa

    Thank you for your insight, Jody. I, too, have been alarmed by the Center for Disease Control’s obsession with their alleged “opiate crisis” and the deceptive way in which they present their already dubious statistics to the American people. The CDC makes no distinction between heroin users who obtain their opiates illegally and patients who are legally prescribed opiates as a palliative measure by their doctors. In fact, the CDC goes out of its way to obfuscate the issue, referring to heroin deaths as “fentanyl” deaths, for example, or failing to mention that they’re only taking data from certain states and a handful of hospitals and extrapolating a national picture from there. Indeed, if you subtract the very different problem of illegal heroin use from the CDC’s opiate picture, the “crisis” numbers drop by more than sixty percent.

    Our nation is undergoing a heroin crisis, not a prescription drug crisis. Yet every federal response to the “opiate crisis” is aimed at doctors, pharmacies, pharmaceutical companies and their distributors, and the American pain patient. Many of these strategies are driven by the DEA, the very agency that should be curbing narco lords from filling our streets with fentanyl-laced heroin. The current heroin crisis is truly the DEA’s most profound failure in a long history of failures known as the War on Drugs. But no worries! The CDC continues to vilify the American pain patient as the equal to a heroin user, palliative care is now a criminal act, and the newly enabled DEA has a big, new state-of-emergency budget to prosecute their War on Pain Relief.

    Now for some even sadder news. Despite the CDC combining heroin deaths with prescription deaths for the sole purpose of achieving “crisis” level numbers, opiate overdose still hasn’t made the top ten causes of death in the US. Suicide, however, has made a dramatic leap to claim the number ten spot. More people now commit suicide than die of opiate-related causes. So what is the federal response to the Suicide Crisis? Perhaps a War on Suicide? A DEA crackdown on the makers and distributors of guns, razor blades, scissors, carbon-monoxide producing cars? Nah. The CDC, to its shame, gives the Suicide Epidemic a single paragraph on their website, tucked away under the category of Violence Prevention. It doesn’t even warrant a graph.

    Why is the CDC so profoundly uninterested in this disastrous suicide crisis that clearly falls under their purview? Because there’s no money in tackling the problem. There’s no big pharma companies for the Department of Justice to sue, no billion-dollar settlement prizes like we saw with the anti-tobacco legislation of the late 90’s. No politician gets bank-rolled/elected on an anti-suicide platform, and punitive measures like those driving the federal anti-opiate freight train just don’t work on people who are already dead.

    And now we come to an understanding of who profits from the Opiate Crisis, and why the CDC is so committed to portraying the epidemic as prescription drug problem when their own statistics demonstrate that heroin is driving the issue. Again, there’s no money in going after the narco-oligarchs who flood our streets with deadly, fentanyl-laced heroin. Instead, there’s billions of dollars to be made in federal lawsuits against pharmaceutical companies. Meanwhile our aging parents, our friends with chronic pain conditions, and our family members that have to postpone much-needed surgeries because the DEA’s attack on palliative care has gutted the IV narcotic supplies of our nation’s hospitals are deprived of the pain relief that the World Health Organization, for instance, and its 194 member states describe as a human right. Our loved ones or perhaps ourselves, we languish in pain because money and political power is more important to our government than the health of its citizens.

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