By Cindy Perlin, LCSW.
Pain patients are suffering more than ever. After decades of pushing opioids as “the” answer to chronic pain, patient access to prescription opioids is being curtailed, often abruptly and with apparently no concern for the welfare of the patients. These cutbacks are justified as a response to an out of control opioid abuse and overdose epidemic.
Denial is rampant. Dr. Jane Ballantyne, president of Physicians for Responsible Opioid Prescribing (PROP) says patients should just learn to accept their pain and not continue to demand treatment with opioids or otherwise. Her stance is a denial of the toll severe chronic pain takes on the patient’s body, mind and spirit. Most medical professionals and all insurance companies deny the proof of effectiveness of other, non-pharmacological treatments for pain and deny the often-terrible side effects of other pharmacological approaches to pain. And chronic pain patients deny the escalating piles of bodies at morgues, dead from opioid abuse and overdoses that often started with a painkiller prescription.
There is a sane way out of this. Does anyone want to hear it?
Step #1: Get the DEA out of doctors’ offices.
The #1 reason that pain patients are being rapidly tapered off their opioid medications, abruptly discontinued or can’t find a doctor to treat them has nothing to do with their medical condition, success of treatment or drug use behavior. The main reason is that doctors are terrified of being prosecuted for writing opioid prescriptions. Prosecution can and often does result in loss of licensure, loss of assets and long prison terms.
Successful prosecutions have occurred even in cases where the physician’s only actions were prescribing opioids for legitimate pain patients. The Drug Enforcement Agency (DEA) deploys dozens of agents with guns drawn for these raids. They seize patient records and threaten arrests of all the practice employees. According to the website Doctors of Courage, run by a physician, Dr. Linda Cheek, who suffered this fate, more than 975 physicians have been victims. Doctors are particularly vulnerable if they are in independent practice without large institutions to back them up, and if they are members of a minority group. Doctors are prosecuted as drug dealers, their assets seized so that they have to rely on public defenders who don’t have the time or funds to mount an adequate defense.
These DEA arrests have been occurring for more than a decade but physician vulnerability has increased since the release of the “voluntary” CDC guidelines on opioid prescribing in March, 2016. Government guidelines are considered “standards of care” and when physicians don’t adhere to them they are at increased risk of having their medical judgements challenged, not only by the DEA, but also in malpractice suits and licensure challenges.
So, the #1 step in ending unwarranted termination of pain prescriptions is to bar the DEA from arresting doctors unless there is clear evidence of actual drug dealing, such as in pill mills. There would still be avenues for addressing poor medical decisions, if they exist. These include complaints to licensing boards, where other doctors would review whether decision were medically appropriate, and malpractice lawsuits, where expert testimony can be weighed in determining whether prescription practices are appropriate.
Step #2: Expand Access to Alternative Pain Treatments
While there may be many pain patients who can only obtain adequate pain relief with opioids, there are also millions of patients whose pain could be more safely and effectively managed with non-pharmacological treatments. Scientific knowledge and understanding of these alternative treatments has been growing for decades but is being blatantly ignored by the conventional medical community and health insurance companies.
Acupuncture, biofeedback, chiropractic, cognitive behavioral therapy, electrical stimulation therapies, energy healing, energy psychology, exercise, herbal therapies (including medical marijuana), homeopathy, low level laser therapy, meditation, nutritional therapies, physical therapy, stem cell therapy and many others are underfunded or completely ignored by insurance companies.
So, step #2 is to require insurance companies to adequately cover alternative pain therapies so all patients can have access to all of the treatments that have the potential to help them.
Step #3: Educate physicians and pain patients about all available pain treatment options
Currently, physicians receive, on average, less than two hours of education on pain diagnosis or treatment of any kind in medical school. This leaves them reliant for the most part on pharmaceutical representatives for their “education”. Little continuing education is available to physicians that is not sponsored by the drug companies. We need medical schools to present a required course in pain management that is comprehensive and unbiased in its presentation of pain treatment options and similar post-graduate educational opportunities.
We also need educational opportunities for pain patients in the form of courses and written material.
That’s it. Three steps to reducing suffering and the chance of addiction. It’s not rocket science.
Cindy Perlin is a Licensed Clinical Social Worker, certified biofeedback practitioner, chronic pain survivor, the author of The Truth About Chronic Pain Treatments: The Best and Worst Strategies for Becoming Pain Free and the creator of the Alternative Pain Treatment Directory.