Pot addicts OK, legitimate chronic pain sufferers in need of opioids not
By Rachel Alexander
There is a strange dichotomy taking place in society today. On the one hand, laws against marijuana are being eliminated. People who abuse pot are now able to feed their addiction with an overly generous supply of the drug. For example, in Arizona, where medical marijuana is legal, users can purchase up to 2.5 ounces every two weeks. This is enough to be stoned every day. Once you have a prescription, you can refill it for an entire year without going back to renew the prescription. It’s easy to get a prescription in most states that have legalized medical marijuana, just inform a doctor you have pain. And if you live in a state like California that has legalized recreational marijuana, there aren’t even any limits on how much you can buy (just how much you can have on hand).
In contrast, opioids, which are commonly prescribed for chronic pain and have been legal for years (with the exception of heroin and some fentanyl) are becoming increasingly restricted. Legitimate chronic pain sufferers who depend on them to reduce their pain are finding themselves going days without any medication or undermedicated as a result of the new crackdown. It began since people were overdosing on opioids.
By October of this year, 33 states had passed laws limiting opioid prescriptions. They limit the supply a doctor may prescribe to seven days or less. This exponentially increases problems with timely refilling prescriptions. One chronic pain sufferer complained, “The insurance companies are lying to their own subscribers in the Prior Auth Dept, ignoring, transferring to dead lines, long appeals that go nowhere, on & on….” It also means more co-pays. Some states are now requiring doctors and pharmacists to take a course on opioids.
Many states have limited the maximum dose as well. Federal opioid prescribing guidelines recommend doctors use caution in prescribing above 50 MME/day. But many patients need 90 MME/day or higher. In Arizona, patients are limited to 90 MME/day. There are exceptions for some types of illnesses — but not chronic pain. For those sufferers, they can only receive a higher dose if their doctor consults with a board-certified pain specialist.
One woman in Arizona who suffers from chronic pain said her opioid dose was lowered from 100 MME/day to 90 MME/day as a result of the new laws. She said her pain has been "terrible" ever since. "It just hurts," she said. "I don't want to walk, I pretty much don't want to do anything."
Two medical associations in Arizona warned before the law was passed, “We strongly oppose putting any kind of dose-strength limitation in state law. ... Every patient is unique and there is no universally accepted threshold for what is acceptable for every situation. Some complex pain patients can be properly cared for and managed by appropriate providers with higher dosages that allow them to manage pain and be active members of society and our economy.”
Another new law requires pharmacists to check and make sure patients aren’t doctor hopping — doubling up on prescriptions. Any accidental overlap between prescriptions hurts the patient, who is humiliated at the pharmacy when caught. Senior citizens are treated by pharmaceutical staff like common criminals.
Doctors risk sanctions if they don’t comply with the new laws. As a result, fewer doctors are prescribing opioids. This is making it more difficult for patients to find doctors. After the laws were passed, doctors reported “feeling pressure to lower patient doses, even for patients who have been on stable regimens of opioids for years without trouble.”
Dr. Julian Grove, president of the Arizona Pain Society, says "A lot of practitioners are reducing opioid medications, not from a clinical perspective, but more from a legal and regulatory perspective for fear of investigation. No practitioner wants to be the highest prescriber." Even doctors that specialize in pain management are feeling pressure to reduce dosages.
Psychiatrist Sally Satel, a fellow at the American Enterprise Institute, says the problem traces back to guidelines put in place by the Centers for Disease Control and Prevention in 2016. The guidelines were not meant to apply to pain specialists, nor were they to be applied as a blanket policy to every patient. "There is no mandate to reduce doses on people who have been doing well," Satel said.
Ironically, chronic pain sufferers are told to switch to medical marijuana to ease their pain — but it doesn’t work for everyone’s pain. A recent Australian study found that marijuana does little for pain.
The reality, according to the National Pain Report, is “America’s so-called ‘opioid epidemic’ is caused by street drugs (some of them diverted prescription drugs) rather than by prescriptions made by doctors to chronic pain patients.” More people die from illegal opioids than prescription opioids. Opioid prescriptions were already decreasing before the crackdown started. In Arizona, prescriptions decreased every year since 2013, a 10 percent decrease total.
And just because a few doctors overprescribed opioids does not mean everyone should be treated like a dangerous addict at risk of overdosing. One size does not fit all. Someone who has been taking a higher dosage of prescription opioids for years without incident should be allowed to continue.
Over 11 percent of the population suffers from chronic pain. It is cruel and bad medical science to prevent this segment from the population from getting the only relief that works for many of them. The laws need to be changed to allow those legitimately suffering to access adequate amounts of prescription opioids, without risk to their doctor or pharmacist. It makes no sense as we’re relaxing the laws prohibiting marijuana.