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Chronic pain patient says that she is ‘treated like a criminal’

August 20, 2018

FREDERICKSBURG, Va. — When the former nonprofit director — a woman with a master’s degree in social work — moved from North Carolina to Spotsylvania County last fall, she brought detailed medical records about her chronic pain and the opioids she takes to treat them.

As she searched for a pain management doctor in the Fredericksburg area, she called at least eight different offices. Before she could even describe her situation, the receptionist would cut her off, saying: “We don’t prescribe opiates.”

The woman, whose first name is Becky, was shocked, then scared. She eventually found a doctor to treat her, and she signed a contract spelling out her expected behavior. It specified monthly urine tests, even though her insurance requires only four a year, and regular pill counts to be sure she didn’t exceed daily dosage. She could use only one pharmacy, even if that facility was temporarily out of stock, and she agreed to pay fines — or be dismissed as a patient — if she violated any terms.

“I think we (chronic) pain patients get it; we understand why this is happening and all of us are willing to do whatever we need to do to show that we’re working with the program,” she said. “But at the same time, we’re being treated like criminals before we even have done the first thing.”

Doctors are looking at opioid prescriptions through a microscopic lens because since 2013, more people in Virginia have died from drug overdoses than vehicle accidents or guns, according to the Virginia Department of Health.

Drugs caused 10,379 fatalities in the commonwealth between 2007 and 2017 — and more than 72,000 deaths in the United States in 2017 alone, according to estimates from the Centers for Disease Control and Prevention.

As a result, the health care industry has reduced the number of opioid prescriptions, hoping to curtail “drug seekers” who may start with pain pills, which become a gateway drug to more illicit substances.

But the cutback also is affecting those with legitimate pain problems.

“People who use drugs responsibly, just like a diabetic uses insulin, face greater scrutiny simply because they are managing their pain to lead as functional lives as possible,” said Sally Balsamo, co-founder of the Alliance for the Treatment of Intractable Pain. “This is yet another byproduct of the other side of the opioid epidemic.”

Becky, the Spotsylvania patient who moved from North Carolina, didn’t want to use her last name for fear someone would look up her address and rob her medicine cabinet.

The 44-year-old doesn’t get out much because of chronic bladder problems and severe nerve pain in the pelvic region. For the last two decades, she’s tried other measures, from lesser drugs to repeated nerve blocks to reduce the pain.

She was coping — and working full-time — despite pain caused by the pudendal nerve, which is in the tailbone and affects bladder and anal continence and sexual function. A 2014 procedure meant to block the pain hit the nerve instead and “kind of took me back a decade in terms of progress,” she said.

“At that point, an opioid was pretty much necessary,” said Becky, who had to quit her job. “I was miserably in pain.”

A recent report from the Virginia Department of Health says prescription opioids have been the leading category of drugs causing or contributing to deaths since 2007. The report also points out that those who die from drug overdoses tend to mix prescribed painkillers with illicit drugs such as cocaine, heroin or fentanyl, a synthetic drug up to 100 times more potent than morphine.

Deaths from all drugs more than doubled in Virginia from 721 in 2007 to 1,538 in 2017, according to the VDH.

But deaths from prescription opioids alone remained constant in the same period, according to the report. In 2007, 401 people died from overdoses of prescription drugs. The number of deaths stayed in the 400-range for the next seven years — even dropping to 398 in 2015 — before hitting 507 in 2017.

That leads patient advocates such as Balsamo to conclude that the opioid epidemic doesn’t extend to those who take only the medicine prescribed to them.

Less than 1 percent of patients with chronic pain problems actually abuse opioids, but they’re all being treated like “drug addicts or junkies,” she added. Distinguishing those who are in legitimate pain can be tricky.

“People who use drugs responsibly, just like a diabetic uses insulin, face greater scrutiny simply because they are managing their pain to lead as functional lives as possible. This is yet another byproduct of the other side of the opioid epidemic.”

Sally Balsamo co-founder of the Alliance for the Treatment of Intractable Pain

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