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#1 User is offline   Liz 

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Posted 27 January 2019 - 03:04 AM

Beyond The Stigma: Chronic Pain Is The Other Side Of The Opioid Epidemic

New Hampshire Union Leader
Jan 26, 2019


Chris Sounia’s spine was crushed and his leg shattered when a drunken driver going the wrong way on I-495 in Massachusetts crashed head-on into the limousine he was driving.

Twenty-five years later, Sounia is among the estimated 19.6 million Americans who suffer from “high-impact” chronic pain, defined by the Centers for Disease Control and Prevention (CDC) as pain that interferes with daily life or work activities.

Many of these patients say they have become victims in the government’s battle against the opioid epidemic, as doctors have become fearful of prescribing these drugs and insurance carriers have refused to pay. They say they are being punished for the misdeeds of others.

And some say the fault lies with the CDC itself.

This is the other side of the opioid epidemic.

A letter of warning

Sounia spent a year at a rehab hospital in Salem after that 1994 crash. He went back to his chauffeur job for a time but a fall in 2000 shattered bones again. “I was eating Tylenol and Motrin like it was candy,” he recalled.

Sounia is convinced that all of that over-the-counter medication contributed to the massive heart attack he suffered in 2012; a surgeon performed a quadruple bypass, removing most of his breastbone and replacing it with a titanium chest plate.

That’s when his primary care doctor sent him to a pain clinic. After trying several other drugs that had terrible side effects, his doctor prescribed oxycodone, and Sounia has been taking it daily ever since.

In 2017, Sounia learned he had colon cancer; that meant more surgery to remove part of his intestine. He figures he’s had about 20 surgeries over the years, and each one came with its own pain.

Sounia is a big man; at 6-foot-7-inches, he weighs 370 pounds. He takes four 30-milligram oxycodones a day; he also has a prescription for up to five 15-milligram pills for days when he needs extra relief.

The letter came last August from the pain clinic where Sounia has been a patient for seven years. Due to a new federal policy taking effect Jan. 1, it warned him, he should expect to begin “weaning” off his prescription painkillers.

In 2016, in response to the opioid crisis, the CDC issued guidelines that recommended limits on prescribing opioids. And since then, public and private payers have been making coverage decisions based on the dosage limits recommended in those guidelines.

Citing the CDC guidelines, the Centers for Medicare and Medicaid Services issued a new policy for Medicare drug plans to follow starting Jan. 1. It requires “safety alerts” when patients present opioid prescriptions that add up to 90 “morphine milligram equivalents” (MME) or greater; the pharmacist is required to contact the prescribing physician “to confirm medical need,” according to the CMS website.

Sounia bristles at the new federal rule. “A pharmacist isn’t an MD,” Sounia said. “What right does he have to tell me what I need, and what goes in my body?”

Allows him to function

Sounia thinks chronic pain patients should be issued cards — like those that allow some patients to legally buy medical cannabis — to allow them to get their prescriptions without fighting with pharmacies or insurance companies.

The medication he takes doesn’t get him high, Sounia said; it just allows him to function, to spend quality time with his four kids and two grandchildren. And there are safeguards, he said; he had to sign an agreement with his pain clinic to comply with random urine testing and pill counts. “If you’re called upon to do a pill count, you bring your prescriptions up there, they count all your pills and they have to equal up to what you’re supposed to have,” he explained.

A spokesman for CMS, speaking on background and not for direct attribution, said in an email that addressing the opioid crisis is a “top priority” of the federal administration. He said “decisions to start, stop, or taper prescription opioids must be carefully considered and ... should be made between the patient and prescriber” and he said patients have the right to appeal a coverage decision.

The aim of the new policy, the CMS spokesman said, is “to strike a better balance between preserving patient access to medically necessary drugs and addressing opioid overuse without negatively impacting the doctor-patient relationship and the doctor’s ability to meet the needs of their patient.”


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#2 User is offline   Severian 

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Posted 27 January 2019 - 11:40 AM

No surprise here, it’s the same govt overreaction as with guns. Some people abuse something, so we will ban or make it difficult for everyone to get it. One kid threw their lollipop at someone so no one gets a lollipop. I know several people with severe chronic pain, most of them from severely damaged spines, and they are all having increasing problems getting enough pain killers to manage even a halfway normal life.

I have one dear friend in another city who I can always tell when a doc has cut his pain meds, or when the pain clinic he has been seeing dicks him over because he goes dark. Doesn’t return phone calls or even emails as he’s bedridden. There has to be a better way to deal with the opioid problem. Say, a border wall, and legalizing medical weed, states with legal pot have fewer opioid deaths and problems.

There’s no problem out there govt can’t make worse, as Reagan said the most frightening words in the English language are “I’m from the govt and I’m here to help.”

#3 User is offline   MontyPython 

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Posted 27 January 2019 - 01:09 PM

View PostSeverian, on 27 January 2019 - 11:40 AM, said:

There has to be a better way to deal with the opioid problem. Say, a border wall, and legalizing medical weed, states with legal pot have fewer opioid deaths and problems.

Yup. Living here in a state that has legalized marijuana I can testify: I know several people with chronic pain problems who used to rely on strong, addictive, dangerous drugs (mostly opioids), but now get relief by just smoking a little pot. Should've been legalized decades ago.


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