But shortly after Stewart stopped playing, he began to have pain, mainly in his back, but also in his knees and other joints. He eventually underwent a two-part back surgery, as well as seven other surgeries in different areas to repair both bone and ligament damage.

“Most of the surgeries weren’t real heavy-duty stuff,” he said. “When I got to the back, it was a difficult surgery.”

Stewart, now 64, was sent home with two types of opioid painkillers in 2008 after the surgery to help deal with the pain. He had been warned about their addictive nature and took only one of them — 30 milligrams of oxycodone, as prescribed — to be able to move around without suffering.

“It was a two-part surgery, and I have chronic pain. It’s nerve on nerve. And I also need neck surgery. So I’m on medication just to try to have a decent day,” he said. “I’m not taking them to party. I don’t feel any ‘highness.’ All I feel is relief that I can go about a little bit of the day for a little while until it wears off.”

Stewart is one of at least 100 million Americans who suffer from chronic pain, according to a 2011 report from the Institute of Medicine. His original prescription said he could take one 30 mg pill four to six times a day, depending on his pain levels.

“I think I have a very good doctor, who did the best he could on my back, and I had to come in every time to get a prescription. There was no funny business,” he said. “I had to come in to see him personally to get a prescription. I never missed an appointment.”

However, just a few months ago in late April, Stewart said things changed. Instead of going to his doctor, he now goes to a pain management center to get his prescription filled, and his dosage amount was also reduced.

“(The pain management center) gave me a prescription for the 30 (mgs), and then when I came back the second time, I was informed, not asked, not, ‘How do you feel about this? What do you think about this?’ — I was told that now you’d be cut down to 15 mg, and that’s all I was told,” he said. “I was given a piece of paper that had this new guideline from the CDC.”

New guidelines

According to a statement from the U.S. Centers for Disease Control and Prevention, “Chronic pain is common, multidimensional and individualized, and treatment can be challenging for health care providers as well as patients.” In response to the critical need for consistent and current opioid prescribing guidelines, the CDC released the “Guideline for Prescribing Opioids for Chronic Pain.”

The purpose of the guidelines is to curb the overprescribing of opioid medication that led to the opioid epidemic, according to a statement from the CDC.

“Improving the way opioids are prescribed through clinical practice guidelines can ensure patients have access to safer, more effective chronic pain treatment, while reducing the risk of opioid use disorder, overdose and death,” the statement said. “Nearly 2 million Americans, aged 12 or older, either abused or were dependent on prescription opioids in 2014.”

In Burlington County, over 90 people have died from an overdose from January to July this year. Nationwide, more than 64,000 people died of an overdose in 2016, according to data from the CDC.

The guidelines focus on three main points: Determining when to initiate or continue opioids for chronic pain; monitoring the opioid selection, dosage, duration, follow-up and potential discontinuation; and assessing the risk and addressing the harms of opioid use.

Dr. Benjamin Duckles, a pain and spine specialist with Virtua who treats many chronic pain patients, said that since the new guidelines came out, he requires that all previous prescription histories and medical records are handed over to him so he can determine the best course of treatment for his patients.

“It depends on what treatment they’ve had prior to seeing me,” Duckles said. “The first and most important notion is to establish a diagnosis so we can discuss the history of their pain experience. I’m a big proponent of involving the patients in the process of understanding their pain or diagnosis.”

One of the new additions to the guidelines is that dosage recommendations for “exercising caution are lower than previous opioid prescribing guidelines.”

That was one of the issues Stewart had with the new restrictions.

“So the 30 (mgs), I could take no later than 8:30-9 in the morning, and that could last me, if i was lucky, until 2 (p.m.),” he said. “Then I would take another one about 3-4 (p.m.), and I was good. Now I take a 15 (mg), I don’t feel anything. I’m still bent over in the morning. They’re just not as effective as the 30 (mgs).”

Stewart said the reduction in dosage has dramatically affected his ability to get around like he used to.

“I’m just a little upset. I just want (my relief) back. I don’t do a whole lot. I’m not very active anymore; I can’t be,” he said.

Unintended consequences

In June, the American Academy of Pain Medicine released a “Future of Pain Care” resolution, noting that while the steps taken to address the opioid epidemic were helpful in many ways, they also adversely affected some patients who had used opioids safely and effectively.

“While the Centers for Disease Control drafted the Guideline for Prescribing Opioids for Chronic Pain to address the dramatic rise in opioid-related deaths, the document has, in some cases, had the unintended consequence of encouraging under-treatment, marginalization and stigmatization of the patients with chronic pain,” the resolution said.

Cassandra Badie, a Camden County resident, said she has felt this stigmatization as someone who suffers from neuropathy, stemming from her diabetes, which causes nerve damage in her feet and legs.

“You just don’t know what the feeling is to be treated like a drug dealer,” Badie said.

Some health officials caution that with all the focus on the opioid epidemic, other areas of the health care system are being ignored.

“All of the oxygen in the room is being used to address opioid addiction but not one of the primary causes, which is inadequate pain treatment,” Dr. Robert E. Wailes, a delegate with the American Academy of Pain Medicine, said in a statement attached to the resolution.

Duckles said he recognizes that opioids can be part of an effective treatment strategy for patients.

“One of the more important things we need to discuss is not forgetting that there are a lot of patients who have used opioids on a chronic basis for a long time and have done well,” he said. “Their pain has improved, and they’re able to do the things that they enjoy, whether that’s work or pleasure.”

Still, he cautioned against solely using opioid pills to treat pain. While each patient’s treatment is individualized, Duckles said he also employs other techniques, such as the use of anti-inflammatory prescriptions and physical therapy.

“My training taught me that the use of opioid therapy should never be done in isolation,” he said. “Opioid therapy alone doesn’t give them the best outcome.”

Patients like Stewart, however, said they at least would like to be included in the discussions that could have drastic effects on their lives.

“I’m not trying to cause a stink for anyone. I just want my medication not to be messed with and just to be talked to about it,” he said. “I’m not here to play any games. All I want to do is just have decent days.”