Daphne Bramham: Patients with chronic pain are collateral damage in opioid epidemic
On Boxing Day, Geoff Moses will run out of the oxycodone pills that have controlled his chronic pain over the past three years, allowing him to work and have a life.
Once that last pill is gone, his pain will intensify and the 41-year-old employment counsellor will begin an ugly, slow withdrawal.
Like thousands of others, Moses is collateral damage in a North American-wide opioid epidemic that has sparked the fentanyl crisis.
Opioid prescriptions in North America is more than six times higher per capita than prescription rates in Europe. In Canada, opioid prescriptions rose to 25.7 million in 2014 from 17.5 million in 2010, while in the United States, it spiked 500 per cent between 2000 and 2011.
For the past three years, Moses has been strictly following his doctor’s orders that have included agreeing to drug testing to ensure that Moses is taking, not selling, his oxycodone.
Last summer, the College of Physicians and Surgeons of British Columbia enacted opioid prescribing guidelines. And in November, it sent a letter to Dr. Andre Hugo.
Hugo immediately began tapering Moses off codeine (Tylenol 3). And, in a letter dated Nov. 18, Hugo explained that Moses’s oxycodone dosage would also have to be cut back.
“As a result of the recent narcotic and fentanyl crisis in British Columbia, the newest ceiling dose for narcotics is 90 mg of morphine equivalent per day as per the College of Physicians and Surgeons [of B.C.],” Hugo wrote. “Your current morphine equivalent dose is 135 mg.”
That he said, “does not comply with the new ceiling dose of the College; guidelines which are being strictly enforced … with consequences to the detriment of physicians who do not demonstrate compliance.”
Hugo wrote that he was willing to “facilitate tapering your narcotic dose to below that ceiling dose.” But if Moses wanted to continue his current drug regimen, “I strongly urge you to obtain the services of another physician as soon as possible.”
(Hugo declined to be interviewed, but his office confirmed that the letter was given to Moses.)
“I’m desperate,” Moses said in an interview. “But I’m not prepared to drop this.”
Reluctantly, late last week he filed a complaint against Hugo with the College even though he remains a supporter of the doctor, whom he calls an ally.
But Moses is already suffering from the codeine withdrawal that’s left him in so much pain that for the past two weeks, he hasn’t been able to work.
He loves his job, helping disabled and older people find work.
“If I could have created a job that’s perfect for me, this would be it,” he said.
“The thought of medical retirement — something I’ve fought constantly — is a now a very strong possibility.”
As Moses said, “You can look at me and know I’m going to hurt.”
He was born with spina bifida and has a spine “like a frozen sack of peas.” He uses forearm crutches to get around because of a leg amputation.
Still, until he was diagnosed with spinal stenosis, it was a point of pride for Moses that he controlled his pain with Tylenol 3 — a prescription that began when he injured his knee skiing.
The spina bifida makes the spinal stenosis inoperable and the three bone spurs have caused nerve damage in his hands and cause chronic, “very significant, sharp pain.”
To deal with that pain, Moses was prescribed OxyContin and, more recently, the time-release, OxyNEO.
The College doesn’t comment on specific cases. But, deputy registrar Ailve McNestry said the guidelines are only guidelines, not ceilings. She emphasized that letters sent to doctors who breach the guidelines are meant to be educational, not disciplinary.
“No doctor in B.C. has ever lost his licence for prescribing practices,” she added.
Beyond filing a complaint with the college, what should Moses do? I asked both McNestry and Doctors of B.C.
Get a new doctor, both said. Try a walk-in clinic. Go to the hospital.
But, despite Premier Christy Clark’s promise that by 2015 every British Columbian would have a GP, there remains a critical shortage of doctors.
In Kelowna, the Walk-in Clinics of B.C. Association said another 35 family doctors are needed for the estimated 40,000 people who haven’t got one.
Two weeks ago, Moses thought he’d found a new doctor. But he was refused as a patient after answering yes to the first question: Are you on an opiate plan?
He was referred to and rejected by the addictions clinic. It’s staffed by psychiatrists and mental health experts, not chronic pain specialists.
As for walk-in clinics, one Okanagan clinic closed this summer and another is closing in early 2017.
So what options is Moses left with? Enforced withdrawal. Street drugs, which he’s adamant he won’t risk because of the fentanyl deaths. Or, experimenting at the local (illegal) cannabis shop.
What kind of choices are those? And with all the attention focused on the fentanyl overdoses and deaths in the street, who’s looking out for people like Moses?
Filed under: General Problems
How do we get heard because media and government exposure doctor wont treat us fairly
The CDC is slowly killing millions of fellow Americans living with severe chronic pain. Without the access to pain management prescriptions these people body’s go into a “shock.” Followed by severe heart issues and an early death. It is absolutely a shame and beyond disgusting that they are so Vague on something so serious! This needs to change Fast… This Not helping communication between doctor and patiants this is alienating all people suffering with Chronic Pain illness. Nobody should be taken off a medications that several doctors have told a patient they must be on to remain Living! God be with us all
Please look at the CDC as they tried hiding new data but, it was found in an article on pain news network. They admittied that the so called “Opioid Epidemic” deaths are more from Heroin, Cocaine, Heroin laced with fentanyl, illegal fentanyl & those getting it illegally. They can’t tell if morphine was in fact Heroin! 6500 pharmacies are robbed every yr, our DEA is corrupt, selling what’s seized & turned at least 2 entire police departments corrupt to sell it for them. 2 entire departments shut down by FBI when a convicted EX-DEA agent turned them in. Our government aren’t doctors & are practicing medicine w/o a license. Many who OD’d in one article that said ” They can’t tell legal fentanyl from illegal” “They can’t tell if RX was legal or not” & “Many are mixing with other substances such as alcohol!” The CDC inflates the numbers to suit their needs. I can tell you w/o a doubt that the165,000 deaths blamed on opioids from 1999-2014 is 0.00039%.I was given this from a pain doc who’s now fighting for his livelihood as the DEA attacked him. To say he’s upset is an understatement & I’m going to contact him to see if I can share this info? He was to speak at our Rally Against Pain 10/22/16 in D.C. by Skype but, due to the wind we couldn’t get him. We’re not giving up fighting until we make them not just LISTEN & HEAR us with CNCP. They’re committing genocide among the very people they are to protect. Many are taking their lives due to pain, cancer pts are being denied, our Vets are suffering & we’re fighting back. Complaints are being filed with the ADA & we’ll continue fighting! We need 1 attorney to steps up & file a class action suit as it’s overdue. We’re discriminated against for having chronic illnesses & chronic pain that we’ve no control over. I contacted the ACLU who fights for ones on Medicaid who can’t get Hep C meds & won! They take cases that are outrageous but, won’t fight for all who are being reduced or cut off cold turkey & committing suicide. They’d fight if one needs/takes HIV, DM, HEART, HBP & other medicines but, not US!!
It’s our DEA who’s attacking our physicians left & right under the CSA. It’s the CDC, FDA, HHS & our government who only care about ADDICTS!! I don’t feel sorry for those with an addiction as they’ll take anything to get high, escape & blame it on Opioids! They lied to many docs to get an RX after breaking their bones on purpose. They saw more than one to get what they needed. They stole from family, friends, rob our vans delivering to pharmacies & rob pharmacies to get high.
It’s been proven that they’re using Imodium AD to get high. They’d add Prilosec OTC to enhance their high. They abuse gabapentin & many states have made this a Schedule II because of them!! Other states are passing laws to put Imodium AD & Prilosec behind the counter & it can’t be bought w/o a license. They did this with OTC medicine containing pseudophedrine but, this did NOT stop them from making meth. An addict will lose it all & if one truly wanted help it’s been available for many yrs FREE of charge. This must STOP now before our government has more blood on their hands then our Vets who fought in Vietnam, Iraq & Afghanistan wars, if they don’t already. Where’s the ACLU? They’re AWOL & won’t stand up for ALL who are being discriminated against, tortured, our human rights, civil rights, against the ADA & against our Constitution!
What happened to “Life, Liberty & the Pursuit of Happiness? Join Vets Fight Back on Facebook as you don’t need to be a Vet? We’re NOT giving up or going AWAY regardless, where you reside. Thank you
Amen,,,ditto,,,maryw
I am a Pain patient and have been following several pain sites and learned a great deal about what the US is allowing the government to intrude on all Drs. Dr’s are afraid of being closed down and simply will not take a pain patient.
The government has lumped Pain Patients in with addicts. The statistics on people who take drugs are not fair and accurate. Most of the time pain patients who take pain pills are helped greatly, they don’t get high just pain relief. I’ve been on OxyContin since the early 90’s. I have remained on the same dose all these years. My pain clinic said my dose is the smallest they make. I am 72 yrs and if I could not get the medication it would be hard to live.
It seems that everything is upside down. Dr’s know what there patients need; the government is not educated enough to make any decisions on medicine. Yes, there are terrible trouble with addicts who by the way are not taking OxyContin because it costs a lot ($700), they take other dangerous pills. The Drs must make sure they are not dealing with an addict. Don’t lump pain patients in with addicts.
If you want both sides of this story check the pain sites, I get a lot of great information from Steve who is also a pain patient.
http://nationalpainreport.com/author/sariens
Please help us get the word out about what pain patients are going through.
Carol,,please contact me,,but I do have 1 question,,Do u blame any of this on the pharmaceutical companies????I DO NOT,,, for again,,I believe their was a supply and demand,its a business,,their gonna make money,,but the BIGGEST reason ,,is no-one is taking responsibility anymore for their own actions,,No addicts are looking in the mirror as to who is to blame for them being addictds,,,,,,jmo,,maryw
Exactly Mrs.Underwood,,,,,u can tell the cowards,the weasels,,Haven’t heard hide nor hare from Freidmen,,hes quitting to go get the 40 billion,,,our government just donated via our tax dollars to addiction centers,,,he’s gotta set-up how to spend our tax dollars,,Klondike bar is hiding in his tax paid billion dollar home along w/the ballaytne,,haven’t heard notta from her,,,and dea is plotting their next take down of a innocent doctor,patient or pharmacist..I wouldn’t dought in my county,,,,,I swear,,history WILL BE ON OUR SIDE,,,just like when Pennhurst was taken out,,but sadly our death toll will be on the levels of genocide committed by Saddam Hussien or worse,,,,,,They,,our government all need too be charged w/the international crime of torture and sentence to life for every life that they took by taking away our medicines,,seriously!!!That what Im going for,,,maryw
The dark ages of pain control, who will live through this? CDC guidelines are understood as the law. CDC needs to come forward and let all doctors know exactly what these vague “guidelines” mean in a legal sense. Who, what, when, where are the “guidelines” meant to cross a legal line? Doctors are covering their behinds so they don’t lose their licenses. Understandable when the word “guidelines” does not accurately and legally define what the heck docs are supposed to do in prescribing pain meds to all people with chronic pain conditions. Don’t be mad at the doctors, this issue is all the fault of CDC being vague. Is this on purpose? By now they must see the damage they have created. Will they be too embarrassed to admit that their “guidelines” are producing non intended consequences, including suicides? Or are they frightened that this consequence will harm their reputations, or possibly lawsuites? Hiding your head in sand and hoping this will go away never works (well, often doesn’t work?). My heart goes out to all who are being harmed, along with their children, husbands, wives, relatives and friends. Along with the jobs that will be lost because of lack of pain medication, the money lost through taxes from jobs that are ended because of people with pain can’t work anymore. This effects all parts of our nation’s structure, all in the name of “guidelines” that are so poorly written or understood. Shame on you who are now hiding from the huge consequences you are responsible for. Stand up and at least take a look at what you have created. “Guidelines” or laws?MAKE YOURSELVES CLEAR. Take responsibility! Lives are at stake!
Sickening,,,just ;like my and 1000’s of other forced to endure physical pain from a medicall illness,,which forced endurement of physical pain perpetrated by ANY government official is legally defined as torture!!!Come on aclu!!!!!!!!!!!!!!!!!!!!!!!!!!!MARY