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Among other things, the bill promotes the use of opioid contracts. These are written agreements between doctors and patients about the conditions for prescribing opioids long term for chronic pain. Opioid contracts clarify for doctors and patients how to prescribe these dangerous medications.
By doing so, they can formalize safer approaches to opioid prescribing. Even the best medicine can sometimes cause harm. When she was 17, Cindy was abducted and sexually assaulted in the basement of a Boston tenement. Gagged and bound to a post, Cindy could hear her family calling for her, but she could not respond.
But to deaden her memories of that horrific experience, she turned to alcohol and heroin. Years later, when Cindy relocated to rural New England, she brought with her HIV infection, a painful nerve condition, and hopes of a better, sober life.
As Cindy reliably took her HIV and pain medications, she got healthier. A bond developed between us. She brought photos of her family to the clinic, and once gave me a little silver dove. It was thanks, she said, for helping her find some measure of peace. It mandated that she keep regular appointments, avoid requests for extra prescriptions, submit to random drug testing, and promise not to sell her pills, among other conditions. After a few months, Cindy broke the contract by taking black market pain and anxiety medications as part of a rare weekend-long relapse.
Ashamed and in pain, Cindy fell back on heroin. When I saw her next, there were healing puncture marks on her arms and tears in her eyes. I referred Cindy to rehab, kept treating her HIV, and got her to see a pain medicine specialist. This doctor also had Cindy sign an opioid contract.
Not long after, she violated it by failing a random drug test — not because it was positive for heroin but because it was negative for her pain medication. The next step was predictable: Stressed and in pain, she returned to heroin.
Days later, Cindy was dead of a heroin overdose. I learned that she had died while I was in the middle of a busy clinic. Patients waited in their rooms while I stared at the wall, unable to breathe. I had lost patients before over the course of more than a decade treating people with HIV and other deadly infections. But this was different. This time, I knew we had let Cindy down. Yet the delicate balance we had struck between the management of pain and addiction collapsed as soon as she was forced to start signing opioid contracts.
These one-size-fits-all forms converted complexity into simplicity: If Cindy showed signs of addiction, her prescription was stopped. Opioid contracts can harm patients in other ways. I have seen doctors use them to dump addicted patients who can be challenging to care for. I have also seen the time-consuming, multifaceted care that patients with addiction need be replaced by quick enactment of a legal-sounding opioid contract.
When patients signal they are at high risk of drug addiction or overdose by signing — or violating — an opioid contract, physicians should recognize that they are managing a complex problem that needs complex solutions. An opioid contract may be a good start, but it should be joined by a panoply of other helpful measures. We may elect in certain circumstances to stop an opioid prescription, but seldom should it be done abruptly and never as the final chapter of care.
When Cindy was 17, she listened helplessly from a dingy basement as her family called out for her. This year, Cindy was the one calling for help, and we did not truly hear her. I hope we can invest similar passion in not abandoning addicted patients when they need us.
The silver dove Cindy once gave me sits on my desk as a reminder we can, and should, do better. What about when your forced off pain medication without being allowed to taper off? Is that even legal? I never did anything wrong, I followed every rule, never failed a urine test. The local ER refuses to treat anyone in withdrawal. I even have a letter from the doc that dropped me saying she is still responsible for my care for the next 30 days but refuses to help.
Why is it legal to drop a patient for no reason and leave them in withdrawal? I had No warning! I am William you can read my story below I would just like everyone to know that I am 60 years old and I am not smoking marijuana and partying with my buddies this is strictly and has been only something I am doing to help cope with the pain.
I tell my doctor that I am in extreme pain all the time and can hardly function as a human being because the pain is so intense I have trouble walking standing sitting laying sleeping at this point my life is more than a mess.
Then comes another urine test I fail this one and test positive for marijuana at this point I cannot tell you how many urine tests I have taken and passed but with the reduction in my pain medication I need to find something to give me some relief And marijuana is my choice. Clean and sober, through the grace of God, St. Sobriety delivers what alcohol and drugs promise.
I am a Chronic Pain Patient not a criminal. I will not ever change my sobriety date, not for anyone or any drug. I will not walk below the victory Jesus died to give me. Medicine in the US has become more about treating parts and bits rather than treating patients as a whole being. Yet Pain Management Docs are using contracts, denying patient scripts and referring to expensive often non-insurance covered treatments over treating the business of pain.
Urine screening is one example of the tactics used however; equally addictive and favorable black Market mental health meds are not being targeted in the aggressive nature as Opiods.
We need to ask! Which kills more people per year than opiods yet is taxed by the Government. Lastly apparently we have learned nothing when it comes to prohibition type legislation. Furthermore science tells us there is a distinct difference between medical dependency and addiction. Chronic pain patients are not any less worthy of this acceptance.
The guidelines will not curb illegal opiate use. Data tells us that less than 5 percent of Chronic Pain Patients abuse their pain meds. So what are we doing? This is discrimination towards sick folk period! When pharmacist have the right to refuse to fill a script without access to medical records- solely on suspicion- this is abuse of the system in an entirely different manner.
The assumption that chronic pain equates to addiction is harming people. I am only allowed opiate persciptions quarterly. Yep, once a quarter per my Pain Management Doctor. This is cruel and unusual.
I refuse to sign a pain contract on principle. I would prefer to suffer everyday than be treated in a manner as a someone who would sell their scripts or abuse their scripts when I have no history of abuse or addiction.
The double standard has to end. V Towsey, I would love to know where you got your statistics from? I am writing a paper for college. Even just a short-term Rx could have saved her without jeopardizing anyone. Asking what could have come been done differently is a valid and productive response when a patient dies.
It is how this story began. When addressing such questions, it is important to understand the risks and complexity involved, and to be compassionate. Opiate treatment for chronic pain is very risky. The risk of overdose is high in anyone, and particularly high in patients who have struggled with addiction or who take multiple medications with additive overdose risks. Whichever option is best for that patient, these are chronic and dangerous illnesses, and there are no simple, short-term, or safe fixes for them.
At times I treated her pain, and because I am not a pain management specialist I helped her access more expert care. This was a sad day for many involved, but rather than being the result of a simple mistake made by any single person, as far as I can tell the problem lay somewhere at the intersection between deadly disease and the challenges our system has providing the complex, multi-disciplinary, nuanced, care she needed.
Lahey has courageously expressed what many of us know to be true. The best medicine in these situations requires authentic, trusting relationships between clinicians and patients.
Opioid contracts have a place, but cannot replace that authenticity. Tim — this was a great read! Thanks Alex — great to hear from you. Hoping that sad experience can help us find a middle way. BatesDiane FabelClinton T. RubinVadim J. Gurvichand Charles C. Leave a Comment Cancel reply Name Please enter your name.
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