By Pat Anson, Editor
An Iowa state legislator is under fire from pain patients and healthcare professionals after suggesting that cancer pain was a “regular ailment” that should not always be treated with opioid pain medication.
Rep. Chuck Isenhart co- hosted a public forum this week on opioid abuse in Dubuque, where he called for new efforts to stop the heroin and opioid epidemic in Iowa.
"We've become dependent really on using strong painkillers for treatment of regular aliments such as cancer and inadvertently many people have become addicted to those painkillers," Isenhart told KCRG-TV in an interview.
The comment angered pain sufferers around the country, who left comments on KCRG’s website.
“If cancer is a regular ailment unworthy of relief, what sort of ailment ‘deserves’ relief?” asked Anne Fuqua, a pain sufferer and patient advocate in Alabama. “Patients with chronic pain are suffering horribly due to pressure not to prescribe opioids. Patients have literally committed suicide as a result of uncontrolled pain.”
“I'd like to know how my dead mother’s cancer was a 'regular ailment.' Also, unless you have actually experienced the pain of chemo and all of the side effects from it, I wouldn't lump that in the same category,” wrote Anne Pavao.
“To call cancer a regular ailment just pisses me off. My husband has Stage 4 mets (metastasized) cancer. This is not a freaking headache. This is a chronic PAIN,” said Rene Saylor.
“Suggesting that cancer-related pain is a ‘regular ailment’ that should not be treated with opioids is just beyond the pale,” said Bob Twillman, PhD, Executive Director of the Academy of Integrative Pain Management. “I worked with people with cancer for 20 years, and I can assure this legislator, and anyone else who cares to ask, that the pain associated with cancer can be very severe and often warrants treatment with opioids—which are usually effective. Statements like this reflect a lack of knowledge that can be very dangerous when making policy.”
Even the CDC's opioid guidelines -- which discourage the prescribing of opioids for chronic pain -- make clear they are not intended for cancer patients or others with terminal illnesses.
"This guideline provides recommendations for primary care clinicians who are prescribing opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care," the CDC guidelines state.
We asked Isenhart if he wanted to clarify his remark.
“Cancers are a common health condition for which painkillers are often properly prescribed per evidence-based medical protocols. In some cases, the use of such opioids – whether proper and improper -- results in dependencies and/or leads to addictions after the initial indication has been addressed,” Isenhart said in an email to PNN.
“This is not my ‘position’ -- this is the testimony we received from medical experts who testified at our forum. If there is testimony to correct or elaborate, we are open to receiving it.”
Isenhart is a member of a special legislative committee charged with evaluating the “prescription pain medication crisis” in Iowa. Among other things, the panel is looking into whether overdoses from opioid medication are under-reported and whether physicians are complying with current prescribing guidelines. The committee is due to submit its recommendations to the full legislature by January 1.
PNN asked Isenhart if further limits on prescription opioids would be recommended.
"This is one of (the) questions that is being asked. I know my own doctor has told me that he would ‘rather prescribe Narcan than narcotics,’” wrote Isenhart. Narcan is an emergency medication used to reverse opioid overdoses.
“The serious lack of knowledge by this legislator is astounding. It suggests to me that his advisors are equally uninformed,” said Lynn Webster, MD, past president of the American Academy of Pain Medicine. “I cannot believe the lack of reason and science that is influencing our policymakers. It has to be frightening for all people in serious pain from cancer or non-cancer pain.”
Webster says only a small percentage of cancer patients develop an opioid addiction.
“People who develop a substance use disorder to opioids are usually polysubstance abusers and have almost always had a prior substance abuse problem. It is rarely the exposure to an opioid that is the problem,” said Webster. “The misinformation about opioids and the risk of abuse is astounding. The real tragedy is that the misinformation will not help solve the opioid crisis but will certainly contribute to more suffering by people in pain who will be ignored or denied compassionate care.”
Like many rural communities and cities across the country, Dubuque is being hit hard by a wave of opioid overdoses. So far this year, 9 deaths and 26 overdoses have been reported In Dubuque County. All were attributed to heroin, not pain medication.