Limiting Opioids for Acute Pain Will Hurt Everyone

By Patricia Young, Guest Columnist

There is a bill in Congress that, if passed, will have a great negative impact on most people in this country. The legislation by Senators John McCain (R-AZ) and Kristen Gillibrand (D-NY) would limit your doctor’s ability to treat short term acute pain by restricting the supply of opioids to 7 days. This would be a prescription that could not be renewed.

Several states have passed or are considering similar measures to limit the initial supply of opioid medication to a week or less.

I am not sure how these senators came up with the magic number of 7 days for all types of acute pain, but this will cause much undue suffering for innocent people.

As a registered nurse who worked in hospitals and nursing homes for 32 years, I have firsthand knowledge of what happens when acute pain goes untreated. Patients who suffer from acute pain often cannot sleep and become agitated at a time when rest is imperative for healing.

There are many painful and complicated surgeries that make a blanket 7 day restriction on opioid medication absurd. Post-surgical patients often do not stay in the hospital long and the continuation of pain medicine is vital to their healing process. Gastrointestinal surgery often results in an open wound requiring constant dressing changes for weeks.

Most people will eventually be adversely affected if such a bill if passed. Pain is real and comes with most surgeries and many medical conditions.

I recently had arthroscopic hip surgery. I had not been prescribed pain medicine for over a year. At one time I was taking opiates daily, but taking them in that fashion never worked for my chronic pain issues and caused adverse reactions, such as gastroparesis and severe sleep apnea. However, I knew that I would not do well after hip surgery without some pain relief.

I told my surgeon about the adverse reactions and he gave me a prescription for Percocet to use for the first 2 weeks following surgery. I felt good that this doctor had my history and I trusted him to regulate my pain medicine.

I had my surgery done as an outpatient and returned home the same day. My husband took the prescriptions signed by my surgeon to the pharmacy and returned with all of the medications, except for the Percocet. By this time I really needed some pain relief and called the pharmacy to see what happened. I was told that they were not going to fill the prescription for Percocet. They told me my Medicare Advantage Plan (Aetna) was rejecting payment for it.

This was the type of news you just do not need after a painful surgery! I immediately went from feelings of anger to hopelessness. In a couple of weeks I was going to begin 3 months of grueling physical therapy so I could walk again. I also wondered what people did for pain after more complicated surgeries which take longer to recover from. What is happening? Is the government regulating our healthcare so that an insurance company or Medicare can deny coverage for a surgeon’s prescription for post-op pain?

I explained to my pharmacy that my prescription for Percocet was for acute pain following a surgery. The pharmacy decided to look into it. I was fortunate, I was allowed this one prescription filled, but no more. The pharmacy said they would not fill another prescription for a painkiller even if prescribed by my surgeon.

I was only partially relieved now. I knew I had a painful road ahead with 3 months of physical therapy. I looked at the bottle of pain pills and thought this must last throughout my 6 month estimated recovery time. I made the decision to not take a pain pill that day. Yes, I was having a great deal of pain, but I felt I had to take them sparingly. I lost several nights of sleep due to pain because I was afraid to use my pain medicine.

By the 6th day post-op, I had only taken 3 Percocet pills and my pain level was an 8 while lying still. I called my insurance company to verify that I would get no more prescription coverage for pain medicine as the pharmacy had said. I was told different information. My insurance would allow coverage for another prescription, if my surgeon writes one, as long it was not over 180 pills for a month.

My fears about pain during physical therapy were eased and I was relieved that I could start taking my pain pills as prescribed. But why would a pharmacy tell me the wrong information?

This may be why people have to go to several pharmacies to get pain prescriptions filled. It is not because they are addicts or misusing their medication, but because pharmacies are too afraid to fill legitimate prescriptions.

Do cookie cutter rules and policies for pain treatment really promote healthcare for everyone? Or are they simplistic solutions to try and put a band aid on a problem that is completely different -- the disease of addiction?

Patricia Young lives in Florida. In a previous guest column, Patricia shared her experience about being falsely accused of having a “history of addiction.”

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The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Bill Would Strictly Limit Opioids for Acute Pain

By Pat Anson, Editor

A bipartisan bill has been introduced in Congress that would put strict limits on the prescribing of opioid medication for the treatment of short-term, acute pain.

The bill by Senators John McCain (R-AZ) and Kirsten Gillibrand (D-NY) would require doctors to limit the initial supply of opioids for acute pain to seven days, a prescription that could not be renewed. The legislation is similar to recent laws adopted in several states, including New Jersey, Arizona and New York.

“Our bipartisan bill would target one of the root causes of the opioid addiction crisis, which is the over-prescription of these powerful and addictive drugs for acute pain,” said Gillibrand. “Too many lives have been destroyed, too many families have been torn apart, and too many communities all over New York are suffering because of this tragic epidemic.”

“One of the main causes for the alarming increase in drug overdoses in the United States is the over-prescription of highly addictive opioids,” said McCain. “We have a long way to go to end the scourge of drugs across our communities, but this legislation is an important step forward in preventing people from getting hooked on these deadly drugs.”

Anti-opioid activists and government regulators have long claimed that even just a few painkillers can easily lead to addiction and death.

“You take a few pills, you can be addicted for life. You take a few too many and you can die,” former CDC Director Thomas Frieden recently told the Washington Post.

But only a small percentage of pain patients become addicted or overdose on prescription opioids. And research shows that less than two percent of patients who are prescribed opioids for acute pain become long-term users.

Under current federal law, doctors must receive a license from the Drug Enforcement Agency (DEA) to prescribe a schedule II, III, or IV controlled substance. The registration must be renewed every three years.

The 7-day limit would not apply to opioid medication used in the treatment of chronic pain or cancer pain, or for patients in hospice care, end-of-life care or palliative care. However, it would prevent doctors from prescribing any opioids for any type of pain if they don't promise to limit prescriptions for acute pain:

“The Attorney General shall not register, or renew the registration of, a practitioner…  who is licensed under State law to prescribe controlled substances in schedule II, III, or IV, unless the practitioner submits to the Attorney General, for each such registration or renewal request, a certification that the practitioner, during the applicable registration period, will not prescribe any schedule II, III, or IV opioid, other than an opioid prescription… for the initial treatment of acute pain in an amount in excess of the lesser of a 7-day supply (for which no refill is available) or an opioid prescription limit established under State law.”

Schedule II opioids include painkillers with “a high potential for abuse” such as hydrocodone, fentanyl, morphine, and codeine. Schedule III opioids have “a potential for abuse” and Schedule IV opioids have “a low potential for abuse.” Opioids such as Suboxone and buprenorphine, which are generally used to treat addiction but are also being abused, are exempted from the legislation.

Anti-anxiety and antidepressant drugs such as Xanax, Soma and Valium – which are classified as Schedule IV controlled substances – are also not covered by McCain and Gillibrand’s bill, even though they are involved in a substantial number of overdoses. The bill was assigned to the Senate Judiciary Committee.

“It’s only too obvious, a careless clueless Congress and state governments have forgotten the lessons of the drug wars and prohibition as they seem intent on repeating the mistakes of the past instead of learning from them when it comes to opioids,” said David Becker, a social worker and patient advocate in New York.

“Furthermore, it is clear they could care less how their opioiphobia harms not only people in pain but their loved ones and those that care and depend on them. It’s clear they never had a real plan to help people in pain but allowed doctors, insurers, and researchers to do their own thing -- unless headlines showing the harms of their lazy laissez faire policies threatened their careers.”