How Fixes for N.H.'s Opioid Crisis May Be Hurting Those With Chronic Pain

Sep 21, 2017

As overdoses and deaths continue, New Hampshire physicians are responding to criticism that they've overprescribed. Now, some patients with chronic pain find themselves cut off from access to medications, left without other treatment options, and feeling that the anti-opioid push has gone overboard.


GUESTS:

  • Dr. Colene Arnold:

Dr. Arnold is an obstetrician and gynecologist at Inner Balance Pelvic Health and Wellness Center in Newington, which treats women with chronic pelvic pain. In 2016, Dr. Arnold co-founded Hope on Haven Hill, a nonprofit residential facility for pregnant women with addiction and their babies. 

Check out the International Pelvic Pain Society's patient educational brochure for more information on chronic pelvic pain.

  • Dr. David Nagel:

Dr. Nagel specializes in pain management at Concord Orthopaedics. He is the New Hampshire representative to the American Academy of Pain Medicine. Dr. Nagel is the author of Needless Suffering: How Society Fails Those with Chronic Pain. 

You can listen to The Exchange's interview with Dr. Nagel about Needless Suffering here.

  • Shirley Phillips:

Phillips has chronic neuropathic pain as a result of chronic pancreatitis caused by a birth defect. She is a former pilot, physical therapist, and currently works in aviation research. She lives in Nashua, New Hampshire. 

Who are opioid refugees?

  Dr. David Nagel, who specializes in pain management at Concord Orthopaedics:

People that were well-managed on opioids for years, sometimes at high doses, who are doing just fine, and then, all of a sudden, were arbitrarily either taken off their medication or placed on lower doses. 

But there's another group within that, who are people that are now coming to doctors with new onset chronic pain or acute pain or serious pain, meaning "end of life" pain, that are not really having their needs met, because they're not even being started on opioids at all.

How has the rise in opioid addiction impacted physicians?

Dr. Colene Arnold, an obstetrician and gynecologist at Inner Balance Pelvic Health and Wellness Center, and a co-founder of Hope on Haven Hill:

We're a very reactionary society. Our government is, our physicians are, and we are in life in general. And so we're now reacting to this opioid crisis by pulling back completely, so that pendulum has swung from one end all the way over to other. And unfortunately, it is going to take time to get back to a centered approach, where we're not essentially over-prescribing. 

Are those with chronic pain sensing a change in the way they are treated as the crisis has evolved?

Shirley Phillips, who has chronic neuropathic pain:

It's definitely getting worse. I've been struggling with the pain for about seven years, but I'm seeing, [poor treatment] is more prevalent now. Even recently, I had to call an ambulance because I had an episode of chronic nausea and severe pain. And the EMTs came in, they asked what medications I was taking, they looked at the oxycodone bottle, and they said, "Oh, oxycodone." And after that they were just incredibly rude, and they treated me, I don't know, like a criminal...

[My physicians] have actually given me a card that has all of the specialists' names [and numbers] on it. It explains my situation. And I hand it to [healthcare providers at the emergency room]. I say, "Call any of these folks. They can explain it to you." And they won't. So I have gotten on my cell phone and gotten [the physician] on the line and said, "Here, talk to them," and they wouldn't talk to them once. 

Once they've made up their mind, it's almost like they don't want to hear that they were maybe wrong. 

Dr. Nagel:

Nobody ever calls me. And then the other problem with that is you see all this unnecessary testing done, unnecessary chastisement. I mean, I've seen thousands and thousands of dollars that could have been saved if you had just called me and said, "What's the deal here?" 

How prevalent is opioid addiction, and how is that different from dependency?

Dr. Nagel:

We may have an opioid crisis, but we do have an addiction crisis. And what that means is that we are seeing people with addiction and we know that addicts tend to follow the laws of economic supply and demand: if it's cheap and accessible, they'll go that way. And a lot of people think the big problem that we created was just dramatically increasing the supply of opioids on the street, which lowers the cost. And then that just brings [those who are addicted] to a better or different source to feed their addiction. 

Or are we as doctors creating more addiction? The answer to that question is not really clear... the risk of developing a new addiction that you've never had is less than one percent...

But chronic pain patients may become dependent on their medication, because they need it to function in their lives. But they rarely become addiction to that medication. What we're seeing now, though, is that they have difficulty accessing their medication, so their pain specialist is no longer a pain specialist, maybe it was their family practitioner or internal medicine doctor, and they're no longer prescribing that medication. And they wean [the patient] off regardless of whether or not they were doing well on their program. 

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