Stop Taking Life-Saving Medication from Ontarians with Chronic Pain

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    As the opioid crisis rages on, there is one category of opioid users who seem to be absent from the conversation: chronic pain patients.  Patients like, for example, my mom.

     My mom is the hardest working woman I know.  So hard-working, in fact, that she hurt her back while doing manual labor some ten years ago.  She experienced intense, unbearable pain, and was tossed around by doctors who could not find out what was wrong with her, nor how to reduce the pain.  This lasted a long time, until she started taking opioids in the form of morphine and methadone.  These medications, while not taking all the pain away, made her life tolerable: she could go for walks;  she could spend time painting;  she could sit through my graduation without walking out in tears.  All these things were unimaginable before opioids were introduced into her life.  Yet, medical colleges are now forcing doctors to take away my mom's life-saving medication.  Indeed, she has already begun the withdrawal process, and that unbearable pain that was barely kept at bay with the help of her medication has now returned in full force: she can barely walk; she cannot focus on anything but the pain; and she spends much of the day in tears.

     This is not just a familial issue.  Chronic pain patients all over Ontario that have relied on opioids to make their lives tolerable have had their lives gambled with, and there is no sign that the medical colleges enforcing these withdrawals seem to care.  

    While the national conversation around opioid abuse takes the form of partisan debates over safe-injection sites, chronic pain patients are having their lives destroyed by doctors who are taking away their life-saving medications, even from patients who have been on the drugs for decades without issue.  This is being done primarily by medical colleges, such as the College of Physicians and Surgeons of Ontario, who are pressuring doctors and threatening them with investigations if they don’t meet their opioid prescription guidelines. What are these guidelines? They can be easily found online and are known as the 2017 Opioid Guidelines.  They call for radical measures, such as a maximum daily intake of 90 mg of a morphine equivalent dose daily and a suggested maximum of 50 mg of a morphine equivalent dose daily. This means that those patients taking above that 50 mg intake, and especially the 90 mg, must somehow manage to lower their intake while still dealing with their chronic pain.  This is no small obstacle when, for example, chronic pain patients like my mother take above 200 mg of a morphine equivalent dose daily. How are patients like my mother, who already suffer enough while taking so much medicine, supposed to survive on less than half of their original dosage?

     However, the medical colleges have been pushing another drug which is supposed to act as an ‘alternative’ for patients who reasonably cannot meet the 2017 Opioid Guidelines without suffering intense pain.  This alternative is called suboxone, and it on the face looks promising. Although it is nowhere near side-effect free, it doesn’t have quite the same risk of overdose as traditional opioids, and it cannot be used to get high.  Yet, it has major major problems which colleges recommending the drug seem hesitant to own up to. For one, it is significantly more expensive than traditional opioids, making it financially out of reach for many chronic pain patients who are physically unable to work.  Secondly, there is no study on the long-term effects of taking suboxone regularly, with it just being approved by the FDA recently, and there is insufficient evidence that suboxone can deal with pain at the same level as traditional opioids. Yet the most important problem with the medication is this:  Once a certain amount of suboxone is taken, taking more does not add any reductions to pain levels, meaning that if pain is insufferable at this maximum prescription level, patients simply have to deal with it, as taking more will not do anything. And this maximum level stills falls under half the morphine equivalent dose of what patients like my mother are taking.  

    So the end result in both options is a lower quality of life than that with which patients started.  Both reducing opioid intake and switching to suboxone means less pain management, withdrawal, and in the latter case an addiction to a slightly less dangerous drug.  So why are the colleges doing this? Well, somewhat surprisingly, it has almost nothing to do with the patients, but with the people dominating the opioid crisis conversation: those who abuse opioids.  

    The argument is that reducing opioid prescriptions mean less opioids being sold on the black market, and less opioids being taken by users who use them not for medical purposes, but for recreational ones.  This is why chronic patients are often lumped in with addicts. You can be sure that this is why the main selling point of suboxone is that it can’t get you high. Indeed, suboxone is primarily used to treat opioid addiction, not chronic pain.  Chronic pain patients are therefore also subject to humiliating procedures from doctors who treat them like addicts: urine testing, being forced to purchase medication from dispensaries aimed at addicts, and having prescriptions renewed on the day their medications run out or after, are all common practices.

    However, this belief that it is pain prescriptions that are the cause of the opioid crisis is so outdated that anyone who follows it is either naive or willfully ignorant.  To cite a single example, 400,000 less opioid prescriptions were filled from 2016-2017, yet opioid related deaths have only increased during the same period. This isn’t a surprise.  If patients are taking opioids because they are in excruciating pain otherwise, you can be damned sure they aren’t going to sell any on the black market.

    Why the government and medical colleges seem happy to reinforce this view and ruin the lives of chronic pain patients using opioids in the process is a serious question:  perhaps it is easier to target powerless patients than go after the systematic problems, such as poverty and mental illness, underlying the crisis. Nevertheless, it should be clear to anyone taking more than a superficial glance at the issue that chronic pain patients, and those who abuse opioids for non-medical reasons, are not in the same category, and that responsible opioid users suffering from chronic pain should not be punished for the mistakes of those who misuse opioids for whatever reason.  

    So what can we do about it? You can sign this petition dedicated to the College Of Physicians and Surgeons of Ontario.  This petition makes two central demands.  Firstly, that the college stop pressuring doctors to reduce opioid prescriptions when some patients clearly require the prescriptions in order to achieve a respectable quality of life.  Secondly, that the college disavow all attempts to treat chronic pain patients like addicts. This means no more urine testing, inconsiderate refill dates, and overall poor treatment of those patients simply trying to live their lives without excruciating pain.  You can also share this petition and spread awareness of the issue and start including chronic pain patients in the national conversation.

    The opioid crisis must be solved.  But making the lives of those suffering from chronic pain harder than they already are is not the right approach.  Thank you for listening.