Wednesday, July 5, 2017

Collateral Damage in the Opioid Epidemic


I wish I were writing this blog to report good news. Unfortunately, things are no different today than they were in 2011 when the Institute of Medicine (IOM) report “Relieving Pain in America” was written. Instead, and even though the IOM report spirited the drafting and publishing of the National Pain Strategy, things have gotten much worse. Hardly a week goes by that I don’t read about a fellow patient taking their life because the source of the physical pain was inadequately treated and their emotional pain unbearable because of feeling judged, many times by those they seek for help and support.

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The opioid epidemic is very real and I do not mean to minimize that fact in any way. However, it is now painfully obvious that the CDC guidelines for opioid prescribing have not helped those who live with addiction. In fact, the guidelines have led to more deaths, not fewer. The forgotten, stigmatized, and judged, people living with persistent pain are now joining the death toll. That’s why I am sharing an article I wrote a year ago for my website, Guidelines for Pain Warriors. If you have been injured, I encourage you to use the links you find in the following letter. Or if you know someone like a recent victim, please encourage his or her family to take action.

Because of the volume of requests for help and the need to meet the demands for my own care, I share the following from my website.

Dear concerned fellow person living with chronic pain,

It is rewarding to write books, articles and blogs to help others manage chronic pain and illness. But coping strategies alone are often not enough. Opioids allow many patients the ability to participate in things they otherwise couldn’t. I advocate for moving complimentary therapies into mainstream but these days, the bulk of my time is donated to the crisis created by limited patient access, if any, to their opioids.

Because of the volume of requests for help and the need to meet the demands for my own care, I investigated information to help you with your personal situation.

It’s important to understand what is happening. Physicians are caught in the middle. The DEA crackdown on prescribing opioids has made them fearful of because of perceived threats to their livelihood. On the other hand, if patient harm results from negligence or abandonment, the provider can be  liable for that too. When a patient is fired, the physician has an ethical obligation to ensure a patient’s care is uninterrupted. However, the DEA, the CDC, the Center for Medicare and Medicaid, and or other government agencies have no liability for the results of their actions. 
We have the ability to hold the right people accountable by providing factual evidence. Evidence includes things, such as:
  • A written letter from your physician stating his/her reasons for stopping your pain care. (If you don’t have one, demand it.)
  • Chronological documentation your physician failed to provide ample notice for finding another provider. 
  • Following are other things to consider:

  1.  Is your physician negligent if no one is willing to continue your care?
  2.  Is your provider fearful to bridge the gap because of the CDC Opioid Prescribing Guidelines or other governing bodies?
  3. Is your provider using the changes as an excuse to abandon care?" Pain that does not abate is a reason to seek medical care, but physicians often feel helpless because treating chronic pain is complex. 
  4.  When the standard of patient care is breached (i.e. abandonment, negligence, or malpractice) and that breach causes harm, there is legal recourse. Currently, three things affect the changing standards, as I see it, (1) the influence of government agencies (2) lobbying by PROP--follow the Phoenix House money trail, and (3) the American Medical Association's decision to cut pain as the 5th vital sign from routine assessment, affecting the standard of pain care negatively.  
  5. Why isn't acupuncture, counseling by a provider trained in pain care, therapeutic manual therapies, or other proven modalities also considered when making changes in the standard of care? Answer: insurance lobbying, another player identified in the pain care market. 
  6. Patient outcome is seldom discussed even though it should be the driving factor of all patient care standards. 

*If you are forced to sign a contract, read it. A contract is between TWO people and may be litigated if either party fails to uphold their part of the contract. The physician’s responsibilities toward your care should also be provided. 

 The laws to protect both the physician and patient are very gray in today’s stormy climate.

  • The physician must  provide evidence as to why they withdraw  care. (See Pain vs. Addiction Behaviors.) Yet, some may feel protected by the CDC guidelines. They are not. The guidelines are not LAW!
  • Failure to provide information such as copies of relevant medical records, treatment notes, tests, etc. to those who are continuing your care is a breech. This does not meet patient care standards.
  • Voice recordings or notes in your medical record that the DEA or other government agency created a burden on the physician’s ability to treat pain are helpful for both the physician and patient, but  difficult to obtain unless a case is being litigated.
  • Documentation of refused emergency care, such as treatment, hospital admission for withdrawal symptoms, suicidal ideation, or any other untoward effect is mandatory. (This is not the same as expecting an ER to continue your outpatient pain care.) 
  • Your loved one has committed suicide and there is documentation abandonment or untreated/undertreated pain was the cause. (many statistics are likely skewed because of the inability to collect life insurance and the stigma associated with suicide and chronic pain). 

*As a patient, you also have a duty. If you are unreasonably demanding, non-compliant (i.e. abusing, diverting, or misusing opioids), or threatening to the physician or staff, you are not protected.

If you have been abandoned and have evidence of harm resulting from changes in your pain care, you have recourse thanks to required reporting in Senate Bill S.483, Ensuring Patient Access and Effective Drug Enforcement Act of 2016, signed into law April 2016. 


Harm constitutes:

  • pain and suffering
  • cost of additional treatment
  • loss of earning capacity, and
  • loss of the ability to enjoy life

If you have sufficient evidence, please submit it to the attorney general for your state, which you can find at  NAAG | Who's My AG?   If anyone is providing evidence on someone else’s behalf make that disclosure and provide contact information.

Remember, if it wasn't documented, in didn't happen. Gather your arsenal and become empowered. Record what you can, when you can. The attorney general needs concrete evidence to move forward. Make sure they know you know they are required to report your case as part of S.483. There are links to additional contacts at the bottom of the Sample Advocacy Letter. I suggest sending a copy of your letter to your attorney to those you feel are appropriate. Be sure to mention the pain care laws for your state (link is courtesy of the Academy of Integrative Pain Management, SPPAN) or by typing “your state’s name state law on pain care” in your browser search engine and select from the results.

Because every case is different, each of us must demand our rights to be treated with dignity and respect. There is opportunity in adversity. Rome wasn’t built in a day, nor will our cries for help be solved quickly, but we must have hope. Despite what many think, those in chronic pain are tough. We overcome hurdles on a regular basis.

I recommend joining an advocacy group to help you stay abreast of recent newsworthy information and/or fight for our rights in Washington.

US Pain Foundation
The National Fibromyalgia and Chronic Pain Association

See The PAINS Project for links to their steering committee members for additional information. 

Helpful links for finding your senator, representative, and governor; medical organizations, and government health related websites, your states attorney general, your state’s pain care laws and more can be found at the bottom of page, Sample Advocacy Letter.



In healing,,Celeste

"Adversity is only an obstacle if we fail to see opportunity."

~ • ~ • ~ • ~ • ~ • ~

Celeste Cooper, RN
Author—Patient—Freelance Writer at Health Central & ProHealth Advocate

Celeste’s Website: http://CelesteCooper.com

Learn more about Celeste’s books at her website or find links here on Celeste's  blog. Subscribe to posts by using the information in the upper right hand corner or use the share buttons to share with others.


All blogs and comments are based on the author's opinions and are not meant to replace medical advice.

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