Are we finally going for the head of a problem, rather than tackling
the tail? Greed has driven a corporation that produces drugs which
can benefit many who suffer from intense pain, into a headlong push
for more profit and more control.
As you glance through the following excerpt from Democracy Now, keep
in mind that there are those who do need serious pain medications in
order to function. This exposure does not make life any easier for
them.
Carl Jarvis
As Oklahoma and Purdue Pharma reach a landmark settlement, we look at
an underreported result of the opioid crisis: the underprescribing of
opioids for
patients who rely on them for pain management. This month, more than
300 doctors and medical researchers sent an open letter to the Centers
for Disease
Control and Prevention warning patients have been harmed by a lack of
clarity in guidelines for prescribing opioids. The CDC revised the
guidelines for
primary care physicians in 2016 in order to improve safety and reduce
risks associated with long-term opioid therapy for chronic pain. But
many say the
new guidelines caused confusion and led to the reduction or
discontinuation of opioids for people who responsibly use the
medication to manage pain related
to cancer, multiple sclerosis, lupus and fibromyalgia. We speak with
Terri Lewis, a social scientist, rehabilitation practitioner and
clinical educator
who is running a national survey of patients and physicians to
calculate the impacts of changes in chronic pain treatment. We also
speak with Barry Meier,
the author of "Pain Killer: An Empire of Deceit and the Origin of
America's Opioid Epidemic." He was the first journalist to shine a
national spotlight
on the abuse of OxyContin.
--------------------------------------------------------------------------------
Transcript
This is a rush transcript. Copy may not be in its final form.
AMY GOODMAN: This is Democracy Now!, as we turn now, end the show, by
looking at the flipside of the opioid crisis: the underprescribing of
opioids for
patients who rely on them for pain management. This month more than
300 doctors and medical researchers sent an
open letter
to the Centers for Disease Control and Prevention, the CDC, that
warns patients have been harmed by a lack of clarity in guidelines for
prescribing opioids.
The CDC revised the guidelines for primary care physicians in 2016 in
order to improve safety and reduce risks associated with long-term
opioid therapy
for chronic pain. But many say the new guidelines caused confusion and
led to the reduction or discontinuation of opioids for people who
responsibly use
the medication to manage pain related to cancer, multiple sclerosis,
lupus, fibromyalgia. A survey by the Pain News Network found more than
85 percent
of patients say the CDC's guidelines have made their pain and quality
of life worse. Almost half those surveyed said the poor management of
their pain
prompted them to consider suicide.
For more, we're joined by Terri Lewis, social scientist,
rehabilitation practitioner, clinical educator, who's running a
national survey of patients and
physicians to calculate the impacts of changes in chronic pain treatment.
Welcome to Democracy Now!, Terri. Can you explain this flipside?
People might be congratulating the CDC by saying that prescriptions
must be much lower.
But talk about what is happening for people who are not addicted but
need serious pain management.
TERRI LEWIS: Well, the bottom line is that the CDC guidelines were
written for primary care, for new cases of illness and injury, and
they were designed
to prevent addiction from developing by not creating new people who
were going to have a problem. The problem that we're seeing is that
these guidelines
have been adopted and Incorporated into federal and state regulations
in a way that they were never intended to. And we have characteristics
in our population
that we haven't accounted for in this design. We've got an aging
population. We've got an existing, multiply chronic care population
that is on the books.
These are people who are stable or have been stable in care, and they
are no longer getting the care that they need, because we have applied
and adopted
a one-size-fits-all policy, a square peg in a round hole. And we're
seeing that problem develops in creating structural barriers
throughout the whole care
system.
AMY GOODMAN: So people are losing the ability to have their drugs paid
by insurance. What role do pharmacies play in this?
TERRI LEWIS: Pharmacies are enrolled in insurer networks. Their job is
to be a party to the dispensing decision that is made for people who
live both in
urban environments and rural environments. As the DEA reduces the
available supplies, the job of the pharmacist is now to parse and
determine who is a
legitimate patient at the dispensing end versus who is not, and,
secondarily, to determine who's a reliable, legitimate prescriber and
who is not. And
that is a new role for pharmacists.
AMY GOODMAN: I want to go to former Attorney General Jeff Sessions
speaking in February of last year about the opioid crisis.
block quote
ATTORNEY GENERAL JEFF SESSIONS: We need to stop addiction. The plain
fact is, I believe, and I am operating on the assumption, that this
country prescribes
too many opioids. I mean, people need to take some aspirin sometimes
and tough it out a little. That's what General Kelly—you know, he's a
marine. He had
a surgery on his hand. It was a painful surgery. He said, "I'm not
taking any drugs." It did hurt, though. He did admit it hurt. But, I
mean, a lot of
people, you can get through these things.
block quote end
AMY GOODMAN: So, that's Jeff Sessions saying, "Just take some
aspirin." I want to bring Barry Meier back into the conversation,
author of Pain Killer:
An Empire of Deceit and the Origin of America's Opioid Epidemic. What
about this flipside, the people who desperately need chronic pain
management, and
now they're not—they're losing their insurance for these drugs?
BARRY MEIER: Well, you know, the management of pain is an extremely
complicated issue. And I agree with what Ms. Lewis said about there
being a need for
those patients to receive appropriate treatment. Appropriate
treatment, however, doesn't necessarily mean opioids. That's not—one
doesn't equal the other.
I think what doctors, what medical institutions are trying to do are
use other technologies, other means of managing pain, other than
opioids. And the
successful application of those strategies has great value for
patients in pain, because while we focus a lot on addiction, there are
other serious health
consequences to the long-term use of high doses of opioids. They have
a range of side effects that patients would be well to be without. So,
I think what
we need to see and encourage is an evolution in pain management. And I
think pain patients are a critical part of that evolution.
AMY GOODMAN: Terri Lewis, can you respond to Barry Meier?
TERRI LEWIS: Yes, I'd like to. First of all, I've been surveying this
population since 2012. The majority of people that we're concerned
about are people
with six or more chronic comorbid conditions. These are people who
have been folded up in car wrecks by freight trucks. They have
multiple progressive
diseases that are not going to get better. By denying care at this
level without a replacement system, we are denying people treatment.
We do not have
replacement treatment to deal with the kinds of problems that these
folks have. Nor do we have payment systems and physicians trained to
provide the care
that is needed, both in urban and rural America, to serve this
population. So, it's a little naive to suggest that grandma, who is
82, who is dealing with
not only Alzheimer's, but also lupus and rheumatoid arthritis, is
going to benefit from yoga and exercise. We have a very diverse,
complex problem. There
are at least four populations of pain patients in this problem. And we
need to get the data right.
AMY GOODMAN: Last comment, Barry Meier?
BARRY MEIER: Well, I think that we have experienced a huge public
health problem. Part of it has to do with the overprescribing of
opioids—the overprescribing
of opioids for patients who could benefit from other treatments. There
are certainly patients that require and deserve these drugs. But for
back pain,
dental pain, the panoply of problems for which Purdue and others
promoted this drug, that laid the seeds for what is the biggest health
crisis we are now
facing.
AMY GOODMAN: Well, I want to thank you both for being with us, Barry
Meier, author of Pain Killer: An Empire of Deceit and the Origin of
America's Opioid
Epidemic, and Terri Lewis, social scientist, rehabilitation
practitioner, who's running a national survey of patients and
physicians to calculate the impacts
of changes in chronic pain treatment.
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