On the day after my 12-hour Whipple surgery in June 2017, as I lay barely conscious in a hospital bed, a doctor put something in the middle of my back that I later learned delivered fentanyl to my body to control post-surgical pain.
It stayed there for three days and because of that, I know exactly how people become addicted. When the doctors busted me down to Tylenol along with some other over-the-counter pain killer, I yearned for, lusted after fentanyl.
The OTC drugs cut the pain to a tolerable level but oh my god, did I miss the feel-good part of fentanyl. I wanted to keep feeling that way. Forever.
Now, the United States is caught up in “the opioid crisis” and I am not here to doubt it. People are dying from opioid overdoses by the tens of thousands a year. According to the U.S. National Institute on Drug Abuse (NIDA) (emphasis is mine),
”More than 70,200 Americans died from drug overdoses in 2017, including illicit drugs and prescription opioids - a 2-fold increase in a decade...
“Drug overdose deaths involving prescription opioids rose from 3,442 in 1999 to 17,029 in 2017.”
When counting all opioid deaths, young people die in much larger numbers than old people. But two age groups in one category - prescription opioids - are just about even according to the U.S. Centers for Disease Control (CDC). They report that in 2017, deaths numbered 1,100 for people 24 and younger, and 1,055 for people 65 and older.
In an effort to combat these terrible numbers, the medical community, reports the Washington Post, is conducting
”...a sweeping change in chronic pain management — the tapering of millions of patients who have been relying, in many case for years, on high doses of opioids.
“With close to 70,000 people in the U.S. dying every year from drug overdoses, and prescription opioids blamed for helping ignite this national catastrophe, the medical community has grown wary about the use of these painkillers.”
I have personally seen the difference in prescriptions related to my cancer. When I left the hospital after that surgery in 2017, I was handed a bottle of oxycodone (or oxycontin – I don't recall which) to take home with me for pain control.
As it turned out, I didn't need it and I later recycled the pills at a drug take-back day in my community.
In the past few months, I have had trouble with severe joint and body pains and opioids were never mentioned. It was suggested, instead, that I take certain over-the-counter pain pills three times a day.
When normal dosages were ineffective, the doctor didn't offer a prescription pain killer. He told me to double up on what I was taking. That worked fairly well, but nothing like fentanyl. When the pains subsided a good deal after a couple of months, I cut back to the normal dosage which I need now only once a day most of the time.
But I wonder if I might have been able to skip the weeks of all-day, all-night pain with an opioid. Here's a short video from the Washington Post story about one man's pain predicament:
This is happening to elders and others with chronic pain all over the U.S. The Washington Post explains further:
”Hank Skinner has been tapered gradually over the course of the year. The situation is worse for people forced to cut back their medication too quickly.
“Even medical experts who advocate a major reduction in the use of opioids for chronic pain have warned that rapid, involuntary tapering could harm patients who are dependent on these drugs.
“There is little doubt among medical experts that opioids have been prescribed at unsound and dangerous levels, particularly in their misuse for chronic pain. But at this point there’s no easy way to dial those dosages back.
“Long-term use of opioids creates dependency. Tapering can cause extreme pain from drug withdrawal, regardless of the underlying ailment.”
So the medical system's cutback on opioid prescriptions appears to be a case of throwing out the elders with the bath water.
Let's be clear about this: very few elders are taking fentanyl or other opioids recreationally. Old people did not cause the opioid crisis.
Lots of old people have lots of pain. Cutting their opioid drugs or recommending over-the-counter drugs instead, is causing them harm, they are suffering as one TGB reader, Elizabeth Rogers has been telling us here for quite awhile and she's angry about it. From last Saturday's comments:
”...ongoing physical pain is a significant challenge,” she writes. “Thanks mostly to 20-somethings who overdosed on illicit opioids used recreationally, our omniscient government cracked down--on chronic pain patients, many of whom are 60+, and their physicians.
“DEA raids on doctors' offices haven't done much to reduce overdoses among 20-somethings from heroin and fentanyl, but they have without question had an impact on patients who have used prescribed pain medications responsibly for years.”
Last year, WebMD reported on a study of opioid use from the Agency for Healthcare Research and Quality (AHRQ):
”...millions of older Americans are now filling prescriptions for many different opioid medications at the same time, while hundreds of thousands are winding up in the hospital with opioid-related complications...
“AHRQ's second report found that nearly 20 percent of seniors filled at least one opioid prescription between 2015 and 2016, equal to about 10 million seniors. And more than 7 percent - or about 4 million seniors - filled prescriptions for four or more opioids, which was characterized as 'frequent' use.”
I'm no physician but yes, I would guess that that number of opioid prescriptions at once is a bit over the top.
My point, if I've be too verbose for it to come through, is that it is wrong, as always, to lump all people together. It is younger people who most often abuse drugs (and we as a country need to be helping them). But old people should not be caused to suffer pain when there is a remedy; their lives are harmed by being denied them.
The secondary issue is that I have no idea what to suggest on how to correct this. I have no suggestions and no advice for Elizabeth Rogers or anyone else to restore needed drugs for elders who suffer with chronic pain.