Chronic pain sufferers struggle amid opioid abuse crackdown

The other side of the epidemic

This Tuesday, Aug. 15, 2017 photo shows an arrangement of pills of the opioid oxycodone-acetaminophen in New York.
This Tuesday, Aug. 15, 2017 photo shows an arrangement of pills of the opioid oxycodone-acetaminophen in New York.

Nationwide efforts to combat opioid abuse might affect a population of people not often cited in the news - patients living with chronic pain.

For people like Mary Cremer, a local advocate for Chiari and pain management options, pain medicine in the form of an opioid gives her the relief she needs to function normally.

Five years ago, Cremer was diagnosed with Chiari, a neurological disorder affect the spinal cord and nerves throughout the body, causing her to suffer from severe pain. She also suffers from Ehler-Danlos, a lifelong disorder that affects the skin, joints and blood vessels.

"The best way that I can describe what's happening with people who are diagnosed with Chiari is that their brain has fallen down into the opening of their skull," Cremer said previously. "This compresses the nerves and blocks cerebral spinal fluid, which causes pain and various symptoms all over your body."

Discussions surrounding reduction of opioid distribution and insurance companies modifying policies to not cover certain medications heighten Cremer's concern.

Schedule II drugs, also known as opioids, include hydrocodone, oxycodone, percocet, oxycontin, methadone and fentanyl.

"There seems to be a stigma that people who take opioids are unemployed," Cremer said. "I'm a functioning person, working full time; plus I'm a mom and wife. I want to be an active part of this and don't want to lose my rights."

In 2016 the U.S. Drug Enforcement Administration cut production of prescription opioids by 25 percent, the Huffington Post reported.

This summer, Sen. Claire McCaskill, D-Missouri, launched an investigation into manufacturers that distribute opioids, with intent to crack down on illegal opioid distribution.

"I've had serious concerns that enforcement actions against opioid distributors have amounted to a slap on the wrist, and the decision by the Department of Justice's watchdog was a much-needed step," McCaskill said in a news release. "We're in the midst of a national epidemic - an epidemic that has taken the lives of thousands of Missourians - and if there's clear evidence that distributors or manufacturers have acted illegally, there needs to be every effort to hold them fully accountable."

Essentially, McCaskill's investigations put a target on distributors whose products are winding up on the black market. But Cremer challenges politicians to stand up for patients living with chronic pain patients.

"We're a part of society, too. And we're just as important as the people who may have lost a family member to addiction or an overdose," Cremer said. "I get the addiction side of it and I do understand. But there's also the people who don't have an addiction, and they're punishing us because of this."

John Lucio, medical director of the pain division in the St. Mary's Hospital Spine and Pain Management Center, said he has heard similar concerns from patients who have experienced the effects of limited distribution.

"It is not only the government. We have seen insurance companies take a position on limiting distribution," Lucio said. "In fact, in some cases, they are overriding the prescriptions of physicians. I can only guess at what is going to happen in the future. However, I am optimistic that the more we get away from prescribing chronic opioids, there will be more pressure on the government and insurance companies to cover behavioral health and complementary medicine practices, which have also been shown to be effective with chronic pain patients."

Patients who suffer from cancer-related illnesses are sometimes prescribed opioids because they are the only medications that provide relief from their pain, Lucio said.

Patients who have had multiple back or neck surgeries and patients allergic to other medications such as ibuprofen or Naprosyn also may require only small amounts of opioids to ease their pain, he added.

"As a rule the physician would want to see that the patients are able to expand their life and functional abilities when taking these medications," Lucio said. "As it stands, there is no clear evidence that opioids are beneficial on a long-term basis and have many side effects that patients need to be aware of."

When insurance companies notify patients they will no longer cover their prescriptions, Lucio explained, it presents a huge financial burden for patients with limited budgets. Essentially, this will be denying the care they need, he said.

From Cremer's perspective, by cutting down legal opioid production, the government is sending a direct message it intends to keep people from getting prescription opioids.

"In all of this talk about opioids, there is a focus on the addiction part of this, but they have totally left off the patients experiencing chronic pain," Cremer said. "I have a health problem that's never going to go away, and they act as if I just have a broken bone. My life isn't going to get any better, per se, so I want to figure out a way to live and function with my family."