“Entire body is shaking and jerking 24/7,” she said.
Ms. Fuqua said she has contacted dozens of doctors trying to find care. She also called the C.D.C.’s Opioid Rapid Response Program, which is intended to help when pain clinics are shut down or large numbers of opioid patients lose doctors for any reason. “It was almost like they thought I was out of line, even ridiculous, for calling them,” she said. The program’s management admits it has difficulty finding physicians to help such patients, and is in the preliminary stages of considering proposals to study why they get rejected.
Patient advocates say the answer is simple: Doctors who agree to take significant numbers of chronic pain patients who need opioids rightly fear law enforcement scrutiny. Physicians with more than a few high-dose patients will immediately stand out in prescription monitoring databases, even if they are pain specialists.
So what can be done to help people with intractable pain that only responds to opioids? First, the surgeon general needs to send another letter to health care professionals, as Dr. Vivek Murthy did when he announced the publication of the 2016 C.D.C. guidelines for opioid prescribing. The new letter must inform providers about the 2022 update and, this time, strongly warn against involuntary dose cuts for existing patients as a way to reduce overdose risk. The initial guideline warranted this high level of national attention, and it hurt people in pain — surely an update intended to improve their treatment would deserve equivalent publicity.
Second, the U.S. attorney general needs to send a similar letter to the D.E.A. and to its prosecutors, instructing them to stop pursuing doctors simply because they prescribe high doses of opioids or potentially risky drug combinations. If there are no other signals of criminal intent, this is a matter of medical judgment and possible malpractice, not an issue that should be handled by federal law enforcement. And when agents find physicians who actually are dealing drugs, they and agencies like the C.D.C. need to ensure that there is no disruption in pain or addiction care for patients, before busting doctors.
Patients who are abandoned to withdrawal and untreated pain have an increased overdose death risk of nearly 300 percent, and their risk of suicide is also significantly elevated. If thousands of them hadn’t been cut off in the first place, the enormous street fentanyl market that now exists might have been minimized rather than given rocket fuel. It is both cruel and nonsensical to increase patients’ risk of overdose death and suicide in an attempt to reduce these harms.
To permanently solve this problem, Congress needs to pass legislation to provide a safe harbor for patients with intractable pain and their doctors. People like Ms. Fuqua who have a clear, documented need for opioids should not have to live as though each time they successfully pick up a prescription it’s a “stay of execution,” as she put it.
It is not the fault of people who suffer pain that America has an addiction problem. Denying them access to needed medication helps no one. At least one man and his wife have already died by suicide following the closure of the clinic Ms. Fuqua attended.
Maia Szalavitz
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