Canada: Is denial of care to chronic pain pts now a PANDEMIC ?

Jennifer Butcher feels 'legitimate' opioid users are being left to suffer after government crackdown on fentanyl.Doctors ‘gun shy’ to prescribe opioids hurting those in pain, say experts

http://www.cbc.ca/news/canada/windsor/doctors-gun-shy-to-prescribe-opioids-hurting-those-in-pain-say-experts-1.4163563

A Windsor, Ont. woman who relies on prescribed narcotics to help with chronic pain believes “responsible” opioid users are being unfairly victimized in the government crackdown on drugs like Fentanyl. 

Jennifer Butcher has been unable to find a physician who will refill her prescriptions ever since her family doctor retired last month. She’s not alone, according to medical professionals and other patients in Windsor who say a spike in deaths across the region and province has doctors reluctant to prescribe opioids.

“I don’t feel like a functioning, productive member of society anymore,” said Butcher. “I am looked down upon by 90 per cent of the people I talk to, including doctors and pharmacists, because of the types of drugs I’ve been prescribed.”

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Jennifer Butcher struggles to stand on her own without her pain medication. (Aadel Haleem/CBC)

Butcher, 46, suffers from fibromyalgia, carpal tunnel syndrome and arthritis. She has neck and back pain from a car accident when she was a teen and has difficulty standing for long periods of time.

She relies on her walker to get around and has been using pain medication for more than 20 years. Her pain has been compounded in recent weeks by the gnawing pangs of withdrawal.

“People like me are slipping through the cracks. I’ve talked to a few people in my situation that really feel there’s going to be an uprise in suicides because of this,” she said. “People don’t want to live in pain and suffering every day — it’s no way to live. If I had cancer, they wouldn’t say, ‘We’re not going to give you chemo because it might kill you.'”

‘Distinct shift’

Angela Lambing has seen a “distinct shift” in how pain management is being addressed. The nurse practitioner believes physicians have become “gun shy” when it comes to prescribing opioids. She’d like to see medical professionals receive more pain management training.

“It’s like anything else, you have one patient that misused, you worry that another patient is going to do it too,” said Lambing. “Physicians are saying there’s going to be a higher rate of suicide because patients aren’t going to get what they need and they’re going to have significant pain, which is difficult to live with.”

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Angela Lambing has seen a ‘distinct shift’ in how pain management is being addressed. The nurse practicioner believes providers are ‘very gun shy’ when it comes to prescribing opioids. (Aadel Haleem/CBC)

Reluctance on the part of physicians is no surprise, considering the provincial government in October announced what it called its first comprehensive opioid strategy.

The moves comes after a steady increase in opioid-related deaths and injuries for more than a decade, according to Public Health Ontario. The latest available statistics are for 2015, when the province recorded more than 730 opioid-related deaths, which is a 99 per cent jump from 2003 figures.

Numbers for emergency room visits are a little more up to date, with 4,420 patients showing up at ERs with opioid-related problems, compared to 1,858 in 2003. Those figures represent a whopping 137 per cent increase.

But as prescription medication dries up, Lambing, who has worked at Detroit’s Henry Ford hospital for 25 years, fears people in pain will turn to the streets.

“They’re going to be taking medicines off the street that are cut with who knows what, and then we’re going to have the same issue that we’re already seeing with that fentanyl,” she said.

Doctors are ‘being cautious’

Dr. Amit Bagga, the president of the Essex County Medical Society, acknowledged doctors are now more “cautious” about prescribing high-dosage opioids to patients with non-cancer pain.

“There are guidelines, and the College [of Physicians and Surgeons] is watching physicians and supervising the dosages that are being used,” said Bagga. “So one is being cautious, one is being careful.”

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Dr.Amit Bagga admits doctors are now more ‘cautious’ to prescribe high-dosage opioids in non-cancer pain. (Aadel Haleem/CBC)

He said doctors need to balance their responsibility to manage pain with the havoc being wrought on the streets by powerful opioids, which is being described by officials across the country as an epidemic. 

“There is appropriate use, but there is misuse. There’s people selling it on the streets, there are people using high doses getting into accidents,” said Bagga. “So at the societal level, physicians are a bit of a gate-keeper, and we have to kind of respect that they are in a tough position.”

Like Butcher, Marcie Porter feels like collateral damage in the battle against the opioid epidemic. She suffers from fibromyalgia and has been taking fentanyl patches and Percocets to ease the pain. Her family doctor shuttered his practice two months ago and now Porter only has enough medication to last another month. 

She said she has called 12 doctors, many of whom are taking new patients, but none will see new patients looking for pain medication. 

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Marcie Porter is wearing two fentanyl patches. She returns used patches to the pharmacy before receiving next prescription. (Aadel Haleem/CBC)

“I feel like we’re being discriminated against because they don’t know us as a person,” said an exasperated Porter. “We’re being looked at as a different person because of the epidemic — and I get the epidemic — but it’s not fair to us that need [opioids] and actually don’t abuse it.”

Porter stressed she is a responsible opioid user in desperate need of pain medication.

“I would like to see doctors looking at people who are in pain more, not to look at us as a druggie or somebody that’s taking them on the streets because that’s not true,” she said. “I take mine back to the pharmacy every time that is needed and I’ve been tested every time when I go to the doctors.”

Refusals must be ‘in good faith’

In an email to CBC, the College of Physicians and Surgeons of Ontario says its Accepting New Patients policy states doctors must accept new patients “on a first-come, first-served basis.”

However, there are exceptions “if a patient’s medical needs don’t align with the physician’s clinical competence or scope of practice. This type of situation would be grounds for refusing a prospective patient. The policy also says that such decisions to refuse must be made in good faith.”

Butcher has been taking pain management drugs for more than two decades now, starting with Tylenol 3s and moving on to Percocets, Oxycontin and finally fentanyl patches. 

She has gone through five physicians since her family doctor retired and none of them will refill her prescription. She is living in pain and fears what may happen to others who may seek solace in the streets. 

“The people that are getting addicted now and that are dying, a lot of times it’s because they can’t get what they’re used to being prescribed,” she said. “Then they turn to the streets and they either go towards heroin, which can be cut with anything, or these new fentanyl patches. They don’t realize that the liquid inside — you cannot drink, lick, smoke or shoot. You have to wear the patch.”

 

2 Responses

  1. To who it may concern , and feel free to publicly post and use this my story of both pain and grief and the Hell of then and now how some of the proof that some are putting legitimate Chronic Pain Sufferers through , its no more than emotional Abuse ( and border line Domestic Emotional Terrorism )!on a scale with only Biblical proportions!To the Editor and Associates I have taken this opportunity to share my heartbreaking story in hopes these witch hunting Opiate ill informed skeptics will read and understand that we as Millions Of Legitimate Chronic Pain Sufferers would have no life without Medically prescribed Opiates by a physicians care and strictly monitored monthly urine and blood test. Please remember that An Opinion Before A Thorough Investigation Is The Epitome Of Ignorance! And that a little more compassion from the Medical Field and its representatives could have saved my beautiful Stepdaughters life. Let me say this! A person who has a addictive personality will abuse anything that helps them feel better. I have taken Oxycontin for 12 years , I have had 20 major surgery’s in 9 years. I have so much physical pain I can not even get out of bed with out pain meds and when I run out I run out and just lay in bed praying the Lord relieve me of this horrible condition and I pray God you pain med skeptics never go through what I go through everyday of my life when the only thing you have to do is threaten what help I get, Shame on them! There will always be drug abuse and as the so called war on drugs has failed all this will! All you do is stoke and aid the drug pushers business to knew heights in the Black Market of Heroin while trying to deprive folks as me to this horrible movement! My Stepdaughter committed suicide 4 years ago because of being treated like a drug addict by her family and doctors when all along she suffered from Lupus and Fibromyalgia which I believe was brought on by a deadly car crash at 18 , she told me between that which I was being put through and what they were putting her through she was not going to be able to live her life in such a hell brought on by people like the Biased Uniformed Skeptics that are on a witch hunt to out law Opiates and pain meds that give us some sort of a life . As a retired Police officer and worked indirectly close to the DEA, you people do not have a clue how thrilled you are making the illegal opiate trade and think of my Late Stepdaughter as you continue on with this 2017 Version of the ( 1940s Propaganda Film named REEFER MADNESS )movement to outlaw opiates! Just like the slaughter of children at Sandy Hook if there would have just been gun laws , my God they were Gun Laws , the guns that murdered all those 20 children were all registered and owned by a school teacher! You fight Drug Addiction in Elementary education by teaching all children the dangers of Booze and Tobacco which if these witch hunters want for us to know the real truth but they do not. I miss my Stepdaughter so much and some of us will continue on the fight to protect our right to feel better and function without fear of these witch hunters trying to convince us to commit suicide . And they are trying to do exactly THAT and are now being successful in this under the table practice of Human Genocide!
    The under line real truth it seems THESE witch hunters would rather us Chronic Pain sufferers commit suicide are and DRINK all the BOOZE we can drink! The Federals legalized it ( ALCOHOL) knowing its a more deadly drug than Strychnine. And just because the DEA has miserably failed with their witch hunt type movement on drugs why do they continuous fully deprive us sick people of our Constitutional Rights to be Happy in that pursuit of with Professional Physicians to take meds that give us relief of this horrible malady of Chronic Pain ! May God have mercy on their miserable souls they that seek to destroy us Chronic Pain Sufferers only and little hope of temporary relief of this horrible sickness.********************************************

    • I couldn’t have said it any better. I am suffering around the clock. There’s no escape i try to stay hopeful but I get worse as the days go by and I can hardly function. I been in these pagamas 4 days now. I need help to bathe! If my pain was being properly addressed i know I could do so much more. I feel useless why am I not worthy of quality of life? Those people that abuse drugs will continue to abuse drugs. Cops aren’t even arresting drug dealers and people stumbling around high as kites are give the red carpet treatment a safe place to shoot up a medical assistant to assist finding a vein if they can’t a brand new syringe a cotton and a cooker for the heroin addict then if they do to much the assistant is right there with the narcan bringing them back to life just so they could do it all over again? But people like us in legitimate physical intractable pain are treated with disdain. The tides have certainly changed. What use to be right is wrong and what was bad is now good. Sometimes I wonder if perhaps Earth has slipped slightly off her access. That would explain how life got so twisted. Maybe Dean Koontz should write a book about this I’m sure it would be a best seller. I hope it has a happy ending but I doubt we’ll see the powers that be admit any wrongdoing and make all this wrong right. No. I won’t see it in the amount of time my pain tells me I have left.

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