For Cathy, opioids are part of the blend of medications that keep her functioning. After she caught polio as a baby — just three years before the vaccine was invented — she suffered from fibromyalgia, she developed arthritis as a teenager, and her nerves started to die as a 40 year old.
“I am a chronic pain patient, I have been on pain pills for 30 years. It has allowed me to raise a child, be a good wife, and to retire gracefully with money of my own,” said Cathy, who didn’t want her last name used. “Without them, I would be a ward of the state. … I have never, never upped my dosage or abused the drug.”
A growing number of chronic pain patients say they are caught in the crosshairs of the war on drugs, where legislators’ good intentions to limit overprescribing have made the lives of actual chronic pain patients hellish.
“It’s insane,” Cathy said. “We are an infinitely easy target in the war on drugs.”
Chronic pain patients are the anomalies in a system designed to target a nationwide epidemic. North Carolina exempted chronic pain patients from its chokehold on opioid prescriptions, but with legal crackdowns and controversy over using opioids to treat long-term chronic pain, more doctors are reluctant to prescribe them.
Thomas Kline, a retired North Carolina physician, has begun to keep a list of suicides he believes were caused by forced tapers of chronic pain medication. The list has grown to 33 names, spanning middle-aged workers, young mothers, and wounded veterans.
“These people are no longer with us due to the policy of ‘you are better off without pain medicines,’” Kline wrote at the end of the list. “Not treating a person in pain is negligence. Abandoning people with painful disease to the streets, with no doctor, is negligence.”
In 2016, enough prescriptions were written in North Carolina for every person to hold more than 65 pills, according to the Centers for Disease Control and Prevention.
The STOP Act and the HOPE Act prioritized shutting down pill mills. The bills limited prescriptions, mandated the use of the prescription database N.C. Controlled Substances Reporting System and gave law enforcement restricted access to the NCCSRS.
“Smarter, safer prescribing is one tool among many that we’re deploying to combat the opioid crisis,” said Gov. Roy Cooper in a 2017 news release. “Setting initial limits on these powerful drugs can help reduce the number of people who become addicted to opioids and it can ultimately save lives.”
Law enforcement doesn’t track the number or type of patients a doctor treats, but the number of opioid pills prescribed. For doctors looking to cut down their pill counts or their paperwork, the easiest option is not to treat chronic pain patients, said Cato Institute Senior Fellow Dr. Jeffrey Singer, a surgeon.
“This crackdown on docs with the subscription monitoring program — everyone is under surveillance for how many prescriptions they write — it’s really frightening doctors,” Singer said. “This has had a chilling effect that has made all doctors afraid to prescribe opioids.”
Pain is so subjective that doctors fear enabling addiction when they try to treat chronic pain.
This frustrates Kline, who says he restored the lives of some of his patients by putting them back on their medicine.
“Anybody who takes opioids is likely to become an addict. That’s an important myth,” Kline said.
When Nancy Henson’s primary care doctor saw the dosage of her medication for chronic pain, she “freaked,” Henson said.
“When you have pain from back surgeries (two fusions) that will never go away, pain from fibromyalgia, and the weird pain from neuropathy, it takes a combo of pain meds to make life bearable,” Henson said by email. “If they do not make exceptions for severe pain patients, we’ll be seeing more suicides. That’s a fact. Not me, but I can understand the frustration that leads to it.”
Critics say that the crackdown on the legal prescriptions has driven patients to more deadly street drugs.
“Lots of patients tell me [doctors] stopped their pain meds,” Forsyth County Emergency Service Captain Tara Tucker said. “We’ve actually seen older folks who have been on chronic pain medications for years that their doctors stopped giving them switch to heroin and overdosing.”