John Heubusch is a novelist and the executive director of the Ronald Reagan Presidential Foundation and Institute in Simi Valley, Calif.
We had tried everything to stop the spread of my cancer. My doctor felt it was time for me to go home, get my affairs in order and say my goodbyes. “Get your Christmas shopping done early,” he said. “You have just a few months to live.”
Five years have passed since that grim day and, strange as it might seem, there have been times I’ve regretted undergoing the last-minute medical gambles that saved my life.
I am not alone. Victims of tragic accidents, disease onset, combat wounds, complicated surgeries, workplace injuries, gun violence or even a simple fall off a ladder are among the 20 million Americans like me who experience some form of high-impact, chronic and often debilitating pain. Many, given a second chance at life after a serious illness or injury, tragically choose suicide over pain. Why? The most unfortunate among them, those with life-altering, unspeakable pain, are being denied access to the medications they need to go on. Their doctors, now numbering nearly 70 percent of our front-line physicians, have enlisted in the nation’s war on opioids. Many have turned away from their patients in chronic pain.
When you see news stories declaring that federal action is driving fewer questionable opioid prescriptions, that Purdue Pharma is in deep trouble for allegedly creating millions of OxyContin addicts, and that the United States has stepped up the fight to interdict drugs on our nation’s borders, no doubt there’s reason to applaud. Lives are being saved. The rising number of deaths since 2015 that necessitated this war on opioids is most often not the fault of doctors or their patients in chronic pain. The real blame — where the war will be won or lost — lies with the illegal trafficking of opioids on the street where you live.
The Centers for Disease Control and Prevention knew this when it trained its guns on the opioid epidemic three years ago. Revising its guidance to physicians in 2016, it sought to limit opioid treatment practices that were outside the bounds of common sense and sound public health. The CDC’s intended audience should have been small; a limited number of bad actors and a minority of doctors overprescribing for short-term pain were the CDC’s real target. But the guidelines were ambiguous and short-sighted. The immediate result: confusion at major medical conferences, inside hospital boardrooms and, most troubling, in just about every doctor’s office.
Next came the law of unintended consequences. At least 33 states, each seemingly eager to outdo the other, have passed their own measures to severely reduce or eliminate the use of such drugs to treat pain. “Just say no,” the national refrain from the 1980s in the war on crack cocaine, has become the standard of care for patients with severe pain.
Enter President Trump. His battle cry, verbatim: “Whether you are a dealer or doctor or trafficker or a manufacturer, if you break the law and illegally peddle these deadly poisons, we will find you, we will arrest you, and we will hold you accountable.”
Lumped in with drug pushers and heroin traffickers, even law-abiding doctors who have responsibly treated patients in chronic pain with opioids began to cower. Just what were these new laws? What dosages for each unique patient with a unique set of needs will keep a doctor out of prison? Administrators of major medical research institutions, teaching hospitals, national pharmacy chains and most particularly overworked private practitioners were not going to wait for answers. With visions of Drug Enforcement Administration agents in their waiting rooms, they headed for their bunkers, leaving desperate patients behind.
We have reached the point where doctors believe the next prescription they write for opioids to treat chronic pain might be their last. In my own case, I’ve had to undergo countless unsuccessful procedures and near superhuman efforts to be granted barely enough medication to try to live a normal life. Even those doctors with the courage to prescribe them for chronic pain sufferers are finding the hurdles established by federal and state reporting requirements so onerous that they are simply turning patients away.
Opioid prescriptions have shrunk substantially, but Washington’s goal now is to cut their number by a further one-third. In a bitter irony, opioid overdose deaths continue to hover at an all-time high. Many chronic pain patients, denied prescriptions, are self-medicating on the street, using synthetic drugs such as fentanyl, 50 times more powerful than heroin. There, danger and overdose lurk around every corner. Even worse, some who have lost all hope for pain relief are choosing to end their pain by ending it all. The risk of suicide among patients with chronic pain is twice that of those without it.
Three weeks ago, more than 300 medical experts wrote to the CDC noting the increase in suicides tied to the agency’s widely misapplied guidance. The patients in chronic pain they defend are not addicts. Far from it. There is a terrible truth for our government complicit in this crisis of its own making: Though it can regulate prescriptions for those in need, it cannot regulate pain.