What About the Patient in Pain?

Meet CARA. CARA stands for the Comprehensive Addiction and Recovery Act which was overwhelmingly passed by Congress then signed into law by President Obama in mid-July. The legislation is designed to empower both medical professionals and law enforcement officials with more tools to help drug addicts. There is, predictably, a lot of discussion about this act (particularly in an election year), not the least of which is how the now-approved programs will be funded. But what concerns many of those in this country who suffer from a chronic disease is that it appears to focus on those who abuse drugs with little regard to those with a legitimate need for pain relief.

According to the CDC, in 2014, there were approximately 28,000 deaths in the United States due to opioid drug overdose. That’s more than 75 deaths every day. That’s a staggering number by anyone’s standards.

But what’s even more staggering that government estimates more than 207 million opioid pain medication prescriptions were written in 2014. Even if you wildly discount half of those prescriptions as perhaps being unnecessary, there is still a population of more than 100 million prescriptions written to relieve chronic or acute pain. That’s a ratio of approximately 3571:1 of patients with valid needs for pain relief. Even a cursory look at the data makes it clear that the number of persons experiencing chronic pain in the United States is overwhelmingly larger than those who abuse the drugs. Recent studies cited by the CDC estimate that 14.6% of adults have pain lasting more than three months and more than 11% have daily pain.

Recent FDA guidelines and CDC regulations combined with CARA are basically a one-two punch aimed against patients with valid needs for pain medication in favor of focusing on helping those who abuse the drugs overcome their addiction. I’m not saying that we should ignore the needs of addicts or close our eyes to the increasing number of deaths via opioids. What I am saying is that we should be compassionate in our approach so those who legitimately need pain relief to sustain quality of life are not be punished. Most of the people I know who take opioids, both within the RA community and outside of it, have already been down the road of the alternate approaches of exercise, meditation, acupuncture and massage, etc. If there were any other answer, they would gladly embrace it, but at a certain point, nothing else but medication addresses the pain.

I was terribly saddened when I saw the recent article referring to “Pain Refugees” who regularly have to travel from Montana to a California clinic to receive treatment and prescriptions to manage their pain. According to the article, one of the patients, Gary Snook, has tried a wide range of treatments including surgery, epidural steroid injections, acupuncture, anti-inflammatories, physical therapy and pool exercises – none of which provided relevant relief. I agree with Mr. Snook’s comment quoted in the article, “I believe pain control is a fundamental human right, or at least an attempt at pain control," he says. "To deny someone with a horrible disease like me access to pain medications is the worst form of cruelty."

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